I 

112TH CONGRESS 

1ST SESSION H. R. 2954 

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

IN THE HOUSE OF REPRESENTATIVES 

SEPTEMBER 15, 2011 

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

Ms. BASS of California, Mr. BISHOP of Georgia, Ms. BORDALLO, Mr. 

BROOKS, Ms. BROWN of Florida, Mr. BUTTERFIELD, Mr. CARSON of Indiana, Ms. CHU, Mr. CLARKE of Michigan, Ms. CLARKE of New York, 

Mr. CLAY, Mr. CLEAVER, Mr. COHEN, Mr. CONYERS, Mr. CUMMINGS, 

Mr. DAVIS of Illinois, Ms. DEGETTE, Ms. DELAURO, Ms. EDWARDS, Mr. 

ELLISON, Mr. FALEOMAVAEGA, Mr. FATTAH, Ms. FUDGE, Mr. GONZALEZ, Mr. AL GREEN of Texas, Mr. GRIJALVA, Mr. GUTIERREZ, Ms. 

HAHN, Ms. HANABUSA, Mr. HASTINGS of Florida, Ms. HIRONO, Mr. 

HONDA, Mr. JACKSON of Illinois, Ms. JACKSON LEE of Texas, Mr. JOHNSON of Georgia, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. LEWIS of 

Georgia, Mr. KUCINICH, Ms. MATSUI, Mr. MCGOVERN, Mr. MEEKS, Ms. 

MOORE, Mrs. NAPOLITANO, Ms. NORTON, Mr. OLVER, Mr. PAYNE, Mr. 

PIERLUISI, Mr. RANGEL, Mr. REYES, Ms. RICHARDSON, Mr. RICHMOND, 

Mr. RUSH, Mr. SABLAN, Ms. LINDA T. SA ́NCHEZ of California, Ms. 

SCHAKOWSKY, Mr. SCOTT of Virginia, Mr. DAVID SCOTT of Georgia, Mr. 

SERRANO, Mr. SIRES, Ms. SLAUGHTER, Mr. THOMPSON of Mississippi, 

Mr. TOWNS, Ms. WATERS, Mr. WATT, Ms. WILSON of Florida, and Ms. 

WOOLSEY) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

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

Affairs, Armed Services, Agriculture, the Judiciary, and Natural Resources, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 


emcdonald on DSK5VPTVN1PROD with BILLS
2 

•HR 2954 IH

A BILL 

To improve the health of minority individuals, and for other 

purposes. 

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

3 SECTION 1. SHORT TITLE. 

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

5 Accountability Act of 2011’’. 

6 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 

Sec. 3. Findings. 

TITLE I—DATA COLLECTION AND REPORTING 

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

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

and analysis. 

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

Sec. 104. Revision of HIPAA claims standards. 

Sec. 105. National Center for Health Statistics. 

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

surveys. 

Sec. 107. Geo-access study. 

Sec. 108. Racial, ethnic, and linguistic data collected by the Federal Government. 

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

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

collection of health data. 

Sec. 111. Optional collection of health data on immigrants and individuals in 

their households. 

Sec. 112. Standards for measuring socioeconomic status in collection of health 

data. 

Sec. 113. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 114. GAO study on compliance with existing FDA requirements to present 

drug and device safety and effectiveness data by sex, age, and 

racial and ethnic subgroups. 

Sec. 115. Improving health data regarding Native Hawaiians and other Pacific 

Islanders. 


emcdonald on DSK5VPTVN1PROD with BILLS
3 

•HR 2954 IH

TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH CARE 

Sec. 201. Definitions. 

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

Sec. 203. Federal reimbursement for culturally and linguistically appropriate 

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

Health Insurance Programs. 

Sec. 204. Increasing understanding of and improving health literacy. 

Sec. 205. Assurances for receiving Federal funds. 

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

Sec. 207. English for speakers of other languages. 

Sec. 208. Implementation. 

Sec. 209. Language access services. 

TITLE III—HEALTH WORKFORCE DIVERSITY 

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

Sec. 302. Hispanic-serving health professions schools. 

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

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

Sec. 305. National report on the preparedness of health professionals to care 

for diverse populations. 

Sec. 306. Scholarship and fellowship programs. 

Sec. 307. Advisory Committee on Health Professions Training for Diversity. 

Sec. 308. McNair Postbaccalaureate Achievement Program. 

Sec. 309. Rules for determination of full-time equivalent residents for cost reporting periods. 

Sec. 310. Developing and implementing strategies for local health equity. 

Sec. 311. Loan forgiveness for mental and behavioral health social workers. 

TITLE IV—IMPROVEMENT OF HEALTH CARE SERVICES 

Subtitle A—Health Empowerment Zones 

Sec. 401. Short title. 

Sec. 402. Findings. 

Sec. 403. Designation of health empowerment zones. 

Sec. 404. Assistance to those seeking designation. 

Sec. 405. Benefits of designation. 

Sec. 406. Definition. 

Sec. 407. Authorization of appropriations. 

Subtitle B—Other Improvements of Health Care Services 

CHAPTER 1—EXPANSION OF COVERAGE

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

Sec. 412. Removing barriers to unsubsidized purchase of private insurance in 

American Health Benefit Exchanges. 

Sec. 413. Study on the uninsured. 

Sec. 414. Medicaid payment parity for the territories. 

Sec. 415. Clarification of Medicaid coverage for citizens of Freely Associated 

States. 


emcdonald on DSK5VPTVN1PROD with BILLS
4 

•HR 2954 IH

Sec. 416. Extension of Medicare secondary payer. 

Sec. 417. Border health grants. 

Sec. 418. Removing Medicare barrier to health care. 

Sec. 419. 100 percent FMAP for medical assistance provided by urban Indian 

health centers. 

Sec. 420. 100 percent FMAP for medical assistance provided to a Native Hawaiian through a federally qualified health center or a Native 

Hawaiian health care system under the Medicaid program. 

CHAPTER 2—EXPANSION OF ACCESS

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

Sec. 422. Critical access hospital improvements. 

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

Sec. 424. Medicare remote monitoring pilot projects. 

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

Sec. 426. Rural health care services. 

Sec. 427. Community health center collaborative access expansion. 

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

Sec. 429. Scoring of preventive health savings. 

Sec. 430. Sense of Congress. 

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

nationality under the Medicaid program. 

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

Sec. 433. Access for Native Americans under PPACA. 

TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 

CHILDREN, AND FAMILIES 

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

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

Sec. 503. Repeal of denial of benefits. 

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

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

Sec. 506. Eliminating disparities in maternity health outcomes. 

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

sudden unexplained death in childhood. 

Sec. 508. Reducing teenage pregnancies. 

Sec. 509. Gestational diabetes. 

Sec. 510. Emergency contraception education and information programs. 

Sec. 511. Supporting healthy adolescent development. 

TITLE VI—MENTAL HEALTH 

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

counselor services under part B of the Medicare program. 

Sec. 602. Community Mental Health and Addiction Safety Net Equity Act. 

Sec. 603. Minority Fellowship Program. 

Sec. 604. Integrated Health Care Demonstration Program. 

Sec. 605. Addressing racial and ethnic minority mental health disparities research gaps. 

TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES 


emcdonald on DSK5VPTVN1PROD with BILLS
5 

•HR 2954 IH

Subtitle A—Cancer 

Sec. 701. Lung Cancer Mortality Reduction Program. 

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

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

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

minorities. 

Sec. 705. Reducing cancer disparities within Medicare. 

Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 

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

Subtitle C—Acquired Bone Marrow Failure Diseases 

Sec. 721. Acquired Bone Marrow Failure Diseases. 

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

Issues 

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

Sec. 732. Coverage of the shingles vaccine under the Medicare program. 

Sec. 733. CDC Wisewoman Screening Program. 

Sec. 734. Report on cardiovascular care for women and minorities. 

Sec. 735. Coverage of comprehensive tobacco cessation services in Medicaid. 

Sec. 736. Clinical research funding for oral health. 

Subtitle E—HIV/AIDS 

Sec. 741. Findings. 

Sec. 742. Addressing HIV/AIDS in communities of color. 

Sec. 743. HIV/AIDS reduction in racial and ethnic minority communities. 

Sec. 744. Repealing ineffective and incomplete abstinence-only education program. 

Sec. 745. Dental Education Loan Repayment Program. 

Sec. 746. Report on the implementation of the national HIV/AIDS strategy. 

Sec. 747. Addressing HIV/AIDS in the African-American community. 

Sec. 748. National Black Clergy for the Elimination of HIV/AIDS. 

Sec. 749. Reducing the spread of sexually transmitted infections in correctional 

facilities. 

Sec. 750. Stop AIDS in prison. 

Sec. 751. Services to reduce HIV/AIDS in racial and ethnic minority communities. 

Sec. 752. Health care professionals treating individuals with HIV/AIDS. 

Sec. 753. Report on impact of HIV/AIDS in racial and ethnic minority communities. 

Sec. 754. Study on status of HIV/AIDS epidemic among African-Americans. 

Subtitle F—Diabetes 

Sec. 755. Treatment of diabetes in minority communities. 

Sec. 756. Eliminating disparities in diabetes prevention access and care. 

Subtitle G—Lung Disease 


emcdonald on DSK5VPTVN1PROD with BILLS
6 

•HR 2954 IH

Sec. 761. Expansion of the National Asthma Education and Prevention Program. 

Sec. 762. Asthma-related activities of the centers for disease control and prevention. 

Sec. 763. Influenza and pneumonia vaccination campaign. 

Sec. 764. Chronic obstructive pulmonary disease action plan. 

TITLE VIII—HEALTH INFORMATION TECHNOLOGY 

Subtitle A—Reducing Health Disparities Through Health IT 

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

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

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

Subtitle B—Modifications to Achieve Parity in Existing Programs 

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

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

minority groups. 

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

to facilitate adoption of certified EHR technology by providers 

serving racial and ethnic minority groups. 

Subtitle C—Additional Research and Studies 

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

Sec. 832. IOM study and report on privacy concerns of certain minority populations. 

Sec. 833. Study of health information technology in medically underserved communities. 

Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 

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

Rico. 

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

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

record incentive payments. 

TITLE IX—ACCOUNTABILITY AND EVALUATION 

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

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

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

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

Act of 1964. 

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

and Human Services. 

Sec. 904. United States Commission on Civil Rights. 

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

racial and ethnic health disparities. 

Sec. 906. GAO and NIH reports. 


emcdonald on DSK5VPTVN1PROD with BILLS
7 

•HR 2954 IH

TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 

ENVIRONMENTAL JUSTICE 

Sec. 1001. Codification of Executive Order 12898. 

Sec. 1002. Implementation of recommendations by Environmental Protection 

Agency. 

Sec. 1003. Grant program. 

Sec. 1004. Additional research on the relationship between the built environment and the health of community residents. 

Sec. 1005. Environment and public health restoration. 

Sec. 1006. Healthy Food Financing Initiative. 

Sec. 1007. GAO report on health effects of Deepwater Horizon oil rig explosion 

in the Gulf Coast. 

1 SEC. 3. FINDINGS. 

2 The Congress finds as follows: 

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

8 health care. 

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

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

12 physical structure of communities, nutrition and 

13 food options, educational attainment, employment, 

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

15 immigrant or citizenship status, sexual orientation, 

16 gender identity, socioeconomic status, or disability 

17 status—that directly and indirectly affect the health, 

18 health care, and wellness of individuals and commu19 nities. 


emcdonald on DSK5VPTVN1PROD with BILLS
8 

•HR 2954 IH

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

2 health care providers and allied health workers and 

3 this shortage disproportionately affects health pro4 fessional shortage areas where many racial and eth5 nic minority populations reside. 

6 (4) All efforts to reduce health disparities and 

7 barriers to quality health services require better and 

8 more consistent data. 

9 (5) A full range of culturally and linguistically 

10 appropriate health care and public health services 

11 must be available and accessible in every community. 

12 (6) Racial and ethnic minorities and under13 served populations must be included early and equi14 tably in health reform innovations. 

15 (7) Efforts to improve minority health have 

16 been limited by inadequate resources in funding, 

17 staffing, stewardship and accountability. Targeted 

18 investments that are focused on disparities elimi19 nation must be made in providing care and services 

20 that are community-based, including prevention and 

21 policies addressing social determinants of health. 

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

23 Human Services developed the HHS Action Plan to 

24 Reduce Racial and Ethnic Health Disparities and 

25 the National Stakeholder Strategy for Achieving 


emcdonald on DSK5VPTVN1PROD with BILLS
9 

•HR 2954 IH

1 Health Equity, two strategic plans that represent 

2 the country’s first coordinated roadmap to reducing 

3 health disparities. Along with the National Preven4 tion Strategy and the National Health Care Quality 

5 Strategy, these comprehensive plans will work to in6 crease the number of Americans who are healthy at 

7 every stage of life. 

8 (9) The Department of Health and Human 

9 Services also developed other strategic planning doc10 uments to combat disease disparities with a high im11 pact on minority populations including the National 

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

13 Prevention, Care and Treatment of Viral Hepatitis. 

14 (10) The Patient Protection and Affordable 

15 Care Act, as amended by the Health Care and Edu16 cation Reconciliation Act, represents the biggest ad17 vancement for minority health in the last 40 years. 

18 TITLE I—DATA COLLECTION 

19 AND REPORTING 

20 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

21 ACT. 

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

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

24 ethnicity, sex, primary language, sexual orientation, disVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
10 

•HR 2954 IH

1 ability status, gender identity, and socioeconomic status 

2 among federally supported health programs. 

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

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

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

6 the following: 

7 ‘‘Subtitle B—Strengthening Data 

8 Collection, Improving Data 

9 Analysis, and Expanding Data 

10 Reporting 

11 ‘‘SEC. 3431. HEALTH DISPARITY DATA. 

12 ‘‘(a) REQUIREMENTS.— 

13 ‘‘(1) IN GENERAL.—Each health-related pro14 gram operated by or that receives funding or reim15 bursement, in whole or in part, either directly or in16 directly from the Department of Health and Human 

17 Services shall— 

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

19 or program involved, of data on the race, eth20 nicity, sex, primary language, sexual orienta21 tion, disability status, gender identity, and so22 cioeconomic status of each applicant for and re23 cipient of health-related assistance under such 

24 program— 


emcdonald on DSK5VPTVN1PROD with BILLS
11 

•HR 2954 IH

1 ‘‘(i) using, at a minimum, the stand2 ards for data collection on race, ethnicity, 

3 sex, primary language, sexual orientation, 

4 disability status, gender identity, and so5 cioeconomic status developed under section 

6 3101; 

7 ‘‘(ii) collecting data for additional 

8 population groups if such groups can be 

9 aggregated into the minimum race and 

10 ethnicity categories; 

11 ‘‘(iii) additionally referring, where 

12 practicable, to the standards developed by 

13 the Institute of Medicine in ‘Race, Eth14 nicity, and Language Data: Standardiza15 tion for Health Care Quality Improve16 ment’; and 

17 ‘‘(iv) where practicable, through self18 reporting; 

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

20 data described in subparagraph (A), for appli21 cants and recipients who are minors, require 

22 communication assistance in speech or writing, 

23 and for applicants and recipients who are other24 wise legally incapacitated, require that— 


emcdonald on DSK5VPTVN1PROD with BILLS
12 

•HR 2954 IH

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

2 parent or legal guardian of such an appli3 cant or recipient; and 

4 ‘‘(ii) the primary language of the par5 ent or legal guardian of such an applicant 

6 or recipient be collected; 

7 ‘‘(C) systematically analyze such data 

8 using the smallest appropriate units of analysis 

9 feasible to detect racial and ethnic disparities, 

10 as well as disparities along the lines of primary 

11 language, sex, disability status, sexual orienta12 tion, gender identity, and socioeconomic status 

13 in health and health care, and report the results 

14 of such analysis to the Secretary, the Director 

15 of the Office for Civil Rights, each agency listed 

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

17 Health, Education, Labor, and Pensions and 

18 the Committee on Finance of the Senate, and 

19 the Committee on Energy and Commerce and 

20 the Committee on Ways and Means of the 

21 House of Representatives; 

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

23 at least an annual basis; and 

24 ‘‘(E) ensure that the provision of assist25 ance to an applicant or recipient of assistance 


emcdonald on DSK5VPTVN1PROD with BILLS
13 

•HR 2954 IH

1 is not denied or otherwise adversely affected be2 cause of the failure of the applicant or recipient 

3 to provide race, ethnicity, primary language, 

4 sex, sexual orientation, disability status, gender 

5 identity, and socioeconomic status data. 

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

7 this subsection shall be construed to— 

8 ‘‘(A) permit the use of information col9 lected under this subsection in a manner that 

10 would adversely affect any individual providing 

11 any such information; and 

12 ‘‘(B) diminish existing or future require13 ments on health care providers to collect data. 

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

15 ensure (through the promulgation of regulations or other16 wise) that all data collected pursuant to subsection (a) are 

17 protected— 

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

19 Secretary applies to other health data under the reg20 ulations promulgated under section 264(c) of the 

21 Health Insurance Portability and Accountability Act 

22 of 1996 (Public Law 104–191; 110 Stat. 2033) re23 lating to the privacy of individually identifiable 

24 health information and other protections; and 


emcdonald on DSK5VPTVN1PROD with BILLS
14 

•HR 2954 IH

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

2 entity that collects, stores, or receives the data, in3 cluding use of such data in determinations of eligi4 bility (or continued eligibility) in health plans, and 

5 from other inappropriate uses, as defined by the 

6 Secretary. 

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

8 Secretary shall develop and implement a national plan to 

9 ensure the collection of data in a culturally appropriate 

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

11 and reporting of racial, ethnic, sex, primary language, sex12 ual orientation, disability status, gender identity, and so13 cioeconomic status data at the Federal, State, territorial, 

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

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

16 carried out under this section are in compliance with the 

17 standards developed under section 3101. The Data Coun18 cil of the Department of Health and Human Services, in 

19 consultation with the National Committee on Vital Health 

20 Statistics, the Office of Minority Health, Office on Wom21 en’s Health, and other appropriate public and private enti22 ties, shall make recommendations to the Secretary con23 cerning the development, implementation, and revision of 

24 the national plan. Such plan shall include recommenda25 tions on how to— 


emcdonald on DSK5VPTVN1PROD with BILLS
15 

•HR 2954 IH

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

2 the cost and administrative burdens of data collec3 tion and reporting; 

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

5 States, territories, Indian tribes, health providers, 

6 health plans, health insurance issuers, and the gen7 eral public that data collection, analysis, and report8 ing by race, ethnicity, primary language, sexual ori9 entation, disability status, gender identity, and socio10 economic status is legal and necessary to assure eq11 uity and nondiscrimination in the quality of health 

12 care services; 

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

14 have data code sets for racial, ethnic, primary lan15 guage, sexual orientation, disability status, gender 

16 identity, and socioeconomic status identifiers and 

17 that such identifiers can be retrieved from clinical 

18 records, including records transmitted electronically; 

19 ‘‘(4) improve health and health care data collec20 tion and analysis for more population groups if such 

21 groups can be aggregated into the minimum race 

22 and ethnicity categories, including exploring the fea23 sibility of enhancing collection efforts in States for 

24 racial and ethnic groups that comprise a significant 

25 proportion of the population of the State; 


emcdonald on DSK5VPTVN1PROD with BILLS
16 

•HR 2954 IH

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

2 racial, ethnic, primary language, sexual orientation, 

3 disability status, gender identity, and socioeconomic 

4 status data, subject to privacy and confidentiality 

5 regulations; and 

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

7 collected under subsection (a). 

8 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col9 lected under subsection (a) shall be obtained, maintained, 

10 and presented (including for reporting purposes) in ac11 cordance with the 1997 Office of Management and Budget 

12 Standards for Maintaining, Collecting, and Presenting 

13 Federal Data on Race and Ethnicity (at a minimum). 

14 ‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION

15 AND REPORTING OF DATA.— 

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

17 directly or through grant or contract, provide tech18 nical assistance to enable a health care program or 

19 an entity operating under such program to comply 

20 with the requirements of this section. 

21 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro22 vided under this subsection may include assistance 

23 to— 

24 ‘‘(A) enhance or upgrade computer tech25 nology that will facilitate racial, ethnic, primary 


emcdonald on DSK5VPTVN1PROD with BILLS
17 

•HR 2954 IH

1 language, sexual orientation, disability status, 

2 gender identity, and socioeconomic status data 

3 collection and analysis; 

4 ‘‘(B) improve methods for health data col5 lection and analysis including additional popu6 lation groups beyond the Office of Management 

7 and Budget categories if such groups can be 

8 aggregated into the minimum race and ethnicity 

9 categories; 

10 ‘‘(C) develop mechanisms for submitting 

11 collected data subject to existing privacy and 

12 confidentiality regulations; and 

13 ‘‘(D) develop educational programs to in14 form health insurance issuers, health plans, 

15 health providers, health-related agencies, and 

16 the general public that data collection and re17 porting by race, ethnicity, primary language, 

18 sexual orientation, disability status, gender 

19 identity, and socioeconomic status are legal and 

20 essential for eliminating health and health care 

21 disparities. 

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

23 Secretary, acting through the Director of the Agency for 

24 Healthcare Research and Quality and in coordination with 

25 the Administrator of the Centers for Medicare & Medicaid 


emcdonald on DSK5VPTVN1PROD with BILLS
18 

•HR 2954 IH

1 Services, shall provide technical assistance to agencies of 

2 the Department of Health and Human Services in meeting 

3 Federal standards for health disparity data collection and 

4 for analysis of racial and ethnic disparities in health and 

5 health care in public programs by— 

6 ‘‘(1) identifying appropriate quality assurance 

7 mechanisms to monitor for health disparities; 

8 ‘‘(2) specifying the clinical, diagnostic, or thera9 peutic measures which should be monitored; 

10 ‘‘(3) developing new quality measures relating 

11 to racial and ethnic disparities and their overlap 

12 with other disparity factors in health and health 

13 care; 

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

15 should be conducted; and 

16 ‘‘(5) sharing data with external organizations 

17 for research and quality improvement purposes. 

18 ‘‘(g) DEFINITION.—In this section, the term ‘health19 related program’ mean a program— 

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

21 301 et seq.) that pays for health care and services; 

22 and 

23 ‘‘(2) under this Act that provides Federal finan24 cial assistance for health care, biomedical research, 


emcdonald on DSK5VPTVN1PROD with BILLS
19 

•HR 2954 IH

1 or health services research and or is designed to im2 prove the public’s health. 

3 ‘‘(h) 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 2012 through 2017. 

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

8 ‘‘(a) ESTABLISHMENT OF EPIDEMIOLOGY CEN9 TERS.—The Secretary shall establish an epidemiology cen10 ter in each service area to carry out the functions de11 scribed in subsection (b). Any new center established after 

12 the date of the enactment of the Health Equity and Ac13 countability Act of 2011 may be operated under a grant 

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

15 grant shall not be divisible. 

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

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

18 and urban indian organizations, each service area epidemi19 ology center established under this subsection shall, with 

20 respect to such service area— 

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

22 progress made toward meeting, each of the health 

23 status objectives of the service, the Indian tribes, 

24 tribal organizations, and urban indian organizations 

25 in the service area; 


emcdonald on DSK5VPTVN1PROD with BILLS
20 

•HR 2954 IH

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

2 systems, and other systems that impact the improve3 ment of Indian health; 

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

5 and urban indian organizations in identifying their 

6 highest priority health status objectives and the 

7 services needed to achieve such objectives, based on 

8 epidemiological data; 

9 ‘‘(4) make recommendations for the targeting 

10 of services needed by the populations served; 

11 ‘‘(5) make recommendations to improve health 

12 care delivery systems for Indians and urban Indians; 

13 ‘‘(6) provide requested technical assistance to 

14 Indian tribes, tribal organizations, and urban indian 

15 organizations in the development of local health 

16 service priorities and incidence and prevalence rates 

17 of disease and other illness in the community; and 

18 ‘‘(7) provide disease surveillance and assist In19 dian tribes, tribal organizations, and urban Indian 

20 organizations to promote public health. 

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

22 Centers for Disease Control and Prevention shall provide 

23 technical assistance to the centers in carrying out the re24 quirements of this subsection. 

25 ‘‘(d) GRANTS FOR STUDIES.— 


emcdonald on DSK5VPTVN1PROD with BILLS
21 

•HR 2954 IH

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

2 grants to Indian tribes, tribal organizations, urban 

3 indian organizations, and eligible intertribal con4 sortia to conduct epidemiological studies of Indian 

5 communities. 

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

7 intertribal consortium is eligible to receive a grant 

8 under this subsection if— 

9 ‘‘(A) the intertribal consortium is incor10 porated for the primary purpose of improving 

11 Indian health; and 

12 ‘‘(B) the intertribal consortium is rep13 resentative of the Indian tribes or urban Indian 

14 communities in which the intertribal consortium 

15 is located. 

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

17 grant under this subsection shall be submitted in 

18 such manner and at such time as the Secretary shall 

19 prescribe. 

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

21 grant under this subsection shall— 

22 ‘‘(A) demonstrate the technical, adminis23 trative, and financial expertise necessary to 

24 carry out the functions described in paragraph 

25 (5); 


emcdonald on DSK5VPTVN1PROD with BILLS
22 

•HR 2954 IH

1 ‘‘(B) consult and cooperate with providers 

2 of related health and social services in order to 

3 avoid duplication of existing services; and 

4 ‘‘(C) demonstrate cooperation from Indian 

5 tribes or urban Indian organizations in the area 

6 to be served. 

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

8 paragraph (1) may be used— 

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

10 in subsection (b); 

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

12 with tribal leaders, urban Indian community 

13 leaders, and related health staff on health care 

14 and health service management issues; and 

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

16 tribal organizations, and urban Indian commu17 nities, to provide the service with information 

18 regarding ways to improve the health status of 

19 Indians. 

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

21 center operated by a grantee pursuant to a grant awarded 

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

23 authority for purposes of the Health Insurance Portability 

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

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


emcdonald on DSK5VPTVN1PROD with BILLS
23 

•HR 2954 IH

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

2 regulation). The Secretary shall grant such grantees ac3 cess to and use of data, data sets, monitoring systems, 

4 delivery systems, and other protected health information 

5 in the possession of the Secretary.’’. 

6 SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP7 PROPRIATIONS FOR DATA COLLECTION AND 

8 ANALYSIS. 

9 Section 3101 of the Public Health Service Act (42 

10 U.S.C. 300kk) is amended— 

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

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

13 (h). 

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

15 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

18 the following: 

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

20 BY THE SOCIAL SECURITY ADMINISTRATION. 

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

22 Security, in consultation with the Administrator of the 

23 Centers for Medicare & Medicaid Services, shall— 

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

25 ethnicity, primary language, and disability status of 


emcdonald on DSK5VPTVN1PROD with BILLS
24 

•HR 2954 IH

1 all applicants for Social Security account numbers or 

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

3 all individuals with respect to whom the Commis4 sioner maintains records of wages and self-employ5 ment income in accordance with reports received by 

6 the Commissioner or the Secretary of the Treas7 ury— 

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

9 for data collection on race, ethnicity, primary 

10 language, and disability status developed under 

11 section 3101 of the Public Health Service Act; 

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

13 additional population groups if such groups can 

14 be aggregated into the minimum race and eth15 nicity categories; and 

16 ‘‘(C) additionally referring, where prac17 ticable, to the standards developed by the Insti18 tute of Medicine in ‘Race, Ethnicity, and Lan19 guage Data: Standardization for Health Care 

20 Quality Improvement’ (released August 31, 

21 2009); 

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

23 described in paragraph (1) for applicants who are 

24 under 18 years of age or otherwise legally incapaci25 tated, require that— 


emcdonald on DSK5VPTVN1PROD with BILLS
25 

•HR 2954 IH

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

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

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

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

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

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

12 Medicare & Medicaid Services and other Federal 

13 health agencies; 

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

15 least an annual basis; and 

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

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

20 status data. 

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

22 Social Security shall ensure (through the promulgation of 

23 regulations or otherwise) that all data collected pursuant 

24 to subsection (a) are protected— 


emcdonald on DSK5VPTVN1PROD with BILLS
26 

•HR 2954 IH

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

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

4 Health Insurance Portability and Accountability Act 

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

7 health information and other protections; and 

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

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

12 from other inappropriate uses, as defined by the 

13 Secretary. 

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

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

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

20 either directly or by grant or contract, provide technical 

21 assistance to enable any health entity to comply with the 

22 requirements of this section. 

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

24 are authorized to be appropriated to carry out this section, 


emcdonald on DSK5VPTVN1PROD with BILLS
27 

•HR 2954 IH

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

2 2012 through 2017.’’. 

3 SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

6 Human Services shall revise the regulations promulgated 

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

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

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

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

12 data collection on race, ethnicity, primary language, 

13 disability, and sex developed under section 3101 of 

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

15 and 

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

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

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

22 subject to the regulations described in such subsection and 

23 provide technical assistance with respect to the collection 

24 of the data involved. 


emcdonald on DSK5VPTVN1PROD with BILLS
28 

•HR 2954 IH

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

2 Human Services shall require that health entities comply 

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

4 later than 2 years after the final promulgation of such 

5 standards. 

6 SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

8 U.S.C. 242k(n)) is amended— 

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

10 inserting ‘‘2016’’; 

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

12 striking ‘‘2003’’ and inserting ‘‘2016’’; and 

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

14 inserting ‘‘2016’’. 

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

16 HAWAIIANS, OR PACIFIC ISLANDERS AND 

17 OTHER UNDERREPRESENTED GROUPS IN 

18 FEDERAL HEALTH SURVEYS. 

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

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


emcdonald on DSK5VPTVN1PROD with BILLS
29 

•HR 2954 IH

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

2 HAWAIIANS, OR PACIFIC ISLANDERS AND 

3 OTHER UNDERREPRESENTED GROUPS IN 

4 FEDERAL HEALTH SURVEYS. 

5 ‘‘(a) NATIONAL STRATEGY.— 

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

7 and Human Services, acting through the Director of 

8 the National Center for Health Statistics (referred 

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

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

13 develop and implement an ongoing and sustainable 

14 national strategy for oversampling Asian-Americans, 

15 Native Hawaiians, or Pacific Islanders, and other 

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

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

21 the enactment of the this section, the Secretary— 

22 ‘‘(A) shall consult with representatives of 

23 community groups, nonprofit organizations, 

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


emcdonald on DSK5VPTVN1PROD with BILLS
30 

•HR 2954 IH

1 Native Hawaiians, or Pacific Islanders, and 

2 other underrepresented populations; and 

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

5 and agencies. 

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

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

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

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

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

14 2012 through 2017.’’. 

15 SEC. 107. GEO-ACCESS STUDY. 

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

18 (1) conduct a study to— 

19 (A) determine which geographic areas of 

20 the United States have shortages of specialty 

21 mental health providers; and 

22 (B) assess the preparedness of speciality 

23 mental health providers to deliver culturally and 

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


emcdonald on DSK5VPTVN1PROD with BILLS
31 

•HR 2954 IH

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

3 SEC. 108. RACIAL, ETHNIC, AND LINGUISTIC DATA COL4 LECTED BY THE FEDERAL GOVERNMENT. 

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

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

8 and office of the Federal Government that has collected 

9 racial, ethnic, or linguistic data during the preceding cal10 endar year shall submit such data to the Secretary of 

11 Health and Human Services. 

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

13 Not later than April 30, 2012, and each April 30 there14 after, the Secretary of Health and Human Services, acting 

15 through the Director of the National Institute on Minority 

16 Health and Health Disparities and the Deputy Assistant 

17 Secretary for Minority Health, shall— 

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

19 linguistic data submitted under subsection (a) for 

20 the preceding calendar year; 

21 (2) make publicly available such data and the 

22 results of such analysis; and 

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

24 data and analysis. 


emcdonald on DSK5VPTVN1PROD with BILLS
32 

•HR 2954 IH

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

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

4 Human Services, acting through the National Institute on 

5 Minority Health and Health Disparities and the Office of 

6 Minority Health, may award grants to access and analyze 

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

9 and eliminate disparities in health and health care. 

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

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

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

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

18 OF HEALTH DATA. 

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

20 U.S.C. 300kk(a)) is amended— 

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

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

23 status’’; 

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

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

26 status’’; and 


emcdonald on DSK5VPTVN1PROD with BILLS
33 

•HR 2954 IH

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

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

3 status’’. 

4 SEC. 111. OPTIONAL COLLECTION OF HEALTH DATA ON IM5 MIGRANTS AND INDIVIDUALS IN THEIR 

6 HOUSEHOLDS. 

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

8 U.S.C. 300k(a)) is amended by adding at the end the fol9 lowing: 

10 ‘‘(4) OPTIONAL UNIFORM CATEGORIES.—Not 

11 later than 12 months after the date of the enact12 ment of this paragraph, the Secretary shall— 

13 ‘‘(A) enter into an arrangement with the 

14 Institute of Medicine of the National Academies 

15 (or, if the Institute of Medicine declines to 

16 enter into such an arrangement, another appro17 priate entity) to— 

18 ‘‘(i) conduct a study and develop rec19 ommended standards for the optional col20 lection of data on immigrants, as well as 

21 citizens living within immigrant households 

22 (mixed-status households), in order to 

23 measure disparities in health coverage, 

24 health care access and quality, and health 

25 status among these populations, and 


emcdonald on DSK5VPTVN1PROD with BILLS
34 

•HR 2954 IH

1 ‘‘(ii) include ensuing recommendations 

2 and results in a report to the Secretary 

3 that includes best practices to protect the 

4 privacy of respondents to the full extent of 

5 applicable law; 

6 ‘‘(B) promulgate standards based on the 

7 recommendations and results of subparagraph 

8 (A) for the optional collection of data in major 

9 health surveys and research; and 

10 ‘‘(C) provide clear guidance that immi11 grant and mixed-status households are optional 

12 uniform categories and data concerning such 

13 households shall— 

14 ‘‘(i) not be required to be collected by 

15 the standards under subparagraph (B); 

16 ‘‘(ii) be collected only in accordance 

17 with— 

18 ‘‘(I) the ‘Tri-Agency Guidance’ 

19 issued by the Food and Nutrition 

20 Service of the Department of Agri21 culture, the Centers for Medicare & 

22 Medicaid Services, the Administration 

23 for Children and Families, and Office 

24 for Civil Rights; and 

25 ‘‘(II) other applicable law; and 


emcdonald on DSK5VPTVN1PROD with BILLS
35 

•HR 2954 IH

1 ‘‘(iii) not be collected for program ap2 plication and enrollment processes beyond 

3 statutory requirements.’’. 

4 SEC. 112. STANDARDS FOR MEASURING SOCIOECONOMIC 

5 STATUS IN COLLECTION OF HEALTH DATA. 

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

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

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

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

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

14 SEC. 113. 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 505D the following: 

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

21 RESPECT TO RACIAL AND ETHNIC BACK22 GROUND. 

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

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


emcdonald on DSK5VPTVN1PROD with BILLS
36 

•HR 2954 IH

1 ethnic background as to the safety or effectiveness of a 

2 drug, then— 

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

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

7 of the Public Health Service Act for approval of a 

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

10 the disparity; and 

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

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

14 ‘‘(b) POSTMARKET STUDIES.— 

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

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

17 ethnic background as to the safety or effectiveness 

18 of a drug for which there is an approved application 

19 under section 505 or a license under section 351 of 

20 the Public Health Service Act, the Secretary may by 

21 order require the holder of the approved application 

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


emcdonald on DSK5VPTVN1PROD with BILLS
37 

•HR 2954 IH

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

2 that the postmarket studies confirm that there is a 

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

4 the drug shall include appropriate information about 

5 the disparity. 

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

7 specify all aspects of study design, including the 

8 number of studies and study participants, and the 

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

11 studies of the drug. 

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

13 Secretary may by order modify any aspect of the 

14 study design as necessary after issuing an order 

15 under paragraph (1). 

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

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

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

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

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

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

25 basis of racial or ethnic background as to safety or 


emcdonald on DSK5VPTVN1PROD with BILLS
38 

•HR 2954 IH

1 effectiveness of a drug in the same chemical class as 

2 the drug; 

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

4 basis of racial or ethnic background in the way the 

5 drug is metabolized; and 

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

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

9 AND 505(j).— 

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

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

13 under that section or misbranded under section 502 

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

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

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

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

24 require that the labeling of a drug approved under 

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


emcdonald on DSK5VPTVN1PROD with BILLS
39 

•HR 2954 IH

1 disparity on the basis of racial or ethnic background 

2 as to the safety or effectiveness of the drug include 

3 a statement of any appropriate contraindications, 

4 warnings, or precautions related to the disparity 

5 that the Secretary considers necessary.’’. 

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

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

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

10 application under section 505 or license under section 351 

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

12 to complete the investigations or studies, or comply with 

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

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

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

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

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

18 SEC. 114. GAO STUDY ON COMPLIANCE WITH EXISTING FDA 

19 REQUIREMENTS TO PRESENT DRUG AND DE20 VICE SAFETY AND EFFECTIVENESS DATA BY 

21 SEX, AGE, AND RACIAL AND ETHNIC SUB22 GROUPS. 

23 (a) IN GENERAL.—The Comptroller General of the 

24 United States shall conduct a study investigating the ex25 tent to which sponsors of clinical studies of investigational 


emcdonald on DSK5VPTVN1PROD with BILLS
40 

•HR 2954 IH

1 drugs, biologics, and devices and sponsors of applications 

2 for approval or licensure of new drugs, biologics, and de3 vices comply with Food and Drug Administration require4 ments and follow guidance for presentation of clinical 

5 study safety and effectiveness data by sex, age, and racial 

6 and ethnic subgroups. 

7 (b) REPORT BY GAO.— 

8 (1) SUBMISSION.—Not later than 18 months 

9 after the date of the enactment of this Act, the 

10 Comptroller General shall complete the study under 

11 subsection (a) and submit to the Committee on En12 ergy and Commerce of the House of Representatives 

13 and the Committee on Health, Education, Labor, 

14 and Pensions of the Senate a report on the results 

15 of such study. 

16 (2) CONTENTS.—The report required by para17 graph (1) shall include each of the following: 

18 (A) An assessment of the extent to which 

19 the Food and Drug Administration assists 

20 sponsors in complying with the requirements 

21 and following the guidance referred to in sub22 section (a). 

23 (B) An assessment of the effectiveness of 

24 the Food and Drug Administration’s enforce25 ment of compliance with such requirements. 


emcdonald on DSK5VPTVN1PROD with BILLS
41 

•HR 2954 IH

1 (C) An analysis of the extent to which fe2 males, racial and ethnic minorities, and adults 

3 of all ages are adequately represented in Food 

4 and Drug Administration-approved clinical 

5 studies (at all phases) so that product safety 

6 and effectiveness data can be evaluated by sex, 

7 age, and racial and ethnic subgroup. 

8 (D) An analysis of the extent to which a 

9 summary of product safety and effectiveness 

10 data disaggregated by sex, age, and racial and 

11 ethnic subgroup is readily available to the pub12 lic in a timely manner by means of the product 

13 label or the Food and Drug Administration’s 

14 Web site. 

15 (E) Recommendations for— 

16 (i) modifications to the requirements 

17 and guidance referred to in subsection (a); 

18 or 

19 (ii) oversight by the Food and Drug 

20 Administration of such requirements. 

21 (c) REPORT BY HHS.—Not later than 6 months 

22 after the submission by the Comptroller General of the 

23 report required under subsection (b), the Secretary of 

24 Health and Human Services shall submit to the Com25 mittee on Energy and Commerce of the House of RepVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
42 

•HR 2954 IH

1 resentatives and the Committee on Health, Education, 

2 Labor, and Pensions of the Senate a response to that re3 port, including a corrective action plan as needed to re4 spond to the recommendations in that report. 

5 (d) DEFINITIONS.—In this section: 

6 (1) The term ‘‘biologic’’ has the meaning given 

7 to the term ‘‘biological product’’ in section 351(i) of 

8 the Public Health Service Act (42 U.S.C. 262(i)). 

9 (2) The term ‘‘device’’ has the meaning given to 

10 such term in section 201(h) of the Federal Food, 

11 Drug, and Cosmetic Act (21 U.S.C. 321(h)). 

12 (3) The term ‘‘drug’’ has the meaning given to 

13 such term in section 201(g) of the Federal Food, 

14 Drug, and Cosmetic Act (21 U.S.C. 321(g)). 

15 SEC. 115. IMPROVING HEALTH DATA REGARDING NATIVE 

16 HAWAIIANS AND OTHER PACIFIC ISLANDERS. 

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

18 (42 U.S.C. 243 et seq.) is amended by inserting after sec19 tion 317U, as added, the following: 

20 ‘‘SEC. 317V. NATIVE HAWAIIAN AND OTHER PACIFIC IS21 LANDER HEALTH DATA. 

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

23 ‘‘(1) COMMUNITY GROUP.—The term ‘commu24 nity group’ means a group of NHOPI who are orga25 nized at the community level, and may include a 


emcdonald on DSK5VPTVN1PROD with BILLS
43 

•HR 2954 IH

1 church group, social service group, national advocacy 

2 organization, or cultural group. 

3 ‘‘(2) NONPROFIT, NONGOVERNMENTAL ORGANI4 ZATION.—The term ‘nonprofit, nongovernmental or5 ganization’ means a group of NHOPI with a dem6 onstrated history of addressing NHOPI issues, in7 cluding a NHOPI coalition. 

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

9 ‘designated organization’ means an entity estab10 lished to represent NHOPI populations and which 

11 has statutory responsibilities to provide, or has com12 munity support for providing, health care. 

13 ‘‘(4) GOVERNMENT REPRESENTATIVES.—The 

14 term ‘government representatives’ means representa15 tives from Hawaii, American Samoa, the Common16 wealth of the Northern Mariana Islands, the Fed17 erated States of Micronesia, Guam, the Republic of 

18 Palau, and the Republic of the Marshall Islands. 

19 ‘‘(5) NATIVE HAWAIIANS AND OTHER PACIFIC

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

21 and Other Pacific Islanders’ or ‘NHOPI’ means peo22 ple having origins in any of the original peoples of 

23 American Samoa, the Commonwealth of the North24 ern Mariana Islands, the Federated States of Micro25 nesia, Guam, Hawaii, the Republic of the Marshall 


emcdonald on DSK5VPTVN1PROD with BILLS
44 

•HR 2954 IH

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

2 island. 

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

4 means Guam, the Commonwealth of Northern Mar5 iana Islands, American Samoa, the United States 

6 Virgin Islands, the Federated States of Micronesia, 

7 the Republic of Palau, or the Republic of the Mar8 shall Islands. 

9 ‘‘(b) NATIONAL STRATEGY.— 

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

11 through the Director of the National Center for 

12 Health Statistics (referred to in this section as 

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

14 Prevention, and other agencies within the Depart15 ment of Health and Human Services as the Sec16 retary determines appropriate, shall develop and im17 plement an ongoing and sustainable national strat18 egy for identifying and evaluating the health status 

19 and health care needs of NHOPI populations living 

20 in the continental United States, Hawaii, American 

21 Samoa, the Commonwealth of the Northern Mariana 

22 Islands, the Federated States of Micronesia, Guam, 

23 the Republic of Palau, and the Republic of the Mar24 shall Islands. 


emcdonald on DSK5VPTVN1PROD with BILLS
45 

•HR 2954 IH

1 ‘‘(2) CONSULTATION.—In developing and imple2 menting a national strategy, as described in para3 graph (1), not later than 180 days after the date of 

4 enactment of the Health Equity and Accountability 

5 Act of 2011, the Secretary— 

6 ‘‘(A) shall consult with representatives of 

7 community groups, designated organizations, 

8 and nonprofit, nongovernmental organizations 

9 and with government representatives of NHOPI 

10 populations; and 

11 ‘‘(B) may solicit the participation of rep12 resentatives from other Federal departments. 

13 ‘‘(c) PRELIMINARY HEALTH SURVEY.— 

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

15 through the Director of NCHS, shall conduct a pre16 liminary health survey in order to identify the major 

17 areas and regions in the continental United States, 

18 Hawaii, American Samoa, the Commonwealth of the 

19 Northern Mariana Islands, the Federated States of 

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

21 Republic of the Marshall Islands in which NHOPI 

22 people reside. 

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

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

25 other data the Secretary determines to be— 


emcdonald on DSK5VPTVN1PROD with BILLS
46 

•HR 2954 IH

1 ‘‘(A) useful in determining health status 

2 and health care needs; or 

3 ‘‘(B) required for developing or imple4 menting a national strategy. 

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

6 health survey described in paragraph (1), including 

7 plans for designing questions, implementation, sam8 pling, and analysis, shall be developed in consulta9 tion with community groups, designated organiza10 tions, nonprofit, nongovernmental organizations, and 

11 government representatives of NHOPI populations, 

12 as determined by the Secretary. 

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

14 this subsection shall be completed not later than 18 

15 months after the date of enactment of the Health 

16 Equity and Accountability Act of 2011. 

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

18 after the date of enactment of the Health Equity and Ac19 countability Act of 2011, the Secretary shall submit to 

20 Congress a progress report, which shall include the na21 tional strategy described in subsection (b)(1). 

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

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

24 into an agreement with the Institute of Medicine to 


emcdonald on DSK5VPTVN1PROD with BILLS
47 

•HR 2954 IH

1 conduct a study, with input from stakeholders in in2 sular areas, on the following: 

3 ‘‘(A) The standards and definitions of 

4 health care applied to health care systems in in5 sular areas and the appropriateness of such 

6 standards and definitions. 

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

8 care systems in insular areas, evaluated based 

9 upon standards and definitions, as the Sec10 retary determines. 

11 ‘‘(C) The effectiveness of donor aid in ad12 dressing health care needs and priorities in in13 sular areas. 

14 ‘‘(D) The progress toward implementation 

15 of recommendations of the Committee on 

16 Health Care Services in the United States—As17 sociated Pacific Basin of the Institute of Medi18 cine that are set forth in the 1998 report, ‘Pa19 cific Partnerships for Health: Charting a New 

20 Course for the 21st Century’. 

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

22 paragraph (1) shall require the Institute of Medicine 

23 to submit to the Secretary and to Congress, not 

24 later than 2 years after the date of the enactment 

25 of the Health Equity and Accountability Act of 


emcdonald on DSK5VPTVN1PROD with BILLS
48 

•HR 2954 IH

1 2011, a report containing a description of the results 

2 of the study conducted under paragraph (1), includ3 ing the conclusions and recommendations of the In4 stitute of Medicine for each of the items described 

5 in subparagraphs (A) through (D) of such para6 graph. 

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

8 carry out this section, there are authorized to be appro9 priated such sums as may be necessary for fiscal years 

10 2012 through 2017.’’. 

11 TITLE II—CULTURALLY AND LIN12 GUISTICALLY APPROPRIATE 

13 HEALTH CARE 

14 SEC. 201. DEFINITIONS. 

15 In this title, the definitions contained in section 3400 

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

17 shall apply. 

18 SEC. 202. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

19 ACT. 

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

21 (1) Effective communication is essential to 

22 meaningful access to quality physical and mental 

23 health care. 

24 (2) Research indicates that the lack of appro25 priate language services creates languages barriers 


emcdonald on DSK5VPTVN1PROD with BILLS
49 

•HR 2954 IH

1 that result in increased risk of misdiagnosis, ineffec2 tive treatment plans and poor health outcomes for 

3 limited-English-proficient individuals and individuals 

4 with communication disabilities such as hearing, vi5 sion or print impairments. 

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

7 residents in the United States who speak English 

8 less than very well and, therefore, cannot effectively 

9 communicate with health and social service providers 

10 continues to increase significantly. 

11 (4) The responsibility to fund language services 

12 in the provision of health care and health care-re13 lated services to limited-English-proficient individ14 uals and individuals with communication disabilities 

15 such as hearing, vision, or print impairments is a so16 cietal one that cannot fairly be visited solely upon 

17 the health care, public health or social services com18 munity. 

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

20 prohibits discrimination based on the grounds of 

21 race, color or national origin by any entity receiving 

22 Federal financial assistance. In order to avoid dis23 crimination on the grounds of national origin, all 

24 programs or activities administered by the Depart25 ment must take adequate steps to ensure that their 


emcdonald on DSK5VPTVN1PROD with BILLS
50 

•HR 2954 IH

1 policies and procedures do not deny or have the ef2 fect of denying limited-English-proficient individuals 

3 with equal access to benefits and services for which 

4 such persons qualify. 

5 (6) Linguistic diversity in the healthcare and 

6 health-care-related-services workforce is important 

7 for providing all patients the environment most con8 ducive to positive health outcomes. 

9 (7) All members of the health care and health10 care-related-services community should continue to 

11 educate their staff and constituents about limited12 English proficient and disability communication 

13 issues and help them identify resources to improve 

14 access to quality care for limited-English-proficient 

15 individuals and individuals with communication dis16 abilities such as hearing, vision, or print impair17 ments. 

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

19 sign language instructions is an important mecha20 nism for ensuring effective communication and elimi21 nating the language barriers that impede access to 

22 health care. 

23 (9) Competent languages services in health care 

24 settings should be available as a matter of course. 


emcdonald on DSK5VPTVN1PROD with BILLS
51 

•HR 2954 IH

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

2 (42 U.S.C. 201 et seq.) is amended by adding at the end 

3 the following: 

4 ‘‘TITLE XXXIV—CULTURALLY 

5 AND LINGUISTICALLY APPRO6 PRIATE HEALTH CARE 

7 ‘‘SEC. 3400. DEFINITIONS. 

8 ‘‘In this title: 

9 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re10 spect to an individual means a person who has suffi11 cient degree of proficiency in two languages. 

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

13 ‘community health worker’ includes a community 

14 health advocate, a lay health educator, a community 

15 health representative, a peer health promoter, a 

16 community health outreach worker, and in Spanish, 

17 promotores de salud. 

18 ‘‘(3) COMPETENT INTERPRETER SERVICES.— 

19 The term ‘competent interpreter services’ means a 

20 translanguage rendition of a spoken or signed mes21 sage in which the interpreter comprehends the 

22 source language and can communicate comprehen23 sively in the target language to convey the meaning 

24 intended in the source language. The interpreter 

25 knows health and health-related terminology and 


emcdonald on DSK5VPTVN1PROD with BILLS
52 

•HR 2954 IH

1 provides accurate interpretations by choosing equiva2 lent expressions that convey the best matching and 

3 meaning to the source language and captures, to the 

4 greatest possible extent, all nuances intended in the 

5 source message. 

6 ‘‘(4) COMPETENT TRANSLATION SERVICES.— 

7 The term ‘competent translation services’ means a 

8 translanguage rendition of a written document in 

9 which the translator comprehends the source lan10 guage and can write or sign comprehensively in the 

11 target language to convey the meaning intended in 

12 the source language. The translator knows health 

13 and health-related terminology and provides accurate 

14 translations by choosing equivalent expressions that 

15 convey the best matching and meaning to the source 

16 language and captures, to the greatest possible ex17 tent, all nuances intended in the source document. 

18 ‘‘(5) CULTURAL COMPETENCE.—The term ‘cul19 tural competence’ means a set of congruent behav20 iors, attitudes, and policies that come together in a 

21 system, agency, or among professionals that enables 

22 effective work in cross-cultural situations. In the 

23 preceding sentence— 

24 ‘‘(A) the term ‘cultural’ refers to inte25 grated patterns of human behavior that include 


emcdonald on DSK5VPTVN1PROD with BILLS
53 

•HR 2954 IH

1 the language, thoughts, communications, ac2 tions, customs, beliefs, values, and institutions 

3 of racial, ethnic, religious, or social groups, in4 cluding lesbian, gay, bisexual, transgender and 

5 intersex individuals, and individuals with phys6 ical and mental disabilities; and 

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

8 the capacity to function effectively as an indi9 vidual and an organization within the context of 

10 the cultural beliefs, behaviors, and needs pre11 sented by consumers and their communities. 

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

13 ‘effective communication’ means an exchange of in14 formation between the provider of health care or 

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

16 services who is limited in English proficiency, or has 

17 a communication impairment such as a hearing, vi18 sion, or learning impairment, that enables access, 

19 understanding, and benefit from health care or 

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

21 the development of their treatment plan. 

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

23 term ‘grievance resolution process’ means all aspects 

24 of dispute resolution including filing complaints, 

25 grievance and appeal procedures, and court action. 


emcdonald on DSK5VPTVN1PROD with BILLS
54 

•HR 2954 IH

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

2 care group’ means a group of physicians organized, 

3 at least in part, for the purposes of providing physi4 cians’ services under the Medicaid, SCHIP, or Medi5 care programs and may include a hospital and any 

6 other individual or entity furnishing services covered 

7 under the Medicaid, SCHIP, or Medicare programs 

8 that is affiliated with the health care group. 

9 ‘‘(9) HEALTH-CARE SERVICES.—The term 

10 ‘health care services’ means services that address 

11 physical as well as mental health conditions in all 

12 care settings. 

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

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

15 social services programs or activities that provide ac16 cess, referrals or links to health care. 

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

18 means any Indian tribe, band, nation, or other orga19 nized group or community, including any Alaska Na20 tive village or group or regional or village corpora21 tion as defined in or established pursuant to the 

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

23 (43 U.S.C. 1601 et seq.), which is recognized as eli24 gible for the special programs and services provided 


emcdonald on DSK5VPTVN1PROD with BILLS
55 

•HR 2954 IH

1 by the United States to Indians because of their sta2 tus as Indians. 

3 ‘‘(12) INTEGRATED HEALTH CARE DELIVERY

4 SYSTEM.—The term ‘integrated health care delivery 

5 system’ means an interdisciplinary system that 

6 brings together providers from the primary health, 

7 mental health, substance use and related disciplines 

8 to improve the health outcomes of an individual. 

9 Providers may include but are not limited to hos10 pitals, health, mental health or substance use clinics 

11 and providers, home health agencies, ambulatory 

12 surgery centers, skilled nursing facilities, rehabilita13 tion centers, and employed, independent or con14 tracted physicians. 

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

16 terms ‘interpreting’ and ‘interpretation’ mean the 

17 transmission of a spoken, written, or signed message 

18 from one language or format into another, faithfully, 

19 accurately, and objectively. 

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

21 access’ means the provision of language services to 

22 an LEP individual or individual with communication 

23 disabilities designed to enhance that individual’s ac24 cess to, understanding of or benefit from health care 

25 or health-care-related services. 


emcdonald on DSK5VPTVN1PROD with BILLS
56 

•HR 2954 IH

1 ‘‘(15) LANGUAGE OR LANGUAGE ACCESS SERV2 ICES.—The term ‘language or language access serv3 ices’ means provision of health care services directly 

4 in a non-English language, interpretation, trans5 lation, signage, video recording, and English or non6 English alternative formats. 

7 ‘‘(16) LEP.—The term ‘LEP’ means limited8 English proficient. 

9 ‘‘(17) LEP RELATED DATA COLLECTION AC10 TIVITIES.—The term ‘LEP related data collection 

11 activities’ includes identifying, collecting, storing, 

12 tracking, and analyzing primary language data, and 

13 information on the methods used to meet the lan14 guage access needs of limited-English-proficient indi15 viduals. 

16 ‘‘(18) MEDICARE, MEDICAID, AND SCHIP.—The 

17 terms ‘Medicare’, ‘Medicaid’, and ‘SCHIP’ means 

18 the respective programs under titles XVIII, XIX, 

19 and XXI of the Social Security Act. 

20 ‘‘(19) MINORITY.— 

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

22 and ‘minorities’ refer to individuals from a mi23 nority group. 


emcdonald on DSK5VPTVN1PROD with BILLS
57 

•HR 2954 IH

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

2 with respect to populations, refers to racial and 

3 ethnic minority groups. 

4 ‘‘(20) MINORITY GROUP.—The term ‘minority 

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

6 ethnic minority group’. 

7 ‘‘(21) RACIAL AND ETHNIC MINORITY GROUP.— 

8 The term ‘racial and ethnic minority group’ means 

9 American Indians and Alaska Natives, African10 Americans (including Caribbean Blacks, Africans 

11 and other Blacks), Asian-Americans, Hispanics (in12 cluding Latinos), and Native Hawaiians and other 

13 Pacific Islanders. 

14 ‘‘(22) ON-SITE INTERPRETING/INTERPRETA15 TION.—The term ‘on-site interpreting/interpretation’ 

16 means a method of interpreting or interpretation for 

17 which the interpreter is in the physical presence of 

18 the provider of health care or health-care-related 

19 services and the recipient of such services who is 

20 limited in English proficiency or has a communica21 tion impairment such as hearing, vision, or learning. 

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

23 means the Secretary of Health and Human Services. 

24 ‘‘(24) SIGHT TRANSLATION.—The term ‘sight 

25 translation’ means the transmission of a written 


emcdonald on DSK5VPTVN1PROD with BILLS
58 

•HR 2954 IH

1 message in one language into a spoken or signed 

2 message in another language, or an alternative for3 mat in English or another language. 

4 ‘‘(25) STATE.—The term ‘State’ means each of 

5 the several States, the District of Columbia, the 

6 Commonwealth of Puerto Rico, the Indian tribes, 

7 the United States Virgin Islands, Guam, American 

8 Samoa, and the Commonwealth of the Northern 

9 Mariana Islands. 

10 ‘‘(26) TELEPHONIC INTERPRETATION.—The 

11 term ‘telephonic interpretation’ (also known as over 

12 the phone interpretation or OPI) means a method of 

13 interpreting/interpretation for which the interpreter 

14 is not in the physical presence of the provider of 

15 health care or related services and the limited16 English-proficient recipient of such services but is 

17 connected via telephone. 

18 ‘‘(27) TRANSLATION.—The term ‘translation’ 

19 means the transmission of a written message in one 

20 language into a written or signed message in an21 other language, and includes translation into an22 other language or alternative format, such as large 

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

24 ‘‘(28) VIDEO INTERPRETATION.—The term 

25 ‘video interpretation’ means a method of interVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00058 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
59 

•HR 2954 IH

1 preting/interpretation for which the interpreter is 

2 not in the physical presence of the provider of health 

3 care or related services and the limited-English-pro4 ficient recipient of such services but is connected via 

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

6 transmission. 

7 ‘‘(29) VITAL DOCUMENT.—The term ‘vital doc8 ument’ includes but is not limited to applications for 

9 government programs that provide health care serv10 ices, medical or financial consent forms, financial as11 sistance documents, letters containing important in12 formation regarding patient instructions (such as 

13 prescriptions, referrals to other providers, and dis14 charge plans) and participation in a program (such 

15 as a Medicaid managed care program), notices per16 taining to the reduction, denial, or termination of 

17 services or benefits, notices of the right to appeal 

18 such actions, and notices advising limited-English19 proficient individuals and individuals with commu20 nication disabilities of the availability of free lan21 guage services, alternative formats, and other out22 reach materials. 


emcdonald on DSK5VPTVN1PROD with BILLS
60 

•HR 2954 IH

1 ‘‘SEC. 3401. IMPROVING ACCESS TO SERVICES FOR INDIVID2 UALS WITH LIMITED ENGLISH PROFICIENCY. 

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

4 13166, it is the purpose of this section— 

5 ‘‘(1) to improve Federal agency performance re6 garding access to federally conducted and federally 

7 assisted programs and activities for individuals who 

8 are limited in their English proficiency; 

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

10 the services it provides and develop and implement 

11 a system by which limited-English-proficient individ12 uals can obtain cultural competence and meaningful 

13 access to those services consistent with, and without 

14 substantially burdening, the fundamental mission of 

15 the agency; 

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

17 that recipients of Federal financial assistance pro18 vide cultural competence and meaningful access to 

19 their limited-English-proficient applicants and bene20 ficiaries; 

21 ‘‘(4) to ensure that recipients of Federal finan22 cial assistance take reasonable steps, consistent with 

23 the guidelines set forth in the Limited English Pro24 ficient Guidance of the Department of Justice (as 

25 issued on June 12, 2002), to ensure cultural com26 petence and meaningful access to their programs 


emcdonald on DSK5VPTVN1PROD with BILLS
61 

•HR 2954 IH

1 and activities by limited-English-proficient individ2 uals; and 

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

4 Civil Rights Act of 1964 and that health care pro5 viders and organizations do not discriminate in the 

6 provision of services. 

7 ‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC8 TIVITIES.— 

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

10 after the date of enactment of this title, each Fed11 eral agency that carries out health-care-related ac12 tivities shall prepare a plan to improve access cul13 tural competence to the federally conducted, health14 are-related programs and activities of the agency by 

15 limited-English-proficient individuals. Each Federal 

16 agency must ensure that such plan is fully imple17 mented not later than one year after the date of en18 actment of this Act. 

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

20 paragraph (1) shall include— 

21 ‘‘(A) the steps the agency will take to en22 sure that limited-English-proficient individuals 

23 have access to the agency’s federally conducted 

24 health care and health-care-related programs 

25 and activities; 


emcdonald on DSK5VPTVN1PROD with BILLS
62 

•HR 2954 IH

1 ‘‘(B) the policies and procedures for identi2 fying, assessing, and meeting the language 

3 needs and cultural competence needs of its lim4 ited-English-proficient beneficiaries served by 

5 federally conducted programs and activities; 

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

7 federally conducted programs and activities to 

8 improve cultural competence to provide a range 

9 of language assistance options, notice to lim10 ited-English-proficient individuals of the right 

11 to competent language services, periodic train12 ing of staff, monitoring and quality assessment 

13 of the language services and, in appropriate cir14 cumstances, the translation of written mate15 rials; 

16 ‘‘(D) the steps the agency will take to en17 sure that applications, forms, and other rel18 evant documents for its federally conducted pro19 grams and activities are competently translated 

20 into the primary language of a limited-English21 proficient client where such materials are need22 ed to improve access to federally conducted and 

23 federally assisted programs and activities for 

24 such a limited-English-proficient individual; and 


emcdonald on DSK5VPTVN1PROD with BILLS
63 

•HR 2954 IH

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

2 to improve cultural competence to assist recipi3 ents of Federal funds to improve access to 

4 health care or health-care-related programs and 

5 activities for limited-English-proficient individ6 uals. 

7 Each agency shall send a copy of such plan to the 

8 Department of Justice, which shall serve as the cen9 tral repository of the Agency’s plans. 

10 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI11 TIES.— 

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

13 after the date of enactment of this title, each Fed14 eral agency providing health-care-related Federal fi15 nancial assistance shall ensure that the guidance for 

16 recipients of Federal financial assistance developed 

17 by the agency to ensure compliance with title VI of 

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

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

20 assistance. Each agency shall send a copy of such 

21 guidance to the Department of Justice which shall 

22 serve as the central repository of the Agency’s plans. 

23 After approval by the Department of Justice, each 

24 agency shall publish its guidance document in the 

25 Federal Register for public comment. 


emcdonald on DSK5VPTVN1PROD with BILLS
64 

•HR 2954 IH

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

2 guidance developed under paragraph (1) shall take 

3 into account the types of health care services pro4 vided by the recipients, the individuals served by the 

5 recipients, and other factors set out in such stand6 ards. 

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 shall examine 

10 such existing guidance, as well as the programs and 

11 activities to which such guidance applies, to deter12 mine if modification of such guidance is necessary to 

13 comply with this subsection. 

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

15 shall consult with the Department of Justice in es16 tablishing the guidances under this subsection. 

17 ‘‘(d) CONSULTATIONS.— 

18 ‘‘(1) IN GENERAL.—In carrying out this sec19 tion, each Federal agency that carriers out health 

20 care and health-care-related activities shall ensure 

21 that stakeholders, such as limited-English-proficient 

22 individuals and their representative organizations, 

23 recipients of Federal assistance, and other appro24 priate individuals or entities, have an adequate opVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00064 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
65 

•HR 2954 IH

1 portunity to provide input with respect to the actions 

2 of the agency. 

3 ‘‘(2) EVALUATION.—Each Federal agency de4 scribed in paragraph (1) shall evaluate the— 

5 ‘‘(A) particular needs of the limited6 English-proficient individuals served by the 

7 agency; 

8 ‘‘(B) particular needs of the limited9 English-proficient individuals served by the 

10 agency’s recipients of Federal financial assist11 ance; and 

12 ‘‘(C) burdens of compliance with the agen13 cy guidance and this section for the agency and 

14 its recipients. 

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

16 LINGUISTICALLY APPROPRIATE SERVICES IN 

17 HEALTH CARE. 

18 ‘‘Recipients of Federal financial assistance from the 

19 Secretary shall, to the extent reasonable and practicable 

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

21 of the Guidance to Federal Financial Assistance Recipi22 ents Regarding Title VI Prohibition Against National Ori23 gin Discrimination Affecting Limited-English Proficient 

24 Persons (June 12, 2002)— 


emcdonald on DSK5VPTVN1PROD with BILLS
66 

•HR 2954 IH

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

2 promote individuals at all levels of the organization 

3 to maintain a diverse staff and leadership that can 

4 provide culturally and linguistically appropriate 

5 health care to patient populations of the service area 

6 of the organization; 

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

8 disciplines of the organization receive ongoing edu9 cation and training in culturally and linguistically 

10 appropriate service delivery; 

11 ‘‘(3) offer and provide language assistance serv12 ices, including trained bilingual staff and interpreter 

13 services, at no cost to each patient with limited14 English proficiency at all points of contact, in a 

15 timely manner during all hours of operation; 

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

17 manner, of their right to receive language assistance 

18 services in their primary language; 

19 ‘‘(5) ensure the competence of language assist20 ance provided to limited-English-proficient patients 

21 by interpreters and bilingual staff, and ensure that 

22 family, particularly minor children, and friends are 

23 not used to provide interpretation services— 

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


emcdonald on DSK5VPTVN1PROD with BILLS
67 

•HR 2954 IH

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

2 has been informed in his or her preferred lan3 guage of the availability of free interpretation 

4 services; 

5 ‘‘(6) make available easily understood patient6 related materials, if such materials exist for non-lim7 ited-English-proficient patients, including informa8 tion or notices about termination of benefits and 

9 post signage in the languages of the commonly en10 countered groups or groups represented in the serv11 ice area of the organization; 

12 ‘‘(7) develop and implement clear goals, poli13 cies, operational plans, and management account14 ability and oversight mechanisms to provide cul15 turally and linguistically appropriate services; 

16 ‘‘(8) conduct initial and ongoing organizational 

17 assessments of culturally and linguistically appro18 priate services-related activities and integrate valid 

19 linguistic, competence-related measures into the in20 ternal audits, performance improvement programs, 

21 patient satisfaction assessments, and outcomes-based 

22 evaluations of the organization; 

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

24 protections provided for under the regulations pro25 mulgated under section 264(c) of the Health InsurVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
68 

•HR 2954 IH

1 ance Portability and Accountability Act of 1996 (42 

2 U.S.C. 1320d–2 note)— 

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

4 ethnicity, primary language, alternative format 

5 preferences, and policy modification needs are 

6 collected in health records, integrated into the 

7 organization’s management information sys8 tems, and periodically updated; and 

9 ‘‘(B) if the patient is a minor or is inca10 pacitated, the primary language of the parent 

11 or legal guardian is collected; 

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

13 and epidemiological profile of the community as well 

14 as a needs assessment to accurately plan for and im15 plement services that respond to the cultural and 

16 linguistic characteristics of the service area of the 

17 organization; 

18 ‘‘(11) develop participatory, collaborative part19 nerships with communities and utilize a variety of 

20 formal and informal mechanisms to facilitate com21 munity and patient involvement in designing and im22 plementing culturally and linguistically appropriate 

23 services-related activities; 

24 ‘‘(12) ensure that conflict and grievance resolu25 tion processes are culturally and linguistically senVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00068 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
69 

•HR 2954 IH

1 sitive and capable of identifying, preventing, and re2 solving cross-cultural conflicts or complaints by pa3 tients; 

4 ‘‘(13) regularly make available to the public in5 formation about their progress and successful inno6 vations in implementing the standards under this 

7 section and provide public notice in their commu8 nities about the availability of this information; and 

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

10 the head of each Federal entity from which Federal 

11 funds are received, information about their progress 

12 and successful innovations in implementing the 

13 standards under this section as required by the head 

14 of such entity. 

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

16 AND LINGUISTIC COMPETENCE IN HEALTH 

17 CARE. 

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

19 through the Director of the Agency for Healthcare Re20 search and Quality, shall establish and support a center 

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

22 and Linguistic Competence in Health Care’ (referred to 

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

24 activities: 


emcdonald on DSK5VPTVN1PROD with BILLS
70 

•HR 2954 IH

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

2 shall provide resources via the Internet to identify 

3 and link health care providers to competent inter4 preter and translation services. 

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

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

7 through contract, vital documents from com8 petent translation services for providers of 

9 health care and health-care-related services at 

10 no cost to such providers. Materials may be 

11 submitted for translation into non-English lan12 guages. Translation services shall be provided 

13 in a timely and reasonable manner and in ac14 cordance with the guidelines and standards set 

15 forth in subsection (c) when such standards be16 come available. The quality of such translation 

17 services shall be monitored and reported pub18 licly. 

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

20 by the Secretary that will be used by LEP indi21 viduals in health care or health-care-related set22 tings, the Center shall translate the form, at a 

23 minimum, into the top 15 non-English lan24 guages in the United States according to the 

25 most recent data from the American CommuVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00070 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
71 

•HR 2954 IH

1 nity Survey or its replacement. The translation 

2 must be completed within 45 days of the Sec3 retary receiving final approval of the form from 

4 the Office of Management and Budget. 

5 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE6 PHONE NUMBER.—The Center shall provide, 

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

8 for LEP individuals— 

9 ‘‘(A) to obtain information about federally 

10 conducted or funded health programs, including 

11 Medicare, Medicaid, and SCHIP; 

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

13 or accessing these programs and understanding 

14 Federal notices written in English; and 

15 ‘‘(C) to learn how to access language serv16 ices. 

17 ‘‘(4) HEALTH INFORMATION CLEARING18 HOUSE.— 

19 ‘‘(A) IN GENERAL.—The Center shall de20 velop and maintain an information clearing21 house to facilitate the provision of language 

22 services by providers of health care and health23 care-related services to reduce medical errors, 

24 improve medical outcomes, to improve cultural 

25 competence, reduce health care costs caused by 


emcdonald on DSK5VPTVN1PROD with BILLS
72 

•HR 2954 IH

1 miscommunication with individuals with lim2 ited-English proficiency, and reduce or elimi3 nate the duplication of effort to translate mate4 rials. The clearinghouse shall make such infor5 mation available on the Internet and in print. 

6 Such information shall include the information 

7 described in the succeeding provisions of this 

8 paragraph. 

9 ‘‘(B) DOCUMENT TEMPLATES.—The Cen10 ter shall collect and evaluate for accuracy, de11 velop, and make available templates for stand12 ard documents that are necessary for patients 

13 and consumers to access and make educated de14 cisions about their health care, including the 

15 following: 

16 ‘‘(i) Administrative and legal docu17 ments, including— 

18 ‘‘(I) intake forms; 

19 ‘‘(II) Medicare, Medicaid, and 

20 SCHIP forms, including eligibility in21 formation; 

22 ‘‘(III) forms informing patient of 

23 HIPAA compliance and consent; and 


emcdonald on DSK5VPTVN1PROD with BILLS
73 

•HR 2954 IH

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

3 and waivers of rights. 

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

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

7 prevention and treatment instructions. 

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

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

11 notices. 

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

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

17 ‘‘(i) ensure that the documents posted 

18 in English and non-English languages are 

19 culturally appropriate; 

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


emcdonald on DSK5VPTVN1PROD with BILLS
74 

•HR 2954 IH

1 ‘‘(iii) allow health care providers to 

2 customize the documents for their use; 

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

5 ‘‘(v) provide technical assistance with 

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

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

9 Secretary determines to be useful to fulfill 

10 the purposes of the clearinghouse. 

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

15 and strategies to improve language services for 

16 LEP individuals, including case studies using 

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

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

23 populations residing in the United States to all 

24 health care providers and health-care-related 


emcdonald on DSK5VPTVN1PROD with BILLS
75 

•HR 2954 IH

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

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

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

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

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

11 types of providers of health care and 

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

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

18 ‘‘(F) INFORMATION ABOUT PROGRESS.— 

19 The Center shall regularly collect and make 

20 publicly available information about the 

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

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


emcdonald on DSK5VPTVN1PROD with BILLS
76 

•HR 2954 IH

1 communities about the availability of this infor2 mation; 

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

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

5 to, the Director of the Agency for Healthcare Research 

6 and Quality. 

7 ‘‘(c) INTERPRETATION AND TRANSLATION GUIDE8 LINES AND STANDARDS.—The Center shall convene a 

9 working group to develop and adopt interpretation and 

10 translation quality guidelines and standards for use by the 

11 Center. The guidelines and standards must be sufficient 

12 to ensure that LEP individuals have the equal opportunity 

13 to benefit from health care services to the same extent 

14 as non-LEP individuals. The guidelines and standards 

15 shall address the training, assessment, and certification of 

16 individuals to provide competent interpreter and trans17 lator services to work in health care and health-care-re18 lated settings and of bilingual staff who provide services 

19 directly in non-English languages. The working group may 

20 develop different guidelines and standards for bilingual 

21 staff, interpreters, and translators. 

22 ‘‘(d) MEMBERSHIP.— 

23 ‘‘(1) QUALIFICATIONS.—The Working Group 

24 shall consist of 14 members as follows: 


emcdonald on DSK5VPTVN1PROD with BILLS
77 

•HR 2954 IH

1 ‘‘(A) Four members from organizations 

2 that advocate on behalf of LEP individuals. 

3 ‘‘(B) One member who represents a profes4 sional interpreter association (that is not the 

5 National Council on Interpreting in Health 

6 Care) or translator association. 

7 ‘‘(C) One member from a nonprofit com8 munity-based organization that provides lan9 guage services. 

10 ‘‘(D) Three members recommended by the 

11 National Council on Interpreting in Health 

12 Care, including one who individual who is a 

13 professional interpreter. 

14 ‘‘(E) Four members who are health care or 

15 mental health providers or represent health care 

16 provider associations, including one individual 

17 who represents a health care practice of fewer 

18 than 5 clinicians. 

19 ‘‘(F) One member who works in or has ex20 tensive knowledge of issues related to health 

21 care risk management. 

22 ‘‘(2) GEOGRAPHIC REPRESENTATION.—The 

23 membership of the Working Group shall reflect a 

24 broad geographic representation including both 


emcdonald on DSK5VPTVN1PROD with BILLS
78 

•HR 2954 IH

1 urban and rural representatives, including represent2 atives of the United States territories. 

3 ‘‘(3) PROHIBITED APPOINTMENTS.—Members 

4 of the Working Group shall not include Members of 

5 Congress or other elected Federal, State, or local 

6 government officials. 

7 ‘‘(4) VACANCIES.—Any vacancies in the Work8 ing Group shall not affect the power and duties of 

9 the Working Group but shall be filled in the same 

10 manner as the original appointment. 

11 ‘‘(5) SUBCOMMITTEES.—The Working Group 

12 may establish subcommittees if doing so increases 

13 the efficiency of the Working Group in completing 

14 its tasks, including subcommittees to develop dif15 ferent guidelines and standards for interpreters, 

16 translators, and bilingual staff. 

17 ‘‘(6) ADVISORY PANEL TO THE WORKING

18 GROUP.—The Working Group shall consult with the 

19 Advisory Panel in the development of the guidelines 

20 and standards. The Advisory Panel shall include— 

21 ‘‘(A) representatives from the American 

22 Translators Association, Association of Lan23 guage Companies, the National Center for 

24 State Courts, and States which have developed 

25 interpreter standards such as California, MasVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00078 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
79 

•HR 2954 IH

1 sachusetts, and Oregon who have experience in 

2 the development or implementation of their or3 ganizations’ interpreter and translator certifi4 cation programs; 

5 ‘‘(B) Federal agencies including the Office 

6 for Civil Rights, the Office of Minority Health, 

7 the Centers for Medicare & Medicaid Services, 

8 and the National Institute on Minority Health 

9 and Health Disparities; and 

10 ‘‘(C) other individuals or entities deter11 mined appropriate by the Secretary who have 

12 specific expertise that will be useful to the 

13 Working Group. 

14 ‘‘(7) PUBLICATION.— 

15 ‘‘(A) DRAFT STANDARDS.—Not later than 

16 18 months after the date of enactment of this 

17 title, the Working Group shall— 

18 ‘‘(i) prepare and make available to the 

19 public through the Internet, the Federal 

20 Register, and other appropriate public 

21 channels, a proposed set of interpretation 

22 and translation guidelines and standards 

23 for training, assessment, and certification; 

24 and 


emcdonald on DSK5VPTVN1PROD with BILLS
80 

•HR 2954 IH

1 ‘‘(ii) accept public comment on such 

2 guidelines and standards for a period of 

3 not less than 90 days. 

4 ‘‘(B) FINAL STANDARDS.—Not later than 

5 120 days after the expiration of the public com6 ment period described in subparagraph (A), the 

7 Director of the Agency for Healthcare Research 

8 and Quality shall publish, after consultation 

9 with and the approval of the Working Group, 

10 final guidelines and standards in the Federal 

11 Register and on the Internet. 

12 ‘‘(C) TESTING DEVELOPMENT.—Not later 

13 than 120 days after the publication of the final 

14 recommendations described in subparagraph 

15 (B), the Director of the Agency for Healthcare 

16 Research and Quality shall, if deemed necessary 

17 by the Working Group, enter into a contract 

18 with an entity experienced in the development 

19 of designing certification tests in language re20 lated fields to develop such tests as may be nec21 essary to implement the guidelines and stand22 ards. 

23 ‘‘(D) PILOT PROJECT.— 

24 ‘‘(i) Not later than 120 days after 

25 completion of the test development deVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00080 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
81 

•HR 2954 IH

1 scribed in subparagraph (C) or after publi2 cation of the final guidelines and stand3 ards, whichever is later, the Secretary shall 

4 design, fund, and implement a pilot project 

5 in up to 50 geographically and demo6 graphically diverse sites, two of which must 

7 be in the United States territories, to test 

8 and evaluate implementation of the rec9 ommendations. 

10 ‘‘(ii) The Secretary shall consult with 

11 the Working Group and the Advisory 

12 Panel in development of the pilot project 

13 and report progress to the Working Group 

14 on an ongoing basis. 

15 ‘‘(iii) The pilot project shall include 

16 interpreters and translators working with 

17 various provider types, including small 

18 group practices, hospitals, mental health 

19 and substance use clinics, and community 

20 health clinics, and shall include broad geo21 graphic representation including both 

22 urban and rural representatives. 

23 ‘‘(iv) The pilot project shall operate 

24 for not less than 2 nor more than 4 years, 

25 as determined by the Secretary. 


emcdonald on DSK5VPTVN1PROD with BILLS
82 

•HR 2954 IH

1 ‘‘(v) If the Working Group determines 

2 that any revisions to guidelines and stand3 ards are necessary as a result of the pilot 

4 project, it shall revise such guidelines and 

5 standards and the Director of the Agency 

6 for Healthcare Research and Quality shall 

7 publish the revisions in the Federal Reg8 ister for notice and comment. Not later 

9 than 120 days after the expiration of the 

10 public comment period on such revisions, 

11 the Director of the Agency for Healthcare 

12 Research and Quality shall publish, after 

13 consultation with and the approval of the 

14 Working Group, final revisions to the 

15 guidelines and standards in the Federal 

16 Register and on the Internet. 

17 ‘‘(8) ADMINISTRATION.— 

18 ‘‘(A) CHAIRPERSON.—Not later than 15 

19 days after the date on which all members of the 

20 Working Group have been appointed under sub21 section (d), the Working Group shall designate 

22 its chairperson. 

23 ‘‘(B) COMPENSATION.—While serving on 

24 the business of the Working Group (including 

25 travel time), a member of the Working Group 


emcdonald on DSK5VPTVN1PROD with BILLS
83 

•HR 2954 IH

1 or the Advisory Panel shall be entitled to com2 pensation at the per diem equivalent of the rate 

3 provided for level IV of the Executive Schedule 

4 under section 5315 of title 5, United States 

5 Code, and while so serving away from home and 

6 the member’s regular place of business, a mem7 ber may be allowed travel expenses, as author8 ized by the chairperson of the Working Group. 

9 For purposes of pay and employment benefits, 

10 rights, and privileges, all personnel of the 

11 Working Group shall be treated as if they were 

12 employees of the House of Representatives. 

13 ‘‘(C) INFORMATION FROM FEDERAL AGEN14 CIES.—The Working Group may secure directly 

15 from any Federal department or agency such 

16 information as the Working Group considers 

17 necessary to carry out this section. Upon re18 quest of the Working Group, the head of such 

19 department or agency shall furnish such infor20 mation. Any information that contains individ21 ually identifiable information received by the 

22 Working Group shall not be disseminated or 

23 disclosed outside of the Working Group and 

24 shall not be used except by the Working Group. 


emcdonald on DSK5VPTVN1PROD with BILLS
84 

•HR 2954 IH

1 ‘‘(D) DETAIL.—Not more than 10 Federal 

2 Government employees employed by the Depart3 ment of Health and Human Services may be 

4 detailed to staff the Working Group under this 

5 section without further reimbursement. Any de6 tail of an employee shall be without interruption 

7 or loss of civil service status or privilege. 

8 ‘‘(E) TEMPORARY AND INTERMITTENT

9 SERVICES.—The Working Group may procure 

10 temporary and intermittent services under sec11 tion 3109(b) of title 5, United States Code, at 

12 rates for individuals which do not exceed the 

13 daily equivalent of the annual rate of basic pay 

14 prescribed for level V of the Executive Schedule 

15 under section 5316 of such title. 

16 ‘‘(F) AUTHORIZATION OF APPROPRIA17 TIONS.—There are authorized to be appro18 priated to carry out this section such sums as 

19 may be necessary for the activities of the Work20 ing Group and Advisory Panel for each of fiscal 

21 years 2012 through 2016, and for the funding 

22 of the pilot project. 

23 ‘‘(9) DEEMED STATUS.— 

24 ‘‘(A) CERTIFICATION BY PRIVATE ORGANI25 ZATION.—If a private accreditation organization 


emcdonald on DSK5VPTVN1PROD with BILLS
85 

•HR 2954 IH

1 establishes training, assessment, or certification 

2 standards for interpreters or translators in 

3 health care which the Secretary determines are 

4 at least equivalent to the training, assessment, 

5 or certification standards promulgated by the 

6 Secretary as described in subsection (c), the 

7 Secretary shall find that all organizations or in8 dividuals accredited by such organization com9 ply also with the standard described in sub10 section (c) if— 

11 ‘‘(i) such organization or individual 

12 authorizes the organization to release to 

13 the Secretary upon the Secretary’s request 

14 (or such State agency as the Secretary 

15 may designate) a copy of the most current 

16 accreditation survey of such organization 

17 or individual made by the organization, to18 gether with any other information directly 

19 related to the survey as the Secretary may 

20 require (including corrective action plans); 

21 and 

22 ‘‘(ii) such organization releases such a 

23 copy and any such information to the Sec24 retary. 


emcdonald on DSK5VPTVN1PROD with BILLS
86 

•HR 2954 IH

1 ‘‘(B) CERTIFICATION BY A STATE OR LO2 CALITY.—If a State or locality has or estab3 lishes training, assessment, or certification 

4 standards for interpreters or translators in 

5 health care which the Secretary determines are 

6 at least equivalent to the training, assessment, 

7 or certification standards promulgated by the 

8 Secretary as described in subsection (c), the 

9 Secretary shall find that all organizations or in10 dividuals accredited by such State or locality 

11 comply also with the standard described in sub12 section (c) if— 

13 ‘‘(i) such organization or individual 

14 authorizes the State or locality to release 

15 to the Secretary upon his request (or such 

16 State agency as the Secretary may des17 ignate) a copy of the most current accredi18 tation survey of such organization or indi19 vidual made by such State or locality, to20 gether with any other information directly 

21 related to the survey as the Secretary may 

22 require (including corrective action plans); 

23 and 


emcdonald on DSK5VPTVN1PROD with BILLS
87 

•HR 2954 IH

1 ‘‘(ii) such State or locality releases 

2 such a copy and any such information to 

3 the Secretary. 

4 ‘‘(C) TIMELY ACTION ON APPLICATION.— 

5 The Secretary shall determine, within 210 days 

6 after the date the Secretary receives an applica7 tion by a private accrediting organization, 

8 State, or locality whether the process of the pri9 vate accrediting organization, State, or locality 

10 meets the requirements with respect to training, 

11 assessment, or certification standards for inter12 preters or translators with respect to which 

13 standards the application is made. The Sec14 retary may not deny an application on the basis 

15 that it seeks to meet the requirements with re16 spect to only one, or more than one, training, 

17 assessment, or certification standards for inter18 preters or translators. 

19 ‘‘(D) DISCLOSURE OF ACCREDITATION

20 SURVEY.—The Secretary may not disclose any 

21 accreditation survey made and released to him 

22 by the National Council on Interpreting in 

23 Health Care or any State or locality of an ac24 credited organization or individual, except that 

25 the Secretary may disclose such a survey and 


emcdonald on DSK5VPTVN1PROD with BILLS
88 

•HR 2954 IH

1 information related to such a survey to the ex2 tent such survey and information relate to an 

3 enforcement action taken by the Secretary. 

4 ‘‘(E) DEFICIENCIES.—If the Secretary 

5 finds that an accredited organization or indi6 vidual has significant deficiencies (as defined in 

7 regulations pertaining to the training, assess8 ment, or certification standards), the organiza9 tion or individual shall, after the date of notice 

10 of such finding to the organization and for such 

11 period as may be prescribed in regulations, be 

12 deemed not to meet the conditions or require13 ments the organization or individual has been 

14 treated as meeting pursuant to subparagraph 

15 (A). 

16 ‘‘(e) AVAILABILITY OF LANGUAGE ACCESS.—The Di17 rector shall collaborate with the Administrator of the Of18 fice of Minority Health, the Administrator of the Centers 

19 for Medicare & Medicaid Services, and the Administrator 

20 of the Health Resources and Services Administration to 

21 notify health care providers and health care organizations 

22 about the availability of language access services by the 

23 Center. 

24 ‘‘(f) EDUCATION.—The Secretary, directly or through 

25 contract, shall undertake a national education campaign 


emcdonald on DSK5VPTVN1PROD with BILLS
89 

•HR 2954 IH

1 to inform providers, LEP individuals, health professionals, 

2 graduate schools, and community health centers about— 

3 ‘‘(1) Federal and State laws and guidelines gov4 erning access to language services; 

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

6 the risks associated with using family members, 

7 friends, minors, and untrained bilingual staff; 

8 ‘‘(3) funding sources for developing and imple9 menting language services; and 

10 ‘‘(4) promising practices to effectively provide 

11 language services. 

12 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—In ad13 dition to the amounts authorized under subsection 

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

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

16 of fiscal years 2012 through 2016. 

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

18 COMPETENCE GRANTS. 

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

20 the Director of the Agency for Healthcare Research and 

21 Quality, shall award grants to eligible entities to enable 

22 such entities to design, implement, and evaluate innova23 tive, cost-effective programs to improve cultural com24 petence and language access in health care for individuals 

25 with limited-English proficiency. The Director of the 


emcdonald on DSK5VPTVN1PROD with BILLS
90 

•HR 2954 IH

1 Agency for Healthcare Research and Quality shall coordi2 nate with, and ensure the participation of, other agencies 

3 including but not limited to the Health Resources and 

4 Services Administration, the Center on Minority Health 

5 and Health Disparities at the National Institutes of 

6 Health, and the Office of Minority Health, regarding the 

7 design and evaluation of the grants program. 

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

9 under subsection (a) an entity shall— 

10 ‘‘(1) be— 

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

12 territory or subdivision thereof; 

13 ‘‘(B) an organization described in section 

14 501(c)(3) of the Internal Revenue Code of 

15 1986; 

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

17 or substance use center or clinic; 

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

19 ‘‘(E) an integrated health care delivery 

20 system; 

21 ‘‘(F) a public hospital; 

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

23 college; or 

24 ‘‘(H) other entity designated by the Sec25 retary; and 


emcdonald on DSK5VPTVN1PROD with BILLS
91 

•HR 2954 IH

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

2 application, at such time, in such manner, and ac3 companied by such additional information as the 

4 Secretary may require. 

5 ‘‘(c) USE OF FUNDS.—An entity shall use funds re6 ceived under a grant under this section to— 

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

8 providing competent interpretation services through 

9 on-site interpretation, telephonic interpretation, or 

10 video interpretation; 

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

12 promote individuals at all levels of the organization 

13 to maintain a diverse staff and leadership that can 

14 promote and provide language services to patient 

15 populations of the service area of the organization; 

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

17 that identifies the current demographic, cultural, 

18 and epidemiological profile of the community to ac19 curately plan for and implement language services 

20 needed in service area of the organization; 

21 ‘‘(4) develop a strategic plan to implement lan22 guage services; 

23 ‘‘(5) develop participatory, collaborative part24 nerships with communities encompassing the LEP 


emcdonald on DSK5VPTVN1PROD with BILLS
92 

•HR 2954 IH

1 patient populations being served to gain input in de2 signing and implementing language services; 

3 ‘‘(6) develop and implement grievance resolu4 tion processes that are culturally and linguistically 

5 sensitive and capable of identifying, preventing, and 

6 resolving complaints by LEP individuals; or 

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

8 interpretation training courses and incentives for bi9 lingual health care staff who are asked to interpret 

10 in the workplace; 

11 ‘‘(8) develop formal training programs, includ12 ing continued professional development and edu13 cation programs as well as supervision, for individ14 uals interested in becoming dedicated health care in15 terpreters and culturally competent providers; 

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

17 which shall include information on the practical limi18 tations of such instruction for non-native speakers; 

19 ‘‘(10) develop policies that address compensa20 tion in salary for staff who receive training to be21 come either a staff interpreter or bi-lingual provider; 

22 ‘‘(11) develop other language assistance services 

23 as determined appropriate by the Secretary; 

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

25 of improving cultural competence; and 


emcdonald on DSK5VPTVN1PROD with BILLS
93 

•HR 2954 IH

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

2 protections provided for under the regulations pro3 mulgated under section 264(c) of the Health Insur4 ance Portability and Accountability Act of 1996 (42 

5 U.S.C. 1320d–2 note), and any applicable State pri6 vacy laws, data on the individual patient or recipi7 ent’s race, ethnicity, and primary language are col8 lected (and periodically updated) in health records 

9 and integrated into the organization’s information 

10 management systems or any similar system used to 

11 store and retrieve data. 

12 ‘‘(d) PRIORITY.—In awarding grants under this sec13 tion, the Secretary shall give priority to entities that pri14 marily engage in providing direct care and that have devel15 oped partnerships with community organizations or with 

16 agencies with experience language access. 

17 ‘‘(e) EVALUATION.— 

18 ‘‘(1) An entity that receives a grant under this 

19 section shall submit to the Secretary an evaluation 

20 that describes, in the manner and to the extent re21 quired by the Secretary, the activities carried out 

22 with funds received under the grant, and how such 

23 activities improved access to health and health-care24 related services and the quality of health care for in25 dividuals with limited-English proficiency. Such evalVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00093 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
94 

•HR 2954 IH

1 uation shall be collected and disseminated through 

2 the Robert T. Matsui Center for Cultural and Lin3 guistic Competence in Health Care established under 

4 section 3403. The Director of the Agency for 

5 Healthcare Research and Quality shall notify grant6 ees of the availability of technical assistance for the 

7 evaluation and provide such assistance upon request. 

8 ‘‘(2) The Director of the Agency for Healthcare 

9 Research and Quality shall evaluate or arrange with 

10 other individuals or organizations to evaluate 

11 projects funded under this section. 

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

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

14 $5,000,000 for each of fiscal years 2012 through 2016. 

15 ‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM16 PETENCE. 

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

18 the Director of the Agency for Healthcare Research and 

19 Quality, shall expand research concerning language access 

20 in the provision of health care. 

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

22 Healthcare Research and Quality may conduct the re23 search described in subsection (a) or enter into contracts 

24 with other individuals or organizations to do so. 


emcdonald on DSK5VPTVN1PROD with BILLS
95 

•HR 2954 IH

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

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

3 ‘‘(1) To identify the barriers to mental and be4 havioral services that are faced by LEP individuals. 

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

6 health administrators’ attitudes, knowledge, and 

7 awareness of the barriers to quality health care serv8 ices that are faced by LEP individuals. 

9 ‘‘(3) To identify optimal approaches for deliv10 ering language access. 

11 ‘‘(4) To identify best practices for data collec12 tion, including— 

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

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

15 the race, ethnicity, and primary language of re16 cipients of such services, taking into account ex17 isting research conducted by the Government or 

18 private sector; 

19 ‘‘(B) the development and implementation 

20 of data collection and reporting systems; and 

21 ‘‘(C) effective privacy safeguards for col22 lected data. 

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

24 for primary language. 


emcdonald on DSK5VPTVN1PROD with BILLS
96 

•HR 2954 IH

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

2 which the Department can create or coordinate, and 

3 then subsidize or otherwise fund telephonic interpre4 tation providers for health care providers, taking 

5 into consideration, among other factors, the flexi6 bility necessary for such a system to accommodate 

7 variations in— 

8 ‘‘(A) provider type; 

9 ‘‘(B) languages needed and their frequency 

10 of use; 

11 ‘‘(C) type of encounter; 

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

13 business hours and after hours; and 

14 ‘‘(E) location of encounter. 

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

16 are authorized to be appropriated to carry out this section, 

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

18 2012 through 2016.’’. 

19 SEC. 203. FEDERAL REIMBURSEMENT FOR CULTURALLY 

20 AND LINGUISTICALLY APPROPRIATE SERV21 ICES UNDER THE MEDICARE, MEDICAID, AND 

22 STATE CHILDREN’S HEALTH INSURANCE 

23 PROGRAMS. 

24 (a) LANGUAGE ACCESS GRANTS FOR MEDICARE

25 PROVIDERS.— 


emcdonald on DSK5VPTVN1PROD with BILLS
97 

•HR 2954 IH

1 (1) ESTABLISHMENT.— 

2 (A) IN GENERAL.—Not later than 6 

3 months after the date of the enactment of this 

4 Act, the Secretary of Health and Human Serv5 ices, acting through the Centers for Medicare & 

6 Medicaid Services and in consultation with the 

7 Center for Medicare and Medicaid Innovation, 

8 shall establish demonstration program under 

9 which the Secretary shall award grants to eligi10 ble Medicare service providers to improve com11 munication between such providers and limited12 English-proficient Medicare beneficiaries, in13 cluding beneficiaries who live in diverse and un14 derserved communities. 

15 (B) APPLICATION OF INNOVATION

16 RULES.—The demonstration project under sub17 paragraph (A) shall be conducted in a manner 

18 that is consistent with the applicable provisions 

19 of subsections (b), (c), and (d) of section 1115A 

20 of the Social Security Act. 

21 (C) NUMBER OF GRANTS.—To the extent 

22 practicible, the Secretary shall award not less 

23 than 24 grants under this subsection. 

24 (D) GRANT PERIOD.—Except as provided 

25 under paragraph (2)(D), each grant awarded 


emcdonald on DSK5VPTVN1PROD with BILLS
98 

•HR 2954 IH

1 under this subsection shall be for a 3-year pe2 riod. 

3 (2) ELIGIBILITY REQUIREMENTS.—To be eligi4 ble for a grant under this subsection, an entity must 

5 meet the following requirements: 

6 (A) MEDICARE PROVIDER.—The entity 

7 must be— 

8 (i) a provider of services under part A 

9 of title XVIII of the Social Security Act; 

10 (ii) a provider of services under part 

11 B of such title; 

12 (iii) a Medicare Advantage organiza13 tion offering a Medicare Advantage plan 

14 under part C of such title; or 

15 (iv) a PDP sponsor offering a pre16 scription drug plan under part D of such 

17 title. 

18 (B) UNDERSERVED COMMUNITIES.—The 

19 entity must serve a community that with re20 spect to necessary langauge services for improv21 ing access and utilization of health care amoung 

22 limited-English proficienct individuals, is 

23 disproportinaly underserved. 

24 (C) APPLICATION.—The entity must pre25 pare and submit to the Secretary an applicaVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00098 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
99 

•HR 2954 IH

1 tion, at such time, in such manner, and accom2 panied by such additional information as the 

3 Secretary may require. 

4 (D) REPORTING.—In the case of a grantee 

5 that received a grant under this subsection in 

6 a previous year, such grantee is only eligible for 

7 continued payments under a grant under this 

8 subsection if the grantee met the reporting re9 quirements under paragraph (9) for such year. 

10 If a grantee fails to meet the requirement of 

11 such paragraph for the first year of a grant, the 

12 Secretary may terminate the grant and solicit 

13 applications from new grantees to participate in 

14 the demonstration program. 

15 (3) DISTRIBUTION.—To the extent feasible, the 

16 Secretary shall award— 

17 (A) at least 6 grants to providers of serv18 ices described in paragraph (2)(A)(i); 

19 (B) at least 6 grants to service providers 

20 described in paragraph (2)(A)(ii); 

21 (C) at least 6 grants to organizations de22 scribed in paragraph (2)(A)(iii); and 

23 (D) at least 6 grants to sponsors described 

24 in paragraph (2)(A)(iv). 

25 (4) CONSIDERATIONS IN AWARDING GRANTS.— 


emcdonald on DSK5VPTVN1PROD with BILLS
100 

•HR 2954 IH

1 (A) VARIATION IN GRANTEES.—In award2 ing grants under this subsection, the Secretary 

3 shall select grantees to ensure the following: 

4 (i) The grantees provide many dif5 ferent types of language services. 

6 (ii) The grantees serve Medicare bene7 ficiaries who speak different languages, 

8 and who, as a population, have differing 

9 needs for language services. 

10 (iii) The grantees serve Medicare 

11 beneficiaries in both urban and rural set12 tings. 

13 (iv) The grantees serve Medicare 

14 beneficiaries in at least two geographic re15 gions, as defined by the Secretary. 

16 (v) The grantees serve Medicare bene17 ficiaries in at least two large metropolitan 

18 statistical areas with racial, ethnic, and 

19 economicly diverse populations. 

20 (B) PRIORITY FOR PARTNERSHIPS WITH

21 COMMUNITY ORGANIZATIONS AND AGENCIES.— 

22 In awarding grants under this subsection, the 

23 Secretary shall give priority to eligible entities 

24 that have a partnership with— 

25 (i) a community organization; or 


emcdonald on DSK5VPTVN1PROD with BILLS
101 

•HR 2954 IH

1 (ii) a consortia of community 

2 origanizations, state agecenices, and local 

3 agencies, 

4 that has experience in providing language serv5 ices. 

6 (5) USE OF FUNDS FOR COMPETENT LANGUAGE

7 SERVICES.— 

8 (A) IN GENERAL.—Subject to subpara9 graph (E), a grantee may only use grant funds 

10 received under this subsection to pay for the 

11 provision of competent language services to 

12 Medicare beneficiaries who are limited-English 

13 proficient. 

14 (B) COMPETENT LANGUAGE SERVICES DE15 FINED.—For purposes of this subsection, the 

16 term ‘‘competent language services’’ means— 

17 (i) interpreter and translation services 

18 that— 

19 (I) subject to the exceptions 

20 under subparagraph (C)— 

21 (aa) if the grantee operates 

22 in a State that has statewide 

23 health care interpreter standards, 

24 meet the State standards cur25 rently in effect; or 


emcdonald on DSK5VPTVN1PROD with BILLS
102 

•HR 2954 IH

1 (bb) if the grantee operates 

2 in a State that does not have 

3 statewide health care interpreter 

4 standards, utilizes competent in5 terpreters who follow the Na6 tional Council on Interpreting in 

7 Health Care’s Code of Ethics and 

8 Standards of Practice; and 

9 (II) that, in the case of inter10 preter services, are provided 

11 through— 

12 (aa) on-site interpretation; 

13 (bb) telephonic interpreta14 tion; or 

15 (cc) video interpretation; 

16 and 

17 (ii) the direct provision of health care 

18 or health-care-related services by a com19 petent bilingual health care provider. 

20 (C) EXCEPTIONS.—The requirements of 

21 subparagraph (B)(i)(I) do not apply— 

22 (i) to a Medicare beneficiary who is 

23 limited-English-proficient who has been in24 formed, in the beneficiary’s primary lan25 guage, of the availability of free interpreter 


emcdonald on DSK5VPTVN1PROD with BILLS
103 

•HR 2954 IH

1 and translation services and who, instead, 

2 requests that a family member, friend, or 

3 other person provide such services, if the 

4 grantee documents such request in the 

5 beneficiary’s medical record; or 

6 (ii) in the case of a medical emergency 

7 where the delay directly associated with ob8 taining a competent interpreter or trans9 lation services would jeopardize the health 

10 of the patient. 

11 Subparagraph (C)(ii) shall not be construed to 

12 exempt emergency rooms or similar entities 

13 that regularly provide health care services in 

14 medical emergencies to limited-English-pro15 ficient patients from any applicable legal or reg16 ulatory requirements related to providing com17 petent interpreter and translation services with18 out undue delay. 

19 (D) MA ORGANIZATIONS AND PDP SPON20 SORS.—If a grantee is a MA organization or a 

21 PDP sponsor, such entity must provide at least 

22 50 percent of the grant funds that the entity 

23 receives under this subsection directly to the en24 tity’s network providers (including physicians 

25 and pharmacies) for the purpose of providing 


emcdonald on DSK5VPTVN1PROD with BILLS
104 

•HR 2954 IH

1 support for such providers to provide competent 

2 language services to Medicare beneficiaries who 

3 are limited-English proficient. 

4 (E) ADMINISTRATIVE AND REPORTING

5 COSTS.—A grantee may use up to 10 percent of 

6 the grant funds to pay for administrative costs 

7 associated with the provision of competent lan8 guage services and for reporting required under 

9 paragraph (9). 

10 (6) DETERMINATION OF AMOUNT OF GRANT

11 PAYMENTS.— 

12 (A) IN GENERAL.—Payments to grantees 

13 under this subsection shall be calculated based 

14 on the estimated numbers of limited-English15 proficient Medicare beneficiaries in a grantee’s 

16 service area utilizing— 

17 (i) data on the numbers of limited18 English-proficient individuals who speak 

19 English less than ‘‘very well’’ from the 

20 most recently available data from the Bu21 reau of the Census or other State-based 

22 study the Secretary determines likely to 

23 yield accurate data regarding the number 

24 of such individuals in such service area; or 


emcdonald on DSK5VPTVN1PROD with BILLS
105 

•HR 2954 IH

1 (ii) data provided by the grantee, if 

2 the grantee routinely collects data on the 

3 primary language of the Medicare bene4 ficiaries that the grantee serves and the 

5 Secretary determines that the data is accu6 rate and shows a greater number of lim7 ited-English-proficient individuals than 

8 would be estimated using the data under 

9 clause (i). 

10 (B) DISCRETION OF SECRETARY.—Subject 

11 to subparagraph (C), the amount of payment 

12 made to a grantee under this subsection may be 

13 modified annually at the discretion of the Sec14 retary, based on changes in the data under sub15 paragraph (A) with respect to the service area 

16 of a grantee for the year. 

17 (C) LIMITATION ON AMOUNT.—The 

18 amount of a grant made under this subsection 

19 to a grantee may not exceed $500,000 for the 

20 period under paragraph (1)(D). 

21 (7) ASSURANCES.—Grantees under this sub22 section shall— 

23 (A) ensure that clinical and support staff 

24 receive appropriate ongoing education and 


emcdonald on DSK5VPTVN1PROD with BILLS
106 

•HR 2954 IH

1 training in linguistically appropriate service de2 livery; 

3 (B) ensure the linguistic competence of bi4 lingual providers; 

5 (C) offer and provide appropriate language 

6 services at no additional charge to each patient 

7 with limited-English proficiency for all points of 

8 contact between the patient and the grantee, in 

9 a timely manner during all hours of operation; 

10 (D) notify Medicare beneficiaries of their 

11 right to receive language services in their pri12 mary language; 

13 (E) post signage in the primary languages 

14 commonly used by the patient population in the 

15 service area of the organization; and 

16 (F) ensure that— 

17 (i) primary language data is collected 

18 for recipients of language services and 

19 such data is consistent with standards de20 veloped under title XXXIV of the Public 

21 Health Service Act, as added by section 

22 202 of this Act, to the extent such stand23 ards are available upon the initiation of the 

24 demonstration program; and 


emcdonald on DSK5VPTVN1PROD with BILLS
107 

•HR 2954 IH

1 (ii) consistent with the privacy protec2 tions provided under the regulations pro3 mulgated pursuant to section 264(c) of the 

4 Health Insurance Portability and Account5 ability Act of 1996 (42 U.S.C. 1320d–2 

6 note), if the recipient of language services 

7 is a minor or is incapacitated, primary lan8 guage data is collected on the parent or 

9 legal guardian of such recipient. 

10 (8) NO COST SHARING.—Limited-English-pro11 ficient Medicare beneficiaries shall not have to pay 

12 cost-sharing or co-payments for competent language 

13 services provided under this demonstration program. 

14 (9) REPORTING REQUIREMENTS FOR GRANT15 EES.—Not later than the end of each calendar year, 

16 a grantee that receives funds under this subsection 

17 in such year shall submit to the Secretary a report 

18 that includes the following information: 

19 (A) The number of Medicare beneficiaries 

20 to whom competent language services are pro21 vided. 

22 (B) The primary languages of those Medi23 care beneficiaries. 

24 (C) The types of language services pro25 vided to such beneficiaries. 


emcdonald on DSK5VPTVN1PROD with BILLS
108 

•HR 2954 IH

1 (D) Whether such language services were 

2 provided by employees of the grantee or 

3 through a contract with external contractors or 

4 agencies). 

5 (E) The types of interpretation services 

6 provided to such beneficiaries, and the approxi7 mate length of time such service is provided to 

8 such beneficiaries. 

9 (F) The costs of providing competent lan10 guage services. 

11 (G) An account of the training or accredi12 tation of bilingual staff, interpreters, and trans13 lators providing services funded by the grant 

14 under this subsection. 

15 (10) EVALUATION AND REPORT TO CON16 GRESS.—Not later than 1 year after the completion 

17 of a 3-year grant under this subsection, the Sec18 retary shall conduct an evaluation of the demonstra19 tion program under this subsection and shall submit 

20 to the Congress a report that includes the following: 

21 (A) An analysis of the patient outcomes 

22 and the costs of furnishing care to the limited23 English-proficient Medicare beneficiaries par24 ticipating in the project as compared to such 

25 outcomes and costs for limited-English-proVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
109 

•HR 2954 IH

1 ficient Medicare beneficiaries not participating, 

2 based on the data provided under paragraph (9) 

3 and any other information available to the Sec4 retary. 

5 (B) The effect of delivering langauge serv6 ices on— 

7 (i) Medicare beneficiary access to care 

8 and utilization of services; 

9 (ii) the efficiency and cost effective10 ness of health care delivery; 

11 (iii) patient satisfaction; 

12 (iv) health outcomes; and 

13 (v) the provision of culturally appro14 priate services provided to such 

15 benificiaries. 

16 (C) The extent to which bilingual staff, in17 terpreters, and translators providing services 

18 under such demonstration were trained or ac19 credited and the nature of accreditation or 

20 training needed by type of provider, service, or 

21 other category as determined by the Secretary 

22 to ensure the provision of high-quality interpre23 tation, translation, or other language services to 

24 Medicare beneficiaries if such services are exVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
110 

•HR 2954 IH

1 panded pursuant to subsection (c) of section 

2 1907 of this Act. 

3 (D) Recommendations, if any, regarding 

4 the extension of such project to the entire Medi5 care program, subject the to provision of section 

6 1115A(c) of the Social Security Act. 

7 (11) APPROPRIATIONS.—There is appropriated 

8 to carry out this subsection, in equal parts from the 

9 Federal Hospital Insurance Trust Fund and the 

10 Federal Supplementary Medical Insurance Trust 

11 Fund, $16,000,000 for each fiscal year of the dem12 onstration program. 

13 (b) LANGUAGE SERVICES UNDER THE MEDICARE

14 PROGRAM.— 

15 (1) Subsection (aa)(1) of section 1861 of the 

16 Social Security Act (42 U.S.C. 1395x) is amended— 

17 (A) in subparagraph (B), by striking the 

18 ‘‘and’’ at the end; 

19 (B) in subparagrpah (C), by inserting 

20 ‘‘and’’ after the comma at the end; and 

21 (C) by inserting after subparagraph (C) 

22 the following: 

23 ‘‘(D) language services as defined in sub24 section (iii),’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
111 

•HR 2954 IH

1 (2) Section 1833(a) of the Social Security Act 

2 (42 U.S.C. 1395l(a)) is amended— 

3 (A) by striking ‘‘and’’ at the end of para4 graph (8); 

5 (B) by edesignating paragraph (9) as para6 graph (10); and 

7 (C) by inserting after paragraph (8) the 

8 following new paragraph: 

9 ‘‘(9) in the case of language services described 

10 in section 1861(iii), 100 percent of the reasonable 

11 charges for such services, as determined in consulta12 tion with the Medicare Payment Advisory Commis13 sion; and’’. 

14 (3) Section 1832(a)(2) of such Act (42 U.S.C. 

15 1395k(a)(2)) is amended— 

16 (A) by striking ‘‘and’’ at the end of sub17 paragraph (I); 

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

19 subparagraph (J) and inserting ‘‘; and’’; and 

20 (C) by adding at the end of subparagraph 

21 (J) the following: 

22 ‘‘(K) language services (as defined in sec23 tion 1861(iii)) furnished by a interpreter or 

24 translator.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
112 

•HR 2954 IH

1 (4) Section 1861 of the Social Security Act (42 

2 U.S.C. 1395x) is amended by adding at the end the 

3 following new subsection: 

4 ‘‘Language Services and Related Terms 

5 ‘‘(iii)(1) LANGUAGE SERVICES DEFINED.—The term 

6 ‘language services’ has the same meaning given ‘language 

7 or langauge access services’ in section 3400 of the Public 

8 Health Service Act. 

9 ‘‘(2) INTERPRETER SERVICES DEFINED.—For the 

10 purposes of this subsection, the term ‘interpreter services’ 

11 has the meaning given ‘competent interpreter services’ 

12 under section 3400(3) of the Public Health Service Act. 

13 ‘‘(3) INTERPRETER DEFINED.—The term ‘inter14 preter’— 

15 ‘‘(A) means an individual— 

16 ‘‘(i) who faithfully, accurately, and objec17 tively transmits a spoken message from one lan18 guage into another language; and 

19 ‘‘(ii) who knows health and health-related 

20 terminology in both languages; and 

21 ‘‘(B) includes individuals who provide in-person, 

22 telephonic, and video interpretation. 

23 ‘‘(4) TRANSLATION DEFINED.—The term ‘trans24 lation’ means the transmission of a written message in one 


emcdonald on DSK5VPTVN1PROD with BILLS
113 

•HR 2954 IH

1 language into a written message in another language that 

2 retains the intended meaning of the original message. 

3 ‘‘(5) LIMITED-ENGLISH-PROFICIENT AND LEP DE4 FINED.—The terms ‘Limited-English-proficient’ and 

5 ‘LEP’ have the meaning given the term ‘limited english 

6 proficient’ under section 9101(25) of the Elementary and 

7 Secondary Education Act of 1965, except that subpara8 graphs (A), (B), and (D) of such section not apply.’’. 

9 (5) WAIVER OF BUDGET NEUTRALITY.—For 

10 the 3-year period beginning on the date of enact11 ment of this section, the budget neutrality provision 

12 of section 1848(c)(2)(B)(ii) of the Social Security 

13 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

14 apply to language services (as such term is defined 

15 in section 1861(iii) of such Act). 

16 (c) MEDICARE PART C AND PART D.— 

17 (1) IN GENERAL.—Medicare Advantage plans 

18 under part C of the Social Security Act and Pre19 scription Drug Plans under part D of such Act shall 

20 provide effective language services to enrollees of 

21 such plans. 

22 (2) REPORTING REQUIREMENTS.—Medicare 

23 Advantage and Prescription Drug plans shall annu24 ally submit to the Secretary of Health and Human 

25 Services a report that contains information on the 


emcdonald on DSK5VPTVN1PROD with BILLS
114 

•HR 2954 IH

1 plan’s internal policies and procedures related to re2 cruitment and retention efforts directed to workforce 

3 diversity and linquistically and culturally appropriate 

4 provision of services in each of the following con5 texts: 

6 (A) The collection of data in a manner 

7 that meets the requirements of title I of this 

8 Act, regarding the enrollee population. 

9 (B) Education of staff and contractors who 

10 have routine contact with enrollees regarding 

11 the various needs of the diverse enrollee popu12 lation. 

13 (C) Evaluation of the health plan’s lan14 guage services programs and services with re15 spect to the plan’s enrollee population, such as 

16 through analysis of complaints or satisfaction 

17 survey results. 

18 (D) Methods by which the plan provides to 

19 the Secretary information regarding the ethnic 

20 diversity of the plan’s enrollee population. 

21 (E) The periodic provision of educational 

22 information to plan enrollees on the plan’s lan23 guage services and programs. 

24 (d) IMPROVING LANGUAGE SERVICES IN MEDICAID

25 AND SCHIP.— 


emcdonald on DSK5VPTVN1PROD with BILLS
115 

•HR 2954 IH

1 (1) Section 1903(a)(2)(E) of the Social Secu2 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended 

3 by— 

4 (A) striking ‘‘75’’ and inserting ‘‘90’’; 

5 (B) striking ‘‘translation or interpretation 

6 services’’ and inserting ‘‘language services’’; 

7 and 

8 (C) striking ‘‘children of families’’ and in9 serting ‘‘individuals’’. 

10 (2) Section 1902(a)(10)(A) of the Social Secu11 rity Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 

12 striking ‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 

13 (3) Section 1905(a) of the Social Security Act 

14 (42 U.S.C. 1396d(a)) is amended by— 

15 (A) in paragraph (28), by striking ‘‘and’’ 

16 at the end; 

17 (B) by redesignating paragraph (29) as 

18 paragraph (30); and 

19 (C) by inserting after paragraph (28) the 

20 following new paragraph: 

21 ‘‘(29) language services, as such term is defined 

22 in section 1861(iii), provided in a timely manner to 

23 limited-English-proficient individuals who need such 

24 services; and’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
116 

•HR 2954 IH

1 (4) Section 1916(a)(2) of the Social Security 

2 Act (42 U.S.C. 1396o(2)) is amended by— 

3 (A) by striking ‘‘or’’ at the end of subpara4 graph (D); 

5 (B) by striking ‘‘; and’’ at the end of sub6 paragraph (E) and inserting ‘‘, or’’; and 

7 (C) by adding at the end the following new 

8 subparagraph: 

9 ‘‘(F) language services described in section 

10 1905(a)(29); and’’. 

11 (5) Section 2103 of the Social Security Act (42 

12 U.S.C. 1397cc) is amended— 

13 (A) in subsection (a), in the matter before 

14 paragraph (1), by striking ‘‘ and (7)’’ and in15 serting ‘‘(7), and (9)’’; and 

16 (B) in subsection (c), by adding at the end 

17 the following new paragraph: 

18 ‘‘(9) LANGUAGE SERVICES.—The child health 

19 assistance provided to a targeted low-income child 

20 shall include coverage of language services, as such 

21 term is defined in section 1861(iii), provided in a 

22 timely manner to limited-English-proficient individ23 uals who need such services.’’; and 

24 (C) in subsection (e)(2)— 


emcdonald on DSK5VPTVN1PROD with BILLS
117 

•HR 2954 IH

1 (i) in the heading, by striking ‘‘PRE2 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 

3 (ii) by inserting ‘‘, subsection (c)(9),’’ 

4 after ‘‘subsection (c)(1)(C)’’. 

5 (6) Section 2110(a)(27) of the Social Security 

6 Act (42 U.S.C. 1397jj) is amended by striking 

7 ‘‘translation’’ and inserting ‘‘language services as 

8 described in section 2103(c)(9)’’. 

9 (7) Pursuant to the reporting requirement de10 scribed in section 2107(b)(1) of the Social Security 

11 Act (42 U.S.C. 1397gg(b)(1)), the Secretary of 

12 Health and Human Services shall require that 

13 States collect data on— 

14 (A) the primary language of individuals re15 ceiving child health assistance under title XXI 

16 of the Social Security Act; and 

17 (B) in the case of such individuals who are 

18 minors or incapacitated, the primary language 

19 of the individual’s parent or guardian. 

20 (8) Section 2105 of the Social Security Act (42 

21 U.S.C. 1397ee(c)) is amended— 

22 (A) in subsection (a)(1) by striking ‘‘75’’ 

23 and inserting ‘‘90’’; and 

24 (B) in subsection (c)(2)(A), by inserting 

25 before the period ‘‘, except that expenditures 


emcdonald on DSK5VPTVN1PROD with BILLS
118 

•HR 2954 IH

1 pursuant to clause (iv) of subparagraph (D) of 

2 such paragraph shall not count towards this 

3 total’’. 

4 (e) FUNDING LANGUAGE SERVICES FURNISHED BY

5 PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE6 LATED SERVICES THAT SERVE HIGH RATES OF UNIN7 SURED LEP INDIVIDUALS.— 

8 (1) PAYMENT OF COSTS.— 

9 (A) IN GENERAL.—Subject to subpara10 graph (B), the Secretary of Health and Human 

11 Services shall make payments (on a quarterly 

12 basis) directly to eligible entities to support the 

13 provision of language services to limited14 English-proficient individuals in an amount 

15 equal to an entity’s eligible costs (as defined 

16 under paragraph (3)) for such services for the 

17 quarter. 

18 (B) FUNDING.—Out of any funds in the 

19 Treasury not otherwise appropriated, there are 

20 appropriated to the Secretary of Health and 

21 Human Services such sums as may be nec22 essary for each of fiscal years 2012 through 

23 2016. 

24 (C) RELATION TO MEDICAID DSH.—Pay25 ments under this subsection shall not offset or 


emcdonald on DSK5VPTVN1PROD with BILLS
119 

•HR 2954 IH

1 reduce payments under section 1923 of the So2 cial Security Act, nor shall payments under 

3 such section be considered when determining 

4 uncompensated costs associated with the provi5 sion of language services. 

6 (2) ELIGIBLE ENTITY.—In order to receive 

7 grants under this paragraph, an entity must— 

8 (A) be a Medicaid provider that is— 

9 (i) a physician; 

10 (ii) a hospital with a low-income utili11 zation rate (as defined in section 

12 1923(b)(3) of the Social Security Act (42 

13 U.S.C. 1396r–4(b)(3))) of greater than 25 

14 percent; or 

15 (iii) a federally qualified health center 

16 (as defined in section 1905(l)(2)(B) of the 

17 Social Security Act (42 U.S.C. 

18 1396d(l)(2)(B))); 

19 (B) provide language services to at least 8 

20 percent of the entity’s total number of patients, 

21 not later than 6 months after the date of the 

22 enactment of the Act; and 

23 (C) prepare and submit an application to 

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

25 and accompanied by such information as the 


emcdonald on DSK5VPTVN1PROD with BILLS
120 

•HR 2954 IH

1 Secretary may require to ascertain the entity’s 

2 eligibility for funding under this subsection. 

3 (3) ELIGIBLE COSTS DEFINED.— 

4 (A) IN GENERAL.—In this subsection, the 

5 term ‘‘eligible costs’’ means, with respect to an 

6 eligible entity that provides language services to 

7 LEP individuals, the product of— 

8 (i) the average per person cost of lan9 guage services, determined according to 

10 the methodology devised under subpara11 graph (B); and 

12 (ii) the number of limited-English-pro13 ficient individuals who are provided lan14 guage services by the entity and for whom 

15 no reimbursement is available for such 

16 services under the amendments made by 

17 subsections (a), (b), (c), or (d) or by pri18 vate health insurance. 

19 (B) METHODOLOGY.— 

20 (i) IN GENERAL.—The Secretary shall 

21 establish a methodology to determine the 

22 average per person cost of language serv23 ices. 

24 (ii) DIFFERENT ENTITIES.—In estab25 lishing such methodology, the Secretary 


emcdonald on DSK5VPTVN1PROD with BILLS
121 

•HR 2954 IH

1 may establish different methodologies for 

2 different types of eligible entities. 

3 (iii) NO INDIVIDUAL CLAIMS.—The 

4 Secretary may not require eligible entities 

5 to submit individual claims for language 

6 services for individual patients as a re7 quirement for payment under this sub8 section. 

9 (4) DATA COLLECTION INSTRUMENT.—For pur10 poses of this subsection, the Secretary shall create a 

11 standard data collection instrument that is con12 sistent with any existing reporting requirements by 

13 the Secretary or relevant accrediting organizations 

14 regarding the number of individuals to whom lan15 guage access are provided. 

16 (5) REPORTING REQUIREMENTS.—Entities re17 ceiving payment under this subsection shall provide 

18 the Secretary with a quarterly report on how the en19 tity used such funds. Such report shall contain ag20 gregate (and may not contain individualized) data 

21 collected using the instrument under paragraph (4) 

22 and shall otherwise be in a form and manner deter23 mined by the Secretary. 

24 (6) LANGUAGE SERVICES.—For purposes of 

25 this subsection, the term ‘‘language services’’ has 


emcdonald on DSK5VPTVN1PROD with BILLS
122 

•HR 2954 IH

1 the meaning given such term in section 1861(iii) of 

2 the Social Security Act. 

3 (7) GUIDELINES AND REPORT.— 

4 (A) ESTABLISHMENT.—Not later than 6 

5 months after the date of enactment of this Act, 

6 the Secretary of Health and Human Services 

7 shall establish and distribute guidelines con8 cerning the implementation of this subsection. 

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

10 the date of enactment of this Act, and every 2 

11 years thereafter, the Secretary shall submit a 

12 report to Congress concerning the implementa13 tion of this subsection. 

14 (f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND

15 OTHER LAWS.—Nothing in this section shall be construed 

16 to limit otherwise existing obligations of recipients of Fed17 eral financial assistance under title VI of the Civil Rights 

18 Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 

19 that protect the civil rights of individuals. 

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

21 this section shall take effect on October 1, 2011. 

22 SEC. 204. INCREASING UNDERSTANDING OF AND IMPROV23 ING HEALTH LITERACY. 

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

25 Director of the Agency for Healthcare Research and QualVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
123 

•HR 2954 IH

1 ity and the Administrator of the Health Resources and 

2 Services Administration, in consultation with the Director 

3 of the National Institute on Minority Health and Health 

4 Disparities and the Office of Minority Health, shall award 

5 grants to eligible entities to improve health care for pa6 tient populations that have low functional health literacy. 

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

8 under subsection (a), an entity shall— 

9 (1) be a hospital, health center or clinic, health 

10 plan, or other health entity (including a nonprofit 

11 minority health organization or association); and 

12 (2) prepare and submit to the Secretary an ap13 plication at such time, in such manner, and con14 taining such information as the Secretary may re15 quire. 

16 (c) USE OF FUNDS.— 

17 (1) AGENCY FOR HEALTHCARE RESEARCH AND

18 QUALITY.—Grants awarded under subsection (a) 

19 through the Agency for Healthcare Research and 

20 Quality shall be used— 

21 (A) to define and increase the under22 standing of health literacy; 

23 (B) to investigate the correlation between 

24 low health literacy and health and health care; 


emcdonald on DSK5VPTVN1PROD with BILLS
124 

•HR 2954 IH

1 (C) to clarify which aspects of health lit2 eracy have an effect on health outcomes; and 

3 (D) for any other activity determined ap4 propriate by the Director of the Agency. 

5 (2) HEALTH RESOURCES AND SERVICES ADMIN6 ISTRATION.—Grants awarded under subsection (a) 

7 through the Health Resources and Services Adminis8 tration shall be used to conduct demonstration 

9 projects for interventions for patients with low 

10 health literacy that may include— 

11 (A) the development of new disease man12 agement programs for patients with low health 

13 literacy; 

14 (B) the tailoring of existing disease man15 agement programs addressing mental, physical, 

16 oral, and behavioral health conditions for pa17 tients with low health literacy; 

18 (C) the translation of written health mate19 rials for patients with low health literacy; 

20 (D) the identification, implementation, and 

21 testing of low health literacy screening tools; 

22 (E) the conduct of educational campaigns 

23 for patients and providers about low health lit24 eracy; and 


emcdonald on DSK5VPTVN1PROD with BILLS
125 

•HR 2954 IH

1 (F) other activities determined appropriate 

2 by the Administrator of the Health Resources 

3 and Services Administration. 

4 (d) DEFINITIONS.—In this section, the term ‘‘low 

5 health literacy’’ means the inability of an individual to ob6 tain, process, and understand basic health information 

7 and services needed to make appropriate health decisions. 

8 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

11 2012 through 2016. 

12 SEC. 205. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 

13 (a) IN GENERAL.—Entities that receive Federal 

14 funds under sections 201 or 202 (including under the 

15 amendments made by such section), in order to ensure the 

16 right of LEP individuals to receive access to quality health 

17 care, shall— 

18 (1) ensure that appropriate clinical and support 

19 staff receive ongoing education and training in lin20 guistically appropriate service delivery; 

21 (2) offer and provide appropriate language serv22 ices at no additional charge to each patient with lim23 ited-English proficiency at all points of contact, in a 

24 timely manner during all hours of operation; 


emcdonald on DSK5VPTVN1PROD with BILLS
126 

•HR 2954 IH

1 (3) notify patients of their right to receive lan2 guage services in their primary language; and 

3 (4) utilize only competent interpreter or trans4 lation services which— 

5 (A) until adoption of the Interpreter and 

6 Translator Guidelines and Standards described 

7 in section 3403(c) of the Public Health Service 

8 Act, are defined in section 3400 of the Public 

9 Health Service Act; and 

10 (B) after adoption of the Interpreter and 

11 Translator Guidelines and Standards described 

12 in section 3403(c) of the Public Health Service 

13 Act, meet those guidelines and standards; 

14 (b) EXEMPTIONS.—The requirements of subsection 

15 (a)(4) shall not apply as follows: 

16 (1) When a patient (who has been informed in 

17 his or her primary language of the availability of 

18 free interpreter and translation services) requests 

19 the use of family, friends, or other persons untrained 

20 in interpretation or translation if the following con21 ditions are met: 

22 (A) The interpreter requested by the pa23 tient is over the age of 18. 

24 (B) The recipient informs the patient that 

25 he or she has the option of having the recipient 


emcdonald on DSK5VPTVN1PROD with BILLS
127 

•HR 2954 IH

1 provide an interpreter for him/her without 

2 charge, or of using his/her own interpreter. 

3 (C) The recipient informs the patient that 

4 the recipient may not require an LEP person to 

5 use a family member or friend as an inter6 preter. 

7 (D) The recipient evaluates whether the 

8 person the patient wishes to use as an inter9 preter is competent. If the recipient has reason 

10 to believe that the interpreter is not competent, 

11 the recipient provides the recipient’s own inter12 preter to protect the recipient from liability if 

13 the patient’s interpreter is later found not com14 petent. 

15 (E) If the recipient has reason to believe 

16 that there is a conflict of interest between the 

17 interpreter and patient, the recipient may not 

18 use the patient’s interpreter. 

19 (F) The recipient has the patient sign a 

20 waiver, witnessed by at least 1 individual not 

21 related to the patient, that includes the infor22 mation stated in subparagraphs (A) through 

23 (E) and is translated into the patient’s lan24 guage. 


emcdonald on DSK5VPTVN1PROD with BILLS
128 

•HR 2954 IH

1 (2) When a medical emergency exists and the 

2 delay directly associated with obtaining competent 

3 interpreter or translation services would jeopardize 

4 the health of the patient but only until a competent 

5 interpreter or translation service is available; how6 ever, nothing in this subsection shall exempt emer7 gency rooms or similar entities that regularly pro8 vide health care services in medical emergencies 

9 from having in place systems to provide competent 

10 interpreter and translation services without undue 

11 delay. 

12 SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL13 TURALLY AND LINGUISTICALLY APPRO14 PRIATE HEALTH CARE SERVICES. 

15 (a) REPORT.—Not later than 1 year after the date 

16 of enactment of this Act and annually thereafter, the Sec17 retary of Health and Human Services shall enter into a 

18 contract with the Institute of Medicine for the preparation 

19 and publication of a report that describes Federal efforts 

20 to ensure that all individuals with limited-English pro21 ficiency have meaningful access culturally competent to 

22 health care and health-care-related services. Such report 

23 shall include— 

24 (1) a description and evaluation of the activities 

25 carried out under this Act; 


emcdonald on DSK5VPTVN1PROD with BILLS
129 

•HR 2954 IH

1 (2) a description and analysis of best practices, 

2 model programs, guidelines, and other effective 

3 strategies for providing access to culturally and lin4 guistically appropriate health care services; 

5 (3) recommendations on the development and 

6 implementation of policies and practices by providers 

7 of health care and health-care-related services for 

8 limited-English-proficient individuals; 

9 (4) a description of the effect of providing lan10 guage services on quality of health care and access 

11 to care; and 

12 (5) a description of the costs associated with or 

13 savings related to the provision of language services. 

14 (b) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

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

17 2012 through 2016. 

18 SEC. 207. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 

19 (a) GRANTS AUTHORIZED.—The Secretary of Edu20 cation is authorized to provide grants to eligible entities 

21 for the provision of English as a second language (here22 after referred to as ‘‘ESL’’) instruction and shall deter23 mine, after consultation with appropriate stakeholders, the 

24 mechanism for administering and distributing such 

25 grants. 


emcdonald on DSK5VPTVN1PROD with BILLS
130 

•HR 2954 IH

1 (b) ELIGIBLE ENTITY DEFINED.—For purposes of 

2 this section, the term ‘‘eligible entity’’ means a State or 

3 community-based organization that employs, and serves, 

4 minority populations. 

5 (c) APPLICATION.—An eligible entity may apply for 

6 a grant under this section by submitting such information 

7 as the Secretary may require and in such form and man8 ner as the Secretary may require. 

9 (d) USE OF GRANT.—As a condition of receiving a 

10 grant under this section, an eligible entity shall— 

11 (1) develop and implement a plan for assuring 

12 the availability of ESL instruction that effectively 

13 integrates information about the nature of the 

14 United States health care system, how to access 

15 care, and any special language skills that may be re16 quired for them to access and regularly negotiate the 

17 system effectively; 

18 (2) develop a plan, including, where appro19 priate, public-private partnerships, for making ESL 

20 instruction progressively available to all individuals 

21 seeking instruction; and 

22 (3) maintain current ESL instruction efforts by 

23 using the additional funds to supplement rather 

24 than supplant any funds expended for ESL instruc25 tion in the State as of January 1, 2006. 


emcdonald on DSK5VPTVN1PROD with BILLS
131 

•HR 2954 IH

1 (e) ADDITIONAL DUTIES OF THE SECRETARY.—The 

2 Secretary of Education shall— 

3 (1) collect and publicize annual data on how 

4 much Federal, State, and local governments spend 

5 on ESL instruction; 

6 (2) collect data from State and local govern7 ments to identify the unmet needs of English lan8 guage learners for appropriate ESL instruction, in9 cluding— 

10 (A) the preferred written and spoken lan11 guage of such English language learners; 

12 (B) the extent of waiting lists including 

13 how many programs maintain waiting lists and, 

14 for programs that do not have waiting lists, the 

15 reasons why not; 

16 (C) the availability of programs to geo17 graphically isolated communities; 

18 (D) the impact of course enrollment poli19 cies, including open enrollment, on the avail20 ability of ESL instruction; 

21 (E) the number individuals in the State 

22 and each participating locality; 

23 (F) the effectiveness of the instruction in 

24 meeting the needs of individuals receiving in25 struction and those needing instruction; 


emcdonald on DSK5VPTVN1PROD with BILLS
132 

•HR 2954 IH

1 (G) as assessment of the need for pro2 grams that integrate job training and ESL in3 struction, to assist individuals to obtain better 

4 jobs; and 

5 (H) the availability of ESL slots by State 

6 and locality; 

7 (3) determine the cost and most appropriate 

8 methods of making ESL instruction available to all 

9 English language learners seeking instruction; and 

10 (4) within 1 year of the date of enactment of 

11 this Act, issue a report to Congress that assesses the 

12 information collected in paragraphs (1), (2), and (3) 

13 and makes recommendations on steps that should be 

14 taken to progressively realize the goal of making 

15 ESL instruction available to all English language 

16 learners seeking instruction. 

17 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated to the Secretary of Edu19 cation for each of fiscal years 2012 through 2015 

20 $250,000,000 to carry out this section. 

21 SEC. 208. IMPLEMENTATION. 

22 (a) GENERAL PROVISIONS.— 

23 (1) A State shall not be immune under the 

24 Eleventh Amendment of the Constitution of the 

25 United States from suit in Federal court for failing 


emcdonald on DSK5VPTVN1PROD with BILLS
133 

•HR 2954 IH

1 to provide the language access funded pursuant to 

2 this title. 

3 (2) In a suit against a State for a violation of 

4 this title, remedies (including remedies at both at 

5 law and in equity) are available for such a violation 

6 to the same extent as such remedies are available for 

7 such a violation in the suit against any public or pri8 vate entity other than a State. 

9 (b) RULE OF CONSTRUCTION.—Nothing in this title 

10 shall be construed to limit otherwise existing obligations 

11 of recipients of Federal financial assistance under title VI 

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

13 seq.) or any other statute. 

14 SEC. 209. LANGUAGE ACCESS SERVICES. 

15 (a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 

16 the Patient Protection and Affordable Care Act (42 

17 U.S.C. 18022(b)(1)) is amended by adding at the end the 

18 following: 

19 ‘‘(K) Language access services, including 

20 oral interpretation and written translations.’’. 

21 (b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL

22 COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev23 enue Code of 1986 is amended by adding at the end the 

24 following: 


emcdonald on DSK5VPTVN1PROD with BILLS
134 

•HR 2954 IH

1 ‘‘(v) COVERAGE MUST INCLUDE LAN2 GUAGE ACCESS AND SERVICES.—Except as 

3 provided in clause (iii), an employee shall 

4 not be treated as eligible for minimum es5 sential coverage if such coverage consists 

6 of an eligible employer-sponsored plan (as 

7 defined in section 5000A(f)(2)) and the 

8 plan does not provide coverage for lan9 guage access services, including oral inter10 pretation and written translations.’’. 

11 (c) QUALITY REPORTING.—Section 2717(a)(1) of the 

12 Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 

13 amended— 

14 (1) by striking ‘‘and’’ at the end of subpara15 graph (C); 

16 (2) by striking the period at the end of sub17 paragraph (D) and inserting ‘‘; and’’; and 

18 (3) by adding at the end the following new sub19 paragraph: 

20 ‘‘(E) reduce health disparities through the 

21 provision of language access services, including 

22 oral interpretation and written translations.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
135 

•HR 2954 IH

1 TITLE III—HEALTH WORKFORCE 

2 DIVERSITY 

3 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

5 Title XXXIV of the Public Health Service Act, as 

6 added by section 202, is amended by adding at the end 

7 the following: 

8 ‘‘Subtitle A—Diversifying the 

9 Health Care Workplace 

10 ‘‘SEC. 3411. REPORT ON WORKFORCE DIVERSITY. 

11 ‘‘(a) IN GENERAL.—Not later than July 1, 2012, and 

12 biannually thereafter, the Secretary, acting through the 

13 director of each entity within the Department of Health 

14 and Human Services, shall prepare and submit to the 

15 Committee on Health, Education, Labor, and Pensions of 

16 the Senate and the Committee on Energy and Commerce 

17 of the House of Representatives a report on health work18 force diversity. 

19 ‘‘(b) REQUIREMENT.—The report under subsection 

20 (a) shall contain the following information: 

21 ‘‘(1) A description of any grant support that is 

22 provided by each entity for workforce diversity ini23 tiatives with the following information— 

24 ‘‘(A) the number of grants made; 

25 ‘‘(B) the purpose of the grants; 


emcdonald on DSK5VPTVN1PROD with BILLS
136 

•HR 2954 IH

1 ‘‘(C) the populations served through the 

2 grants; 

3 ‘‘(D) the organizations and institutions re4 ceiving the grants; and 

5 ‘‘(E) the tracking efforts that were used to 

6 follow the progress of participants. 

7 ‘‘(2) A description of the entity’s plan to 

8 achieve workforce diversity goals that includes, to 

9 the extent relevant to such entity— 

10 ‘‘(A) the number of underrepresented mi11 nority health professionals that will be needed 

12 in various disciplines over the next 10 years to 

13 achieve population parity; 

14 ‘‘(B) the level of funding needed to fully 

15 expand and adequately support health profes16 sions pipeline programs; 

17 ‘‘(C) the impact such programs have had 

18 on the admissions practices and policies of 

19 health professions schools; 

20 ‘‘(D) the management strategy necessary 

21 to effectively administer and institutionalize 

22 health profession pipeline programs; and 

23 ‘‘(E) the impact that the Government Per24 formance and Results Act (GPRA) has had on 

25 evaluating the performance of grantees and 


emcdonald on DSK5VPTVN1PROD with BILLS
137 

•HR 2954 IH

1 whether the GPRA is the best assessment tool 

2 for programs under titles VII and VIII. 

3 ‘‘(3) A description of measurable objectives of 

4 each entity relating to workforce diversity initiatives. 

5 ‘‘(c) PUBLIC AVAILABILITY.—The report under sub6 section (a) shall be made available for public review and 

7 comment. 

8 ‘‘SEC. 3412. NATIONAL WORKING GROUP ON WORKFORCE 

9 DIVERSITY. 

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

11 the Bureau of Health Professions within the Health Re12 sources and Services Administration, shall award a grant 

13 to an entity determined appropriate by the Secretary for 

14 the establishment of a national working group on work15 force diversity. 

16 ‘‘(b) REPRESENTATION.—In establishing the national 

17 working group under subsection (a): 

18 ‘‘(1) The grantee shall ensure that the group 

19 has representatives of the following: 

20 ‘‘(A) The Health Resources and Services 

21 Administration. 

22 ‘‘(B) The Department of Health and 

23 Human Services Data Council. 

24 ‘‘(C) The Office of Minority Health. 


emcdonald on DSK5VPTVN1PROD with BILLS
138 

•HR 2954 IH

1 ‘‘(D) The Bureau of Labor Statistics of 

2 the Department of Labor. 

3 ‘‘(E) The Public Health Practice Program 

4 Office—Office of Workforce Policy and Plan5 ning. 

6 ‘‘(F) The National Institute on Minority 

7 Health and Health Disparities. 

8 ‘‘(G) The Agency for Healthcare Research 

9 and Quality. 

10 ‘‘(H) The Institute of Medicine Study 

11 Committee for the 2004 workforce diversity re12 port. 

13 ‘‘(I) The Indian Health Service. 

14 ‘‘(J) Minority-serving academic institu15 tions. 

16 ‘‘(K) Consumer organizations. 

17 ‘‘(L) Health professional associations, in18 cluding those that represent underrepresented 

19 minority populations. 

20 ‘‘(M) Researchers in the area of health 

21 workforce. 

22 ‘‘(N) Health workforce accreditation enti23 ties. 

24 ‘‘(O) Private foundations that have spon25 sored workforce diversity initiatives. 


emcdonald on DSK5VPTVN1PROD with BILLS
139 

•HR 2954 IH

1 ‘‘(2) The grantee shall ensure that, in addition 

2 to the representatives under paragraph (1), the 

3 group has not less than 5 health professions stu4 dents representing various health profession fields 

5 and levels of training. 

6 ‘‘(c) ACTIVITIES.—The working group established 

7 under subsection (a) shall convene at least twice each year 

8 to complete the following activities: 

9 ‘‘(1) Review current public and private health 

10 workforce diversity initiatives. 

11 ‘‘(2) Identify successful health workforce diver12 sity programs and practices. 

13 ‘‘(3) Examine challenges relating to the devel14 opment and implementation of health workforce di15 versity initiatives. 

16 ‘‘(4) Draft a national strategic work plan for 

17 health workforce diversity, including recommenda18 tions for public and private sector initiatives. 

19 ‘‘(5) Develop a framework and methods for the 

20 evaluation of current and future health workforce di21 versity initiatives. 

22 ‘‘(6) Develop recommended standards for work23 force diversity that could be applicable to all health 

24 professions programs and programs funded under 

25 this Act. 


emcdonald on DSK5VPTVN1PROD with BILLS
140 

•HR 2954 IH

1 ‘‘(7) Develop curriculum guidelines for diversity 

2 training. 

3 ‘‘(8) Develop a strategy for the inclusion of 

4 community members on admissions committees for 

5 health profession schools. 

6 ‘‘(9) Other activities determined appropriate by 

7 the Secretary. 

8 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

9 the establishment of the working group under subsection 

10 (a), and annually thereafter, the working group shall pre11 pare and make available to the general public for com12 ment, an annual report on the activities of the working 

13 group. Such report shall include the recommendations of 

14 the working group for improving health workforce diver15 sity. 

16 ‘‘(e) 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 2012 through 2017. 

20 ‘‘SEC. 3413. TECHNICAL CLEARINGHOUSE FOR HEALTH 

21 WORKFORCE DIVERSITY. 

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

23 the Office of Minority Health, and in collaboration with 

24 the Bureau of Health Professions within the Health Re25 sources and Services Administration, the National InstiVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
141 

•HR 2954 IH

1 tute on Minority Health and Health Disparities, shall es2 tablish a technical clearinghouse on health workforce di3 versity within the Office of Minority Health and coordi4 nate current and future clearinghouses. 

5 ‘‘(b) INFORMATION AND SERVICES.—The clearing6 house established under subsection (a) shall offer the fol7 lowing information and services: 

8 ‘‘(1) Information on the importance of health 

9 workforce diversity. 

10 ‘‘(2) Statistical information relating to under11 represented minority representation in health and al12 lied health professions and occupations. 

13 ‘‘(3) Model health workforce diversity practices 

14 and programs. 

15 ‘‘(4) Admissions policies that promote health 

16 workforce diversity and are in compliance with Fed17 eral and State laws. 

18 ‘‘(5) Lists of scholarship, loan repayment, and 

19 loan cancellation grants as well as fellowship infor20 mation for underserved populations for health pro21 fessions schools. 

22 ‘‘(6) Foundation and other large organizational 

23 initiatives relating to health workforce diversity. 

24 ‘‘(c) CONSULTATION.—In carrying out this section, 

25 the Secretary shall consult with non-Federal entities which 


emcdonald on DSK5VPTVN1PROD with BILLS
142 

•HR 2954 IH

1 may include minority health professional associations to 

2 ensure the adequacy and accuracy of information. 

3 ‘‘(d) 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 2012 through 2017. 

7 ‘‘SEC. 3414. SUPPORT FOR INSTITUTIONS COMMITTED TO 

8 WORKFORCE DIVERSITY. 

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

10 the Administrator of the Health Resources and Services 

11 Administration and the Centers for Disease Control and 

12 Prevention, shall award grants to eligible entities that 

13 demonstrate a commitment to health workforce diversity. 

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

15 under subsection (a), an entity shall— 

16 ‘‘(1) be an educational institution or entity that 

17 historically produces or trains meaningful numbers 

18 of underrepresented minority health professionals, 

19 including— 

20 ‘‘(A) historically Black colleges and univer21 sities; 

22 ‘‘(B) Hispanic-serving health professions 

23 schools; 

24 ‘‘(C) Hispanic-serving institutions; 

25 ‘‘(D) tribal colleges and universities; 


emcdonald on DSK5VPTVN1PROD with BILLS
143 

•HR 2954 IH

1 ‘‘(E) Asian-American, Native American, 

2 and Pacific Islander-serving institutions; 

3 ‘‘(F) institutions that have programs to re4 cruit and retain underrepresented minority 

5 health professionals, in which a significant 

6 number of the enrolled participants are under7 represented minorities; 

8 ‘‘(G) health professional associations, 

9 which may include underrepresented minority 

10 health professional associations; and 

11 ‘‘(H) institutions— 

12 ‘‘(i) located in communities with pre13 dominantly underrepresented minority pop14 ulations; 

15 ‘‘(ii) with whom partnerships have 

16 been formed for the purpose of increasing 

17 workforce diversity; and 

18 ‘‘(iii) in which at least 20 percent of 

19 the enrolled participants are underrep20 resented minorities; and 

21 ‘‘(2) submit to the Secretary an application at 

22 such time, in such manner, and containing such in23 formation as the Secretary may require. 

24 ‘‘(c) USE OF FUNDS.—Amounts received under a 

25 grant under subsection (a) shall be used to expand existing 


emcdonald on DSK5VPTVN1PROD with BILLS
144 

•HR 2954 IH

1 workforce diversity programs, implement new workforce 

2 diversity programs, or evaluate existing or new workforce 

3 diversity programs, including with respect to mental 

4 health care professions. Such programs shall enhance di5 versity by considering minority status as part of an indi6 vidualized consideration of qualifications. Possible activi7 ties may include— 

8 ‘‘(1) educational outreach programs relating to 

9 opportunities in the health professions; 

10 ‘‘(2) scholarship, fellowship, grant, loan repay11 ment, and loan cancellation programs; 

12 ‘‘(3) postbaccalaureate programs; 

13 ‘‘(4) academic enrichment programs, particu14 larly targeting those who would not be competitive 

15 for health professions schools; 

16 ‘‘(5) kindergarten through 12th grade and 

17 other health pipeline programs; 

18 ‘‘(6) mentoring programs; 

19 ‘‘(7) internship or rotation programs involving 

20 hospitals, health systems, health plans and other 

21 health entities; 

22 ‘‘(8) community partnership development for 

23 purposes relating to workforce diversity; or 

24 ‘‘(9) leadership training. 


emcdonald on DSK5VPTVN1PROD with BILLS
145 

•HR 2954 IH

1 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

2 a grant under this section, and annually for the term of 

3 the grant, a grantee shall submit to the Secretary a report 

4 that summarizes and evaluates all activities conducted 

5 under the grant. 

6 ‘‘(e) DEFINITION.—In this section, the term ‘Asian7 American, Native American, and Pacific Islander-serving 

8 institutions’ has the same meaning as the term ‘Asian 

9 American and Native American Pacific Islander-serving 

10 institution’ as defined in section 371(c) of the Higher 

11 Education Act of 1965 (20 U.S.C. 1067q(c)). 

12 ‘‘(f) 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 2012 through 2017. 

16 ‘‘SEC. 3415. CAREER DEVELOPMENT FOR SCIENTISTS AND 

17 RESEARCHERS. 

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

19 the Director of the National Institutes of Health, the Di20 rector of the Centers for Disease Control and Prevention, 

21 the Commissioner of Food and Drugs, and the Director 

22 of the Agency for Healthcare Research and Quality, shall 

23 award grants that expand existing opportunities for sci24 entists and researchers and promote the inclusion of 

25 underrepresented minorities in the health professions. 


emcdonald on DSK5VPTVN1PROD with BILLS
146 

•HR 2954 IH

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 racial and ethnic disparities in 

22 health. The Secretary shall promulgate regulations to de23 fine the scope and procedures for the program under this 

24 subsection. 


emcdonald on DSK5VPTVN1PROD with BILLS
147 

•HR 2954 IH

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 racial and ethnic disparities in health. 

5 Students participating in the program shall make a min6 imum 5-year commitment to work at an accredited health 

7 profession school. The Secretary shall promulgate addi8 tional regulations to define the scope and procedures for 

9 the program under this subsection. 

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 2012 through 2017. 

14 ‘‘SEC. 3416. CAREER SUPPORT FOR NON-RESEARCH 

15 HEALTH PROFESSIONALS. 

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

17 the Director of the Centers for Disease Control and Pre18 vention, the Administrator of the Substance Abuse and 

19 Mental Health Services Administration, the Administrator 

20 of the Health Resources and Services Administration, and 

21 the Administrator of the Centers for Medicare and Med22 icaid Services shall establish a program to award grants 

23 to eligible individuals for career support in non-research24 related health care. 


emcdonald on DSK5VPTVN1PROD with BILLS
148 

•HR 2954 IH

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; 

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; and 

22 ‘‘(4) to establish and promote leadership train23 ing programs to decrease health disparities and to 

24 increase cultural competence with the goal of in25 creasing diversity in leadership positions. 


emcdonald on DSK5VPTVN1PROD with BILLS
149 

•HR 2954 IH

1 ‘‘(d) DEFINITION.—In this section, the term ‘career 

2 in non-research-related health care’ means employment or 

3 intended employment in the field of public health, health 

4 policy, health management, health administration, medi5 cine, nursing, pharmacy, psychology, social work, psychi6 atry, other mental and behavioral health, allied health, 

7 community health, social work, or other fields determined 

8 appropriate by the Secretary, other than in a position that 

9 involves research. 

10 ‘‘(e) 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 2012 through 2017. 

14 ‘‘SEC. 3417. RESEARCH ON THE EFFECT OF WORKFORCE DI15 VERSITY ON QUALITY. 

16 ‘‘(a) IN GENERAL.—The Director of the Agency for 

17 Healthcare Research and Quality, in collaboration with 

18 the Deputy Assistant Secretary for Minority Health and 

19 the Director of the National Institute on Minority Health 

20 and Health Disparities, shall award grants to eligible enti21 ties to expand research on the link between health work22 force diversity and quality health care. 

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

24 under subsection (a) an entity shall— 


emcdonald on DSK5VPTVN1PROD with BILLS
150 

•HR 2954 IH

1 ‘‘(1) be a clinical, public health, or health serv2 ices research entity or other entity determined ap3 propriate by the Director; and 

4 ‘‘(2) submit to the Secretary an application at 

5 such time, in such manner, and containing such in6 formation as the Secretary may require. 

7 ‘‘(c) USE OF FUNDS.—Amounts received under a 

8 grant awarded under subsection (a) shall be used to sup9 port research that investigates the effect of health work10 force diversity on— 

11 ‘‘(1) language access; 

12 ‘‘(2) cultural competence; 

13 ‘‘(3) patient satisfaction; 

14 ‘‘(4) timeliness of care; 

15 ‘‘(5) safety of care; 

16 ‘‘(6) effectiveness of care; 

17 ‘‘(7) efficiency of care; 

18 ‘‘(8) patient outcomes; 

19 ‘‘(9) community engagement; 

20 ‘‘(10) resource allocation; 

21 ‘‘(11) organizational structure; 

22 ‘‘(12) compliance of care; or 

23 ‘‘(13) other topics determined appropriate by 

24 the Director. 


emcdonald on DSK5VPTVN1PROD with BILLS
151 

•HR 2954 IH

1 ‘‘(d) PRIORITY.—In awarding grants under sub2 section (a), the Director shall give individualized consider3 ation to all relevant aspects of the applicant’s background. 

4 Consideration of prior research experience involving the 

5 health of underserved communities shall be such a factor. 

6 ‘‘(e) 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 2012 through 2017. 

10 ‘‘SEC. 3418. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

12 through the National Institute on Minority Health and 

13 Health Disparities and in collaboration with the Office of 

14 Minority Health, the Office for Civil Rights, the Centers 

15 for Disease Control and Prevention, the Centers for Medi16 care & Medicaid Services, the Health Resources and Serv17 ices Administration, and other appropriate public and pri18 vate entities, shall establish and coordinate a health and 

19 health care disparities education program to support, de20 velop, and implement educational initiatives and outreach 

21 strategies that inform health care professionals and the 

22 public about the existence of and methods to reduce racial 

23 and ethnic disparities in health and health care. 

24 ‘‘(b) ACTIVITIES.—The Secretary, through the edu25 cation program established under subsection (a) shall, 


emcdonald on DSK5VPTVN1PROD with BILLS
152 

•HR 2954 IH

1 through the use of public awareness and outreach cam2 paigns targeting the general public and the medical com3 munity at large— 

4 ‘‘(1) disseminate scientific evidence for the ex5 istence and extent of racial and ethnic disparities in 

6 health care, including disparities that are not other7 wise attributable to known factors such as access to 

8 care, patient preferences, or appropriateness of 

9 intervention, as described in the 2002 Institute of 

10 Medicine Report entitled ‘Unequal Treatment: Con11 fronting Racial and Ethnic Disparities in Health 

12 Care’, as well as the impact of disparities related to 

13 age, disability status, socioeconomic status, sex, gen14 der identity, and sexual orientation on racial and 

15 ethnic minorities; 

16 ‘‘(2) disseminate new research findings to 

17 health care providers and patients to assist them in 

18 understanding, reducing, and eliminating health and 

19 health care disparities; 

20 ‘‘(3) disseminate information about the impact 

21 of linguistic and cultural barriers on health care 

22 quality and the obligation of health providers who 

23 receive Federal financial assistance to ensure that 

24 people with limited-English proficiency have access 

25 to language access services; 


emcdonald on DSK5VPTVN1PROD with BILLS
153 

•HR 2954 IH

1 ‘‘(4) disseminate information about the impor2 tance and legality of racial, ethnic, disability status, 

3 socioeconomic status, sex, gender identity, and sex4 ual orientation, and primary language data collec5 tion, analysis, and reporting; 

6 ‘‘(5) design and implement specific educational 

7 initiatives to health care providers relating to health 

8 and health care disparities; and 

9 ‘‘(6) assess the impact of the programs estab10 lished under this section in raising awareness of 

11 health and health care disparities and providing in12 formation on available resources. 

13 ‘‘(c) 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 2012 through 2017.’’. 

17 SEC. 302. HISPANIC-SERVING HEALTH PROFESSIONS 

18 SCHOOLS. 

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

20 (42 U.S.C. 293 et seq.) is amended by adding at the end 

21 the following: 

22 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

23 SCHOOLS. 

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

25 the Administrator of the Health Resources and Services 


emcdonald on DSK5VPTVN1PROD with BILLS
154 

•HR 2954 IH

1 Administration, shall award grants to Hispanic-serving 

2 health professions schools for the purpose of carrying out 

3 programs to recruit Hispanic individuals to enroll in and 

4 graduate from such schools, which may include providing 

5 scholarships and other financial assistance as appropriate. 

6 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His7 panic-serving health professions school’ means an entity 

8 that— 

9 ‘‘(1) is a school or program under section 

10 799B; 

11 ‘‘(2) has an enrollment of full-time equivalent 

12 students that is made up of at least 9 percent His13 panic students; 

14 ‘‘(3) has been effective in carrying out pro15 grams to recruit Hispanic individuals to enroll in 

16 and graduate from the school; 

17 ‘‘(4) has been effective in recruiting and retain18 ing Hispanic faculty members; 

19 ‘‘(5) has a significant number of graduates who 

20 are providing health services to medically under21 served populations or to individuals in health profes22 sional shortage areas; and 

23 ‘‘(6) Regional Hispanic Centers of Excellence.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
155 

•HR 2954 IH

1 SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 

2 DISEASE CONTROL AND PREVENTION. 

3 Section 317F(c) of the Public Health Service Act (42 

4 U.S.C. 247b–7(c)) is amended— 

5 (1) by striking ‘‘and’’ after ‘‘1994,’’; and 

6 (2) by inserting before the period the following: 

7 ‘‘$750,000 for fiscal year 2012, and such sums as 

8 may be necessary for each of the fiscal years 2013 

9 through 2017.’’. 

10 SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE11 GREE PROGRAMS AT SCHOOLS OF PUBLIC 

12 HEALTH AND SCHOOLS OF ALLIED HEALTH. 

13 Part B of title VII of the Public Health Service Act 

14 (42 U.S.C. 293 et seq.), as amended by section 302, is 

15 further amended by adding at the end the following: 

16 ‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE17 GREE PROGRAMS. 

18 ‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 

19 acting through the Administrator of the Health Resources 

20 and Services Administration, in consultation with the Di21 rector of the Centers for Disease Control and Prevention, 

22 the Director of the Agency for Healthcare Research and 

23 Quality, and the Deputy Assistant Secretary for Minority 

24 Health, shall award cooperative agreements to schools of 

25 public health and schools of allied health to design and 

26 implement online degree programs. 


emcdonald on DSK5VPTVN1PROD with BILLS
156 

•HR 2954 IH

1 ‘‘(b) PRIORITY.—In awarding cooperative agreements 

2 under this section, the Secretary shall give priority to any 

3 school of public health or school of allied health that has 

4 an established track record of serving medically under5 served communities. 

6 ‘‘(c) REQUIREMENTS.—Awardees must design and 

7 implement an online degree program, that meet the fol8 lowing restrictions: 

9 ‘‘(1) Enrollment of individuals who have ob10 tained a secondary school diploma or its recognized 

11 equivalent. 

12 ‘‘(2) Maintaining a significant enrollment of 

13 underrepresented minority or disadvantaged stu14 dents. 

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

16 are authorized to be appropriated to carry out this section, 

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

18 2012 through 2017.’’. 

19 SEC. 305. NATIONAL REPORT ON THE PREPAREDNESS OF 

20 HEALTH PROFESSIONALS TO CARE FOR DI21 VERSE POPULATIONS. 

22 The Secretary of Health and Human Services, in col23 laboration with the Bureau of Health Professions, the Of24 fice of Minority Health and the National Institute on Mi25 nority Health and Health Disparities, shall prepare and 


emcdonald on DSK5VPTVN1PROD with BILLS
157 

•HR 2954 IH

1 disseminate a report that details and assesses the pre2 paredness of health professionals to care for racially and 

3 ethnically diverse populations. Such information, which 

4 shall be collected by the Bureau of Health Professions, 

5 shall include— 

6 (1) with respect to health professions education, 

7 the number and percentage of hours of classroom 

8 discussion relating to minority health issues, includ9 ing cultural competence; 

10 (2) a description of the coursework involved in 

11 such education; 

12 (3) a description of the results of an evaluation 

13 of the preparedness of students in such education; 

14 (4) a description of the types of exposure that 

15 students have during their education to minority pa16 tient populations; and 

17 (5) a description of model programs and prac18 tices. 

19 SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

20 Subtitle A of title XXXIV of the Public Health Serv21 ice Act, as amended by section 301, is further amended 

22 by inserting after section 3418 the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
158 

•HR 2954 IH

1 ‘‘SEC. 3419. DAVID SATCHER PUBLIC HEALTH AND HEALTH 

2 SERVICES CORPS. 

3 ‘‘(a) IN GENERAL.—The Administrator of the Health 

4 Resources and Services Administration and the Director 

5 of the Centers for Disease Control and Prevention, in col6 laboration with the Deputy Assistant Secretary for Minor7 ity Health, shall award grants to eligible entities to in8 crease awareness among postprimary and postsecondary 

9 students of career opportunities in the health professions. 

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

11 under subsection (a) an entity shall— 

12 ‘‘(1) be a clinical, public health or health serv13 ices organization, community-based or nonprofit en14 tity, or other entity determined appropriate by the 

15 Director of the Centers for Disease Control and Pre16 vention; 

17 ‘‘(2) serve a health professional shortage area, 

18 as determined by the Secretary; 

19 ‘‘(3) work with students, including those from 

20 racial and ethnic minority backgrounds, that have 

21 expressed an interest in the health professions; and 

22 ‘‘(4) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 

25 ‘‘(c) USE OF FUNDS.—Grant awards under sub26 section (a) shall be used to support internships that will 


emcdonald on DSK5VPTVN1PROD with BILLS
159 

•HR 2954 IH

1 increase awareness among students of non-research-based 

2 and career opportunities in the following health profes3 sions: 

4 ‘‘(1) Medicine. 

5 ‘‘(2) Nursing. 

6 ‘‘(3) Public Health. 

7 ‘‘(4) Pharmacy. 

8 ‘‘(5) Health administration and management. 

9 ‘‘(6) Health policy. 

10 ‘‘(7) Psychology. 

11 ‘‘(8) Dentistry. 

12 ‘‘(9) International health. 

13 ‘‘(10) Social work. 

14 ‘‘(11) Allied health. 

15 ‘‘(12) Psychiatry. 

16 ‘‘(13) Hospice care. 

17 ‘‘(14) Other professions deemed appropriate by 

18 the Director of the Centers for Disease Control and 

19 Prevention. 

20 ‘‘(d) PRIORITY.—In awarding grants under sub21 section (a), the Director of the Centers for Disease Con22 trol and Prevention shall give priority to those entities 

23 that— 

24 ‘‘(1) serve a high proportion of individuals from 

25 disadvantaged backgrounds; 


emcdonald on DSK5VPTVN1PROD with BILLS
160 

•HR 2954 IH

1 ‘‘(2) have experience in health disparity elimi2 nation programs; 

3 ‘‘(3) facilitate the entry of disadvantaged indi4 viduals into institutions of higher education; and 

5 ‘‘(4) provide counseling or other services de6 signed to assist disadvantaged individuals in success7 fully completing their education at the postsecondary 

8 level. 

9 ‘‘(e) STIPENDS.—The Secretary may approve sti10 pends under this section for individuals for any period of 

11 education in student-enhancement programs (other than 

12 regular courses) at health professions schools, programs, 

13 or entities, except that such a stipend may not be provided 

14 to an individual for more than 6 months, and such a sti15 pend may not exceed $20 per day (notwithstanding any 

16 other provision of law regarding the amount of stipends). 

17 ‘‘(f) 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 2012 through 2017. 

21 ‘‘SEC. 3420. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

22 PROGRAM. 

23 ‘‘(a) IN GENERAL.—The Director of the Centers for 

24 Disease Control and Prevention, in collaboration with the 

25 Deputy Assistant Secretary for Minority Health, shall 


emcdonald on DSK5VPTVN1PROD with BILLS
161 

•HR 2954 IH

1 award scholarships to postsecondary students who seek a 

2 career in public health. 

3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol4 arship under subsection (a) an individual shall— 

5 ‘‘(1) have experience in public health research 

6 or public health practice, or other health professions 

7 as determined appropriate by the Director of the 

8 Centers for Disease Control and Prevention; 

9 ‘‘(2) reside in a health professional shortage 

10 area as determined by the Secretary; 

11 ‘‘(3) have expressed an interest in public health; 

12 ‘‘(4) demonstrate promise for becoming a leader 

13 in public health; 

14 ‘‘(5) secure admission to a 4-year institution of 

15 higher education; 

16 ‘‘(6) comply with subsection (f); and 

17 ‘‘(7) submit to the Secretary an application at 

18 such time, in such manner, and containing such in19 formation as the Secretary may require. 

20 ‘‘(c) USE OF FUNDS.—Amounts received under an 

21 award under subsection (a) shall be used to support oppor22 tunities for students to become public health professionals. 

23 ‘‘(d) PRIORITY.—In awarding grants under sub24 section (a), the Director shall give priority to those stu25 dents that— 


emcdonald on DSK5VPTVN1PROD with BILLS
162 

•HR 2954 IH

1 ‘‘(1) are from disadvantaged backgrounds; 

2 ‘‘(2) have secured admissions to a minority3 serving institution; and 

4 ‘‘(3) have identified a health professional as a 

5 mentor at their school or institution and an aca6 demic advisor to assist in the completion of their 

7 baccalaureate degree. 

8 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

9 payment of scholarships under this section for such indi10 viduals for any period of education in student under11 graduate tenure, except that such a scholarship may not 

12 be provided to an individual for more than 4 years, and 

13 such scholarships may not exceed $10,000 per academic 

14 year (notwithstanding any other provision of law regard15 ing the amount of scholarship). 

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 2012 through 2017. 

20 ‘‘SEC. 3420A. PATSY MINK HEALTH AND GENDER RESEARCH 

21 FELLOWSHIP PROGRAM. 

22 ‘‘(a) IN GENERAL.—The Director of the Centers for 

23 Disease Control and Prevention, in collaboration with the 

24 Deputy Assistant Secretary for Minority Health, the Ad25 ministrator of the Substance Abuse and Mental Health 


emcdonald on DSK5VPTVN1PROD with BILLS
163 

•HR 2954 IH

1 Services Administration, and the Director of the Indian 

2 Health Services, shall award research fellowships to post3 baccalaureate students to conduct research that will exam4 ine gender and health disparities and to pursue a career 

5 in the health professions. 

6 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow7 ship under subsection (a) an individual shall— 

8 ‘‘(1) have experience in health research or pub9 lic health practice; 

10 ‘‘(2) reside in a health professional shortage 

11 area as determined by the Secretary; 

12 ‘‘(3) have expressed an interest in the health 

13 professions; 

14 ‘‘(4) demonstrate promise for becoming a leader 

15 in the field of women’s health; 

16 ‘‘(5) secure admission to a health professions 

17 school or graduate program with an emphasis in 

18 gender studies; 

19 ‘‘(6) comply with subsection (f); and 

20 ‘‘(7) 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 researchers and advance 


emcdonald on DSK5VPTVN1PROD with BILLS
164 

•HR 2954 IH

1 the research base on the intersection between gender and 

2 health. 

3 ‘‘(d) PRIORITY.—In awarding grants under sub4 section (a), the Director of the Centers for Disease Con5 trol and Prevention shall give priority to those applicants 

6 that— 

7 ‘‘(1) are from disadvantaged backgrounds; and 

8 ‘‘(2) have identified a mentor and academic ad9 visor who will assist in the completion of their grad10 uate or professional degree and have secured a re11 search assistant position with a researcher working 

12 in the area of gender and health. 

13 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

14 Disease Control and Prevention may approve fellowships 

15 for individuals under this section for any period of edu16 cation in the student’s graduate or health profession ten17 ure, except that such a fellowship may not be provided 

18 to an individual for more than 3 years, and such a fellow19 ship may not exceed $18,000 per academic year (notwith20 standing any other provision of law regarding the amount 

21 of fellowship). 

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

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

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

25 2012 through 2017. 


emcdonald on DSK5VPTVN1PROD with BILLS
165 

•HR 2954 IH

1 ‘‘SEC. 3420B. 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 Deputy Assistant Secretary for Minority Health, shall 

6 award research fellowships to college students or recent 

7 graduates 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 


emcdonald on DSK5VPTVN1PROD with BILLS
166 

•HR 2954 IH

1 to advance their knowledge about international issues re2 lating to health care 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 volun12 teer organization, or other international institution 

13 or program that focuses on increasing health care 

14 access and quality for residents in developing coun15 tries. 

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) AUTHORIZATION OF APPROPRIATIONS.—There 

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


emcdonald on DSK5VPTVN1PROD with BILLS
167 

•HR 2954 IH

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

2 2012 through 2017. 

3 ‘‘SEC. 3420C. EDWARD R. ROYBAL HEALTH CARE SCHOLAR 

4 PROGRAM. 

5 ‘‘(a) IN GENERAL.—The Director of the Agency for 

6 Healthcare Research and Quality, the Director of the Cen7 ters for Medicaid & Medicare, and the Administrator for 

8 Health Resources and Services Administration, in collabo9 ration with the Deputy Assistant Secretary for Minority 

10 Health, shall award grants to eligible entities to expose 

11 entering graduate students to the health professions. 

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

13 under subsection (a) an entity shall— 

14 ‘‘(1) be a clinical, public health or health serv15 ices organization, community-based or nonprofit en16 tity, or other entity determined appropriate by the 

17 Director of the Agency for Healthcare Research and 

18 Quality; 

19 ‘‘(2) serve in a health professional shortage 

20 area as determined by the Secretary; 

21 ‘‘(3) work with students obtaining a degree in 

22 the health professions; and 

23 ‘‘(4) submit to the Secretary an application at 

24 such time, in such manner, and containing such in25 formation as the Secretary may require. 


emcdonald on DSK5VPTVN1PROD with BILLS
168 

•HR 2954 IH

1 ‘‘(c) USE OF FUNDS.—Amounts received under a 

2 grant awarded under subsection (a) shall be used to sup3 port opportunities that expose students to non-research4 based health professions, including— 

5 ‘‘(1) public health policy; 

6 ‘‘(2) health care and pharmaceutical policy; 

7 ‘‘(3) health care administration and manage8 ment; 

9 ‘‘(4) health economics; and 

10 ‘‘(5) other professions determined appropriate 

11 by the Director of the Agency for Healthcare Re12 search and Quality. 

13 ‘‘(d) PRIORITY.—In awarding grants under sub14 section (a), the Director of the Agency for Healthcare Re15 search and Quality shall give priority to those entities 

16 that— 

17 ‘‘(1) have experience with health disparity elimi18 nation programs; 

19 ‘‘(2) facilitate training in the fields described in 

20 subsection (c); and 

21 ‘‘(3) provide counseling or other services de22 signed to assist such individuals in successfully com23 pleting their education at the postsecondary level. 

24 ‘‘(e) STIPENDS.—The Secretary may approve the 

25 payment of stipends for individuals under this section for 


emcdonald on DSK5VPTVN1PROD with BILLS
169 

•HR 2954 IH

1 any period of education in student-enhancement programs 

2 (other than regular courses) at health professions schools 

3 or entities, except that such a stipend may not be provided 

4 to an individual for more than 2 months, and such a sti5 pend may not exceed $100 per day (notwithstanding any 

6 other provision of law regarding the amount of stipends). 

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

8 is authorized to be appropriated to carry out this section 

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

10 2012 through 2017.’’. 

11 SEC. 307. ADVISORY COMMITTEE ON HEALTH PROFES12 SIONS TRAINING FOR DIVERSITY. 

13 (a) ESTABLISHMENT.—The Secretary of Health and 

14 Human Services (referred to in this section as the ‘‘Sec15 retary’’) shall establish an advisory committee to be known 

16 as the Advisory Committee on Health Professions Train17 ing for Diversity (in this section referred to as the ‘‘Advi18 sory Committee’’). 

19 (b) COMPOSITION.— 

20 (1) IN GENERAL.—The Secretary shall deter21 mine the appropriate number of individuals to serve 

22 on the Advisory Committee. Such individuals shall 

23 not be officers or employees of the Federal Govern24 ment. 


emcdonald on DSK5VPTVN1PROD with BILLS
170 

•HR 2954 IH

1 (2) APPOINTMENT.—Not later than 60 days 

2 after the date of enactment of this section, the Sec3 retary shall appoint the members of the Advisory 

4 Committee from among individuals who are health 

5 professionals. In making such appointments, the 

6 Secretary shall ensure a fair balance between the 

7 health professions, that at least 75 percent of the 

8 members of the Advisory Committee are health pro9 fessionals, a broad geographic representation of 

10 members and a balance between urban and rural 

11 members. Members shall be appointed based on their 

12 competence, interest, and knowledge of the mission 

13 of the profession involved. 

14 (3) MINORITY REPRESENTATION.—In appoint15 ing the members of the Advisory Committee under 

16 paragraph (2), the Secretary shall ensure the ade17 quate representation of women and minorities. 

18 (c) TERMS.— 

19 (1) IN GENERAL.—A member of the Advisory 

20 Committee shall be appointed for a term of 3 years, 

21 except that of the members first appointed— 

(A) 1 22 ⁄3 of such members shall serve for a 

23 term of 1 year; 

(B) 1 24 ⁄3 of such members shall serve for a 

25 term of 2 years; and 


emcdonald on DSK5VPTVN1PROD with BILLS
171 

•HR 2954 IH

(C) 1 1 ⁄3 of such members shall serve for a 

2 term of 3 years. 

3 (2) VACANCIES.— 

4 (A) IN GENERAL.—A vacancy on the Advi5 sory Committee shall be filled in the manner in 

6 which the original appointment was made and 

7 shall be subject to any conditions which applied 

8 with respect to the original appointment. 

9 (B) FILLING UNEXPIRED TERM.—An indi10 vidual chosen to fill a vacancy shall be ap11 pointed for the unexpired term of the member 

12 replaced. 

13 (d) DUTIES.— 

14 (1) IN GENERAL.—The Advisory Committee 

15 shall— 

16 (A) provide advice and recommendations to 

17 the Secretary concerning policy and program 

18 development and other matters of significance 

19 concerning activities under this part; and 

20 (B) not later than 2 years after the date 

21 of enactment of this section, and annually 

22 thereafter, prepare and submit to the Secretary, 

23 and the Committee on Health, Education, 

24 Labor, and Pensions of the Senate, and the 

25 Committee on Energy and Commerce of the 


emcdonald on DSK5VPTVN1PROD with BILLS
172 

•HR 2954 IH

1 House of Representatives, a report describing 

2 the activities of the Committee. 

3 (2) CONSULTATION WITH STUDENTS.—In car4 rying out duties under paragraph (1), the Advisory 

5 Committee shall consult with individuals who are at6 tending health professions schools with which this 

7 part is concerned. 

8 (e) MEETINGS AND DOCUMENTS.— 

9 (1) MEETINGS.—The Advisory Committee shall 

10 meet not less than 2 times each year. Such meetings 

11 shall be held jointly with other related entities estab12 lished under this title where appropriate. 

13 (2) DOCUMENTS.—Not later than 14 days prior 

14 to the convening of a meeting under paragraph (1), 

15 the Advisory Committee shall prepare and make 

16 available an agenda of the matters to be considered 

17 by the Advisory Committee at such meeting. At any 

18 such meeting, the Advisory Committee shall dis19 tribute materials with respect to the issues to be ad20 dressed at the meeting. Not later than 30 days after 

21 the adjourning of such a meeting, the Advisory Com22 mittee shall prepare and make available a summary 

23 of the meeting and any actions taken by the Com24 mittee based upon the meeting. 

25 (f) COMPENSATION AND EXPENSES.— 


emcdonald on DSK5VPTVN1PROD with BILLS
173 

•HR 2954 IH

1 (1) COMPENSATION.—Each member of the Ad2 visory Committee shall be compensated at a rate 

3 equal to the daily equivalent of the annual rate of 

4 basic pay prescribed for level IV of the Executive 

5 Schedule under section 5315 of title 5, United 

6 States Code, for each day (including travel time) 

7 during which such member is engaged in the per8 formance of the duties of the Committee. 

9 (2) EXPENSES.—The members of the Advisory 

10 Committee shall be allowed travel expenses, includ11 ing per diem in lieu of subsistence, at rates author12 ized for employees of agencies under subchapter I of 

13 chapter 57 of title 5, United States Code, while 

14 away from their homes or regular places of business 

15 in the performance of services for the Committee. 

16 (g) FACA.—The Federal Advisory Committee Act 

17 shall apply to the Advisory Committee under this section 

18 only to the extent that the provisions of such Act do not 

19 conflict with the requirements of this section. 

20 SEC. 308. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 

21 PROGRAM. 

22 Section 402E of the Higher Education Act of 1965 

23 (20 U.S.C. 1070a–15) is amended by striking subsection 

24 (g) and inserting the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
174 

•HR 2954 IH

1 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI2 VERSITY TRAINING PROGRAMS.—The Secretary shall co3 ordinate with the Secretary of Health and Human Serv4 ices to ensure that there is collaboration between the goals 

5 of the program under this section and programs of the 

6 Health Resources and Services Administration that pro7 mote health workforce diversity. The Secretary of Edu8 cation shall take such measures as may be necessary to 

9 encourage participants in programs under this section to 

10 consider health profession careers. 

11 ‘‘(h) FUNDING.—From amounts appropriated pursu12 ant to the authority of section 402A(g), the Secretary 

13 shall, to the extent practicable, allocate funds for projects 

14 authorized by this section in an amount which is not less 

15 than $31,000,000 for each of the fiscal years 2012 

16 through 2018.’’. 

17 SEC. 309. RULES FOR DETERMINATION OF FULL-TIME 

18 EQUIVALENT RESIDENTS FOR COST REPORT19 ING PERIODS. 

20 (a) DGME DETERMINATIONS.—Section 1886(h)(4) 

21 of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) 

22 is amended— 

23 (1) in subparagraph (E), by striking ‘‘Subject 

24 to subparagraphs (J) and (K), such rules’’ and inVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
175 

•HR 2954 IH

1 serting ‘‘Subject to subparagraphs (J), (K), and (L), 

2 such rules’’; 

3 (2) in subparagraph (J), by striking ‘‘Such 

4 rules’’ and inserting ‘‘Subject to subparagraph (L), 

5 such rules’’; 

6 (3) in subparagraph (K), by striking ‘‘In deter7 mining’’ and inserting ‘‘Subject to subparagraph 

8 (L), in determining’’; and 

9 (4) by adding at the end the following new sub10 paragraph: 

11 ‘‘(L) For purposes of cost-reporting peri12 ods beginning on or after October 1, 2011, in 

13 determining the hospital’s number of full-time 

14 equivalent residents for purposes of this sub15 paragraph, all the time spent by an intern or 

16 resident in an approved medical residency train17 ing program shall be counted toward the deter18 mination of full-time equivalency if the hos19 pital— 

20 ‘‘(i) is recognized as a subsection (d) 

21 hospital; 

22 ‘‘(ii) is recognized as a subsection (d) 

23 Puerto Rico hospital; 


emcdonald on DSK5VPTVN1PROD with BILLS
176 

•HR 2954 IH

1 ‘‘(iii) is reimbursed under a reim2 bursement system authorized under section 

3 1814(b)(3); or 

4 ‘‘(iv) is a provider-based hospital out5 patient department.’’. 

6 (b) IME DETERMINATIONS.—Section 1886(d)(5)(B) 

7 of such Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 

8 (1) in clause (x)(II), by striking ‘‘In deter9 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 

10 in determining’’; 

11 (2) in clause (x)(III), by striking ‘‘In deter12 mining’’ and inserting ‘‘Subject to subclause (x)(IV), 

13 in determining’’; and 

14 (3) by adding at the end the following new sub15 clause: 

16 ‘‘(IV) The provisions of subpara17 graph (L) of subsection (h)(4) shall 

18 apply under this subparagraph in the 

19 same manner as they apply under 

20 such subsection.’’. 

21 SEC. 310. DEVELOPING AND IMPLEMENTING STRATEGIES 

22 FOR LOCAL HEALTH EQUITY. 

23 (a) GRANTS.—The Secretaries of Health and Human 

24 Services, Education, and Labor, acting jointly, shall make 

25 grants to academic institutions for the purposes of— 


emcdonald on DSK5VPTVN1PROD with BILLS
177 

•HR 2954 IH

1 (1) in accordance with subsection (b), devel2 oping capacity— 

3 (A) to build an evidence base for successful 

4 strategies for increasing local health equity; and 

5 (B) to serve as national models of driving 

6 local health equity; 

7 (2) in accordance with subsection (c), devel8 oping a strategic partnership with the community in 

9 which the academic institution is located; and 

10 (3) collecting data on, and periodically evalu11 ating, the effectiveness of the institution’s programs 

12 funded through this section to enable the institution 

13 to adapt accordingly for maximum efficiency and 

14 success. 

15 (b) DEVELOPING CAPACITY FOR INCREASING LOCAL

16 HEALTH EQUITY.—As a condition on receipt of a grant 

17 under subsection (a), an academic institution shall agree 

18 to use the grant to build an evidence base for successful 

19 strategies for increasing local health equity, and to serve 

20 as a national model of driving local health equity, by sup21 porting— 

22 (1) resources to strengthen institutional metrics 

23 and capacity to execute institutionwide health work24 force goals that can serve as models for increasing 

25 health equity in communities across the country ; 


emcdonald on DSK5VPTVN1PROD with BILLS
178 

•HR 2954 IH

1 (2) collaborations among a cohort of institu2 tions in implementing systemic change, partnership 

3 development, and programmatic efforts supportive of 

4 health equity goals across disciplines and popu5 lations; and 

6 (3) enhanced or newly developed data systems 

7 and research infrastructure capable of informing 

8 current and future workforce efforts and building a 

9 foundation for a broader research agenda targeting 

10 urban health disparities. 

11 (c) STRATEGIC PARTNERSHIPS.—As a condition on 

12 receipt of a grant under subsection (a), an academic insti13 tution shall agree to use the grant to develop a strategic 

14 partnership with the community in which the institution 

15 is located for the purposes of— 

16 (1) strengthening connections between the insti17 tution and the community— 

18 (A) to improve evaluation of and address 

19 the community’s health and health workforce 

20 needs; and 

21 (B) to engage the community in health 

22 workforce development; 

23 (2) developing, enhancing, or accelerating inno24 vative undergraduate and graduate programs in the 

25 biomedical sciences and health professions; and 


emcdonald on DSK5VPTVN1PROD with BILLS
179 

•HR 2954 IH

1 (3) strengthening the ‘‘birth to career’’ pipeline 

2 in the biomedical sciences and health professions, in3 cluding by developing partnerships between institu4 tions of higher education and elementary and sec5 ondary schools to recruit the next generation of 

6 health professionals earlier in the pipeline to a 

7 health care career. 

8 SEC. 311. LOAN FORGIVENESS FOR MENTAL AND BEHAV9 IORAL HEALTH SOCIAL WORKERS. 

10 Section 455 of the Higher Education Act of 1965 (20 

11 U.S.C. 1087e) is amended by adding at the end the fol12 lowing new subsection: 

13 ‘‘(q) REPAYMENT PLAN FOR MENTAL AND BEHAV14 IORAL HEALTH SOCIAL WORKERS.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall cancel 

16 the balance of interest and principal due on any eli17 gible Federal Direct Loan not in default for a bor18 rower who— 

19 ‘‘(A) has made 120 monthly payments on 

20 the eligible Federal Direct Loan after October 

21 1, 2012, pursuant to any one or a combination 

22 of the following— 

23 ‘‘(i) payments under an income-based 

24 repayment plan under section 493C; 


emcdonald on DSK5VPTVN1PROD with BILLS
180 

•HR 2954 IH

1 ‘‘(ii) payments under a standard re2 payment plan under subsection (d)(1)(A), 

3 based on a 10-year repayment period; 

4 ‘‘(iii) monthly payments under a re5 payment plan under subsection (d)(1) or 

6 (g) of not less than the monthly amount 

7 calculated under subsection (d)(1)(A), 

8 based on a 10-year repayment period; or 

9 ‘‘(iv) payments under an income con10 tingent repayment plan under subsection 

11 (d)(1)(D); and 

12 ‘‘(B)(i) is employed as a mental health or 

13 behavioral health social worker, as defined by 

14 the Secretary by regulation, at the time of such 

15 forgiveness; and 

16 ‘‘(ii) has been employed as such a mental 

17 health or behavioral health social worker during 

18 the period in which the borrower makes each of 

19 the 120 payments as described in subparagraph 

20 (A). 

21 ‘‘(2) LOAN CANCELLATION AMOUNT.—After the 

22 conclusion of the employment period described in 

23 paragraph (1), the Secretary shall cancel the obliga24 tion to repay the balance of principal and interest 

25 due as of the time of such cancellation, on the eligiVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
181 

•HR 2954 IH

1 ble Federal Direct Loans made to the borrower 

2 under this part. 

3 ‘‘(3) DEFINITION OF ELIGIBLE FEDERAL DI4 RECT LOAN.—In this subsection, the term ‘eligible 

5 Federal Direct Loan’ means a Federal Direct Staf6 ford Loan, Federal Direct PLUS Loan, Federal Di7 rect Unsubsidized Stafford Loan, or a Federal Di8 rect Consolidation Loan.’’. 

9 TITLE IV—IMPROVEMENT OF 

10 HEALTH CARE SERVICES 

11 Subtitle A—Health Empowerment 

12 Zones 

13 SEC. 401. SHORT TITLE. 

14 This subtitle may be cited as the ‘‘Health Empower15 ment Zone Act of 2011’’. 

16 SEC. 402. FINDINGS. 

17 The Congress finds the following: 

18 (1) Numerous studies and reports, including 

19 the National Healthcare Disparities Report and Un20 equal Treatment, the 2002 Institute of Medicine Re21 port, document the extensiveness to which health 

22 disparities exist across the country. 

23 (2) These studies have found that, on average, 

24 racial and ethnic minorities are disproportionately 

25 afflicted with chronic and acute conditions—such as 


emcdonald on DSK5VPTVN1PROD with BILLS
182 

•HR 2954 IH

1 cancer, diabetes, and hypertension—and suffer 

2 worse health outcomes, worse health status, and 

3 higher mortality rates than their White counter4 parts. 

5 (3) Several recent studies also show that health 

6 disparities are a function of not only access to health 

7 care, but also the social determinants of health—in8 cluding the environment, the physical structure of 

9 communities, nutrition and food options, educational 

10 attainment, employment, race, ethnicity, geography, 

11 and language preference—that directly and indi12 rectly affect the health, health care, and wellness of 

13 individuals and communities. 

14 (4) Integrally involving and fully supporting the 

15 communities most affected by health inequities in 

16 the assessment, planning, launch, and evaluation of 

17 health disparity elimination efforts is among the 

18 leading recommendations made to adequately ad19 dress and ultimately reduce health disparities. 

20 (5) Recommendations also include supporting 

21 the efforts of community stakeholders from a broad 

22 crosssection—including, but not limited to local 

23 businesses, local departments of commerce, edu24 cation, labor, urban planning, and transportation, 

25 and community-based and other nonprofit organizaVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00182 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
183 

•HR 2954 IH

1 tions—to find areas of common ground around 

2 health disparity elimination and collaborate to im3 prove the overall health and wellness of a community 

4 and its residents. 

5 SEC. 403. DESIGNATION OF HEALTH EMPOWERMENT 

6 ZONES. 

7 (a) IN GENERAL.—At the request of an eligible com8 munity partnership, the Secretary may designate an eligi9 ble area as a health empowerment zone. 

10 (b) ELIGIBILITY CRITERIA.— 

11 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

12 community partnership is eligible to submit a re13 quest under this section if the partnership— 

14 (A) demonstrates widespread public sup15 port from key individuals and entities in the eli16 gible area, including State and local govern17 ments, nonprofit organizations, and community 

18 and industry leaders, for designation of the eli19 gible area as a health empowerment zone; and 

20 (B) includes representatives of— 

21 (i) a broad cross section of stake22 holders and residents from communities in 

23 the eligible area experiencing dispropor24 tionate disparities in health status and 

25 health care; and 


emcdonald on DSK5VPTVN1PROD with BILLS
184 

•HR 2954 IH

1 (ii) organizations, facilities, and insti2 tutions that have a history of working 

3 within and serving such communities. 

4 (2) ELIGIBLE AREA.—An area is eligible to be 

5 designated as a health empowerment zone under this 

6 section if one or more communities in the area expe7 rience disproportionate disparities in health status 

8 and health care. In determining whether a commu9 nity experiences such disparities, the Secretary shall 

10 consider the data collected by the Department of 

11 Health and Human Services focusing on the fol12 lowing areas: 

13 (A) Access to affordable high-quality 

14 health services. 

15 (B) Arthritis, osteoporosis, and chronic 

16 back conditions. 

17 (C) Cancer. 

18 (D) Chronic kidney disease. 

19 (E) Diabetes. 

20 (F) Injury and violence prevention. 

21 (G) Maternal, infant, and child health. 

22 (H) Medical product safety. 

23 (I) Mental health and mental disorders. 

24 (J) Nutrition and overweight. 

25 (K) Disability and secondary conditions. 


emcdonald on DSK5VPTVN1PROD with BILLS
185 

•HR 2954 IH

1 (L) Educational and community-based 

2 health programs. 

3 (M) Environmental health. 

4 (N) Family planning. 

5 (O) Food safety. 

6 (P) Health communication. 

7 (Q) Health disease and stroke. 

8 (R) HIV/AIDS. 

9 (S) Immunization and infectious diseases. 

10 (T) Occupational safety and health. 

11 (U) Oral health. 

12 (V) Physical activity and fitness. 

13 (W) Public health infrastructure. 

14 (X) Respiratory diseases. 

15 (Y) Sexually transmitted diseases. 

16 (Z) Substance abuse. 

17 (AA) Tobacco use. 

18 (BB) Vision and hearing. 

19 (CC) The degree to which those who have 

20 disabilities have access to health services, in21 cluding physical activity and fitness, including 

22 the ability to physically access the locations 

23 where such services are provided. 

24 (c) PROCEDURE.— 


emcdonald on DSK5VPTVN1PROD with BILLS
186 

•HR 2954 IH

1 (1) REQUEST.—A request under subsection (a) 

2 shall— 

3 (A) describe the bounds of the area to be 

4 designated as a health empowerment zone and 

5 the process used to select those bounds; 

6 (B) demonstrate that the partnership sub7 mitting the request is an eligible community 

8 partnership described in subsection (b)(1); 

9 (C) demonstrate that the area is an eligible 

10 area described in subsection (b)(2); 

11 (D) include a comprehensive assessment of 

12 disparities in health status and health care ex13 perience by one or more communities in the 

14 area; 

15 (E) set forth— 

16 (i) a vision and a set of values for the 

17 area; and 

18 (ii) a comprehensive and holistic set of 

19 goals to be achieved in the area through 

20 designation as a health empowerment zone; 

21 and 

22 (F) include a strategic plan for achieving 

23 the goals described in subparagraph (E)(ii). 

24 (2) APPROVAL.—Not later than 60 days after 

25 the receipt of a request for designation of an area 


emcdonald on DSK5VPTVN1PROD with BILLS
187 

•HR 2954 IH

1 as a health empowerment zone under this section, 

2 the Secretary shall approve or disapprove the re3 quest. 

4 (d) MINIMUM NUMBER.—The Secretary— 

5 (1) shall designate not more than 110 health 

6 empowerment zones under this section; and 

7 (2) shall designate at least one health empower8 ment zone in each of the several States, the District 

9 of Columbia, and each territory or possession of the 

10 United States. 

11 SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

12 At the request of any organization or entity seeking 

13 to submit a request under section 403(a), the Secretary 

14 shall provide technical assistance, and may award a grant, 

15 to assist such organization or entity— 

16 (1) to form an eligible community partnership 

17 described in section 403(b)(1); 

18 (2) to complete a health assessment, including 

19 an assessment of health disparities under section 

20 403(c)(1)(D); or 

21 (3) to prepare and submit a request, including 

22 a strategic plan, in accordance with section 403. 


emcdonald on DSK5VPTVN1PROD with BILLS
188 

•HR 2954 IH

1 SEC. 405. BENEFITS OF DESIGNATION. 

2 (a) PRIORITY.—In awarding any competitive grant, 

3 a Federal official shall give priority to any applicant 

4 that— 

5 (1) meets the eligibility criteria for the grant; 

6 (2) proposes to use the grant for activities in a 

7 health empowerment zone; and 

8 (3) demonstrates that such activities will di9 rectly and significantly further the goals of the stra10 tegic plan approved for such zone under section 403. 

11 (b) GRANTS FOR INITIAL IMPLEMENTATION OF

12 STRATEGIC PLAN.— 

13 (1) IN GENERAL.—Upon designating an eligible 

14 area as a health empowerment zone at the request 

15 of an eligible community partnership, the Secretary 

16 shall, subject to the availability of appropriations, 

17 make a grant to the community partnership for im18 plementation of the strategic plan for such zone. 

19 (2) GRANT PERIOD.—A grant under paragraph 

20 (1) for a health empowerment zone shall be for a pe21 riod of 2 years and may be renewed, except that the 

22 total period of grants under paragraph (1) for such 

23 zone may not exceed 10 years. 

24 (3) LIMITATION.—In awarding grants under 

25 this subsection, the Secretary shall not give less pri26 ority to an applicant or reduce the amount of a 


emcdonald on DSK5VPTVN1PROD with BILLS
189 

•HR 2954 IH

1 grant because the Secretary rendered technical as2 sistance or made a grant to the same applicant 

3 under section 404. 

4 (4) REPORTING.—The Secretary shall require 

5 each recipient of a grant under this subsection to re6 port to the Secretary not less than every 6 months 

7 on the progress in implementing the strategic plan 

8 for the health empowerment zone. 

9 SEC. 406. DEFINITION. 

10 In this subtitle, the term ‘‘Secretary’’ means the Sec11 retary of Health and Human Services, acting through the 

12 Administrator of the Health Resources and Services Ad13 ministration and the Deputy Assistant Secretary for Mi14 nority Health, and in cooperation with the Director of the 

15 Office of Community Services and the Director of the Na16 tional Institute for Minority Health and Health Dispari17 ties. 

18 SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 

19 To carry out this subtitle, there is authorized to be 

20 appropriated $100,000,000 for fiscal year 2012. 


emcdonald on DSK5VPTVN1PROD with BILLS
190 

•HR 2954 IH

1 Subtitle B—Other Improvements of 

2 Health Care Services 

3 CHAPTER 1—EXPANSION OF COVERAGE 

4 SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

6 Title XXXIV of the Public Health Service Act, as 

7 amended by titles I, II, III, and IX of this Act, is further 

8 amended by inserting after subtitle C the following: 

9 ‘‘Subtitle D—Reconstruction and 

10 Improvement Grants for Public 

11 Health Care Facilities Serving 

12 Pacific Islanders and the Insu13 lar Areas 

14 ‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 

15 INITIATIVES. 

16 ‘‘(a) IN GENERAL.—The Secretary, in collaboration 

17 with the Administrator of the Health Resources and Serv18 ices Administration, the Director of the Agency for 

19 Healthcare Research and Quality, and the Administrator 

20 of the Centers for Medicare & Medicaid Services, shall 

21 award grants to eligible entities for the conduct of dem22 onstration projects to improve the quality of and access 

23 to health care. 

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

25 under subsection (a), an entity shall— 


emcdonald on DSK5VPTVN1PROD with BILLS
191 

•HR 2954 IH

1 ‘‘(1) be a health center, hospital, health plan, 

2 health system, community clinic. or other health en3 tity determined appropriate by the Secretary— 

4 ‘‘(A) that, by legal mandate or explicitly 

5 adopted mission, provides patients with access 

6 to services regardless of their ability to pay; 

7 ‘‘(B) that provides care or treatment for a 

8 substantial number of patients who are unin9 sured, are receiving assistance under a State 

10 program under title XIX of the Social Security 

11 Act, or are members of vulnerable populations, 

12 as determined by the Secretary; and 

13 ‘‘(C)(i) with respect to which, not less than 

14 50 percent of the entity’s patient population is 

15 made up of racial and ethnic minorities; or 

16 ‘‘(ii) that— 

17 ‘‘(I) serves a disproportionate percent18 age of local, minority racial and ethnic pa19 tients, or that has a patient population, at 

20 least 50 percent of which is limited-English 

21 proficient; and 

22 ‘‘(II) provides an assurance that 

23 amounts received under the grant will be 

24 used only to support quality improvement 


emcdonald on DSK5VPTVN1PROD with BILLS
192 

•HR 2954 IH

1 activities in the racial and ethnic popu2 lation served; and 

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

4 application at such time, in such manner, and con5 taining such information as the Secretary may re6 quire. 

7 ‘‘(c) PRIORITY.—In awarding grants under sub8 section (a), the Secretary shall give priority to applicants 

9 under subsection (b)(2) that— 

10 ‘‘(1) demonstrate an intent to operate as part 

11 of a health care partnership, network, collaborative, 

12 coalition, or alliance where each member entity con13 tributes to the design, implementation, and evalua14 tion of the proposed intervention; or 

15 ‘‘(2) intend to use funds to carry out system16 wide changes with respect to health care quality im17 provement, including— 

18 ‘‘(A) improved systems for data collection 

19 and reporting; 

20 ‘‘(B) innovative collaborative or similar 

21 processes; 

22 ‘‘(C) group programs with behavioral or 

23 self-management interventions; 

24 ‘‘(D) case management services; 


emcdonald on DSK5VPTVN1PROD with BILLS
193 

•HR 2954 IH

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 health care quality 

9 improvement activities or minority health and health care 

10 disparity reduction activities that include— 

11 ‘‘(1) with respect to health care 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; 

17 ‘‘(E) patient centeredness; and 

18 ‘‘(F) health information technology; and 

19 ‘‘(2) with respect to patients, activities relating 

20 to— 

21 ‘‘(A) staying healthy; 

22 ‘‘(B) getting well; 

23 ‘‘(C) living with illness or disability; and 

24 ‘‘(D) coping with end-of-life issues. 


emcdonald on DSK5VPTVN1PROD with BILLS
194 

•HR 2954 IH

1 ‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 

2 provide financial and other technical assistance to grant3 ees under this section for the development of common data 

4 systems. 

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

6 are authorized to be appropriated to carry out this section, 

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

8 2010 through 2015. 

9 ‘‘SEC. 3452. CENTERS OF EXCELLENCE. 

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

11 the Administrator of the Health Resources and Services 

12 Administration, shall designate centers of excellence at 

13 public hospitals, and other health systems serving large 

14 numbers of minority patients, that— 

15 ‘‘(1) meet the requirements of section 

16 3451(b)(1); 

17 ‘‘(2) demonstrate excellence in providing care to 

18 minority populations; and 

19 ‘‘(3) demonstrate excellence in reducing dispari20 ties in health and health care. 

21 ‘‘(b) REQUIREMENTS.—A hospital or health system 

22 that serves as a Center of Excellence under subsection (a) 

23 shall— 

24 ‘‘(1) design, implement, and evaluate programs 

25 and policies relating to the delivery of care in raVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00194 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
195 

•HR 2954 IH

1 cially, ethnically, and linguistically diverse popu2 lations; 

3 ‘‘(2) provide training and technical assistance 

4 to other hospitals and health systems relating to the 

5 provision of quality health care to minority popu6 lations; and 

7 ‘‘(3) develop activities for graduate or con8 tinuing medical education that institutionalize a 

9 focus on cultural competence training for health care 

10 providers. 

11 ‘‘(c) 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 2010 through 2015. 

15 ‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 

16 FOR PUBLIC HEALTH CARE FACILITIES SERV17 ING PACIFIC ISLANDERS AND THE INSULAR 

18 AREAS. 

19 ‘‘(a) IN GENERAL.—The Secretary shall provide di20 rect financial assistance to designated health care pro21 viders and community health centers in American Samoa, 

22 Guam, the Commonwealth of the Northern Mariana Is23 lands, the United States Virgin Islands, Puerto Rico, and 

24 Hawaii for the purposes of reconstructing and improving 

25 health care facilities and services. 


emcdonald on DSK5VPTVN1PROD with BILLS
196 

•HR 2954 IH

1 ‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi2 nancial assistance under subsection (a), an entity shall be 

3 a public health facility or community health center located 

4 in American Samoa, Guam, the Commonwealth of the 

5 Northern Mariana Islands, the United States Virgin Is6 lands, Puerto Rico, or Hawaii that— 

7 ‘‘(1) is owned or operated by— 

8 ‘‘(A) the Government of American Samoa, 

9 Guam, the Commonwealth of the Northern 

10 Mariana Islands, the United States Virgin Is11 lands, Puerto Rico, or Hawaii or a unit of local 

12 government; or 

13 ‘‘(B) a nonprofit organization; and 

14 ‘‘(2)(A) provides care or treatment for a sub15 stantial number of patients who are uninsured, re16 ceiving assistance under a State program under a 

17 title XVIII of the Social Security Act, or a State 

18 program under title XIX of such Act, or who are 

19 members of a vulnerable population, as determined 

20 by the Secretary; or 

21 ‘‘(B) serves a disproportionate percentage of 

22 local, minority racial and ethnic patients. 

23 ‘‘(c) REPORT.—Not later than 180 days after the 

24 date of enactment of this title and annually thereafter, the 

25 Secretary shall submit to the Congress and the President 


emcdonald on DSK5VPTVN1PROD with BILLS
197 

•HR 2954 IH

1 a report that includes an assessment of health resources 

2 and facilities serving populations in American Samoa, 

3 Guam, the Commonwealth of the Northern Mariana Is4 lands, the United States Virgin Islands, Puerto Rico, and 

5 Hawaii. In preparing such report, the Secretary shall— 

6 ‘‘(1) consult with and obtain information on all 

7 health care facilities needs from the entities de8 scribed in subsection (b); 

9 ‘‘(2) include all amounts of Federal assistance 

10 received by each entity in the preceding fiscal year; 

11 ‘‘(3) review the total unmet needs of each juris12 diction for health care facilities, including needs for 

13 renovation and expansion of existing facilities; and 

14 ‘‘(4) include a strategic plan for addressing the 

15 needs of each jurisdiction identified in the report. 

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

17 are authorized to be appropriated such sums as necessary 

18 to carry out this section.’’. 

19 SEC. 412. REMOVING BARRIERS TO UNSUBSIDIZED PUR20 CHASE OF PRIVATE INSURANCE IN AMER21 ICAN HEALTH BENEFIT EXCHANGES. 

22 (a) IN GENERAL.—Section 1312(f) of the Patient 

23 Protection and Affordable Care Act (42 U.S.C.18032(f)) 

24 is amended— 


emcdonald on DSK5VPTVN1PROD with BILLS
198 

•HR 2954 IH

1 (1) in the subsection heading, by striking the 

2 semicolon and all that follows through ‘‘RESI3 DENTS’’; and 

4 (2) by striking paragraph (3). 

5 (b) CONFORMING AMENDMENT.—Section 1411(a)(1) 

6 of such Act (42 U.S.C. 18081(a)(1)) is amended by strik7 ing ‘‘1312(f)(3),’’. 

8 SEC. 413. STUDY ON THE UNINSURED. 

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

10 Human Services shall— 

11 (1) conduct a study on the demographic charac12 teristics of the population of individuals who do not 

13 have health insurance coverage; and 

14 (2) predict, based on such study, the demo15 graphic characteristics of the population of individ16 uals who will not have health insurance coverage 

17 after January 1, 2014. 

18 (b) REPORTING REQUIREMENTS.— 

19 (1) IN GENERAL.—Not later than 12 months 

20 after the date of the enactment of this Act, the Sec21 retary shall submit to the Congress the results of 

22 the study under subsection (a)(1) and the prediction 

23 made under subsection (a)(2). 

24 (2) REPORTING OF DEMOGRAPHIC CHARACTER25 ISTICS.—The Secretary shall report the demographic 


emcdonald on DSK5VPTVN1PROD with BILLS
199 

•HR 2954 IH

1 characteristics under paragraphs (1) and (2) of sub2 section (a) on the basis of racial and ethnic group, 

3 and shall stratify the reporting on each racial and 

4 ethnic group by other demographic characteristics 

5 that can impact access to health insurance coverage, 

6 such as sexual orientation, gender identity, primary 

7 language, disability status, sex, socioeconomic sta8 tus, and citizenship and immigration status, in a 

9 manner consistent with title I of this Act. 

10 SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI11 TORIES. 

12 (a) ELIMINATION OF FUNDING LIMITATIONS FOR

13 PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 

14 GUAM, THE COMMONWEALTH OF THE NORTHERN MAR15 IANA ISLANDS, AND AMERICAN SAMOA.— 

16 (1) IN GENERAL.—Section 1108 of the Social 

17 Security Act (42 U.S.C. 1308) is amended— 

18 (A) in subsection (f), in the matter before 

19 paragraph (1), by striking ‘‘subsection (g)’’ and 

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

21 (B) in subsection (g)(2), in the matter be22 fore subparagraph (A), by inserting ‘‘and sub23 section (h)’’ after ‘‘paragraphs (3) and (5)’’; 

24 and 


emcdonald on DSK5VPTVN1PROD with BILLS
200 

•HR 2954 IH

1 (C) by adding at the end the following new 

2 subsection: 

3 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER4 TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 

5 THE COMMONWEALTH OF THE NORTHERN MARIANA IS6 LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 

7 shall not apply to Puerto Rico, the United States Virgin 

8 Islands, Guam, the Commonwealth of the Northern Mar9 iana Islands, and American Samoa for any fiscal year 

10 after fiscal year 2011.’’. 

11 (2) CONFORMING AMENDMENT.—Section 

12 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend13 ed by striking paragraph (4). 

14 (3) EFFECTIVE DATE.—The amendments made 

15 by this subsection shall apply beginning with fiscal 

16 year 2012. 

17 (b) PARITY IN FMAP.— 

18 (1) IN GENERAL.—Section 1905(b)(2) of such 

19 Act (42 U.S.C. 1396d(b)(2)) is amended by insert20 ing after ‘‘50 per centum’’ the following: ‘‘(except 

21 that, beginning with fiscal year 2014, the Federal 

22 medical assistance percentage for Puerto Rico, the 

23 United States Virgin Islands, Guam, the Common24 wealth of the Northern Mariana Islands, and Amer25 ican Samoa shall be the Federal medical assistance 


emcdonald on DSK5VPTVN1PROD with BILLS
201 

•HR 2954 IH

1 percentage determined by the Secretary in consulta2 tion (for the United States Virgin Islands, Guam, 

3 the Commonwealth of the Northern Mariana Is4 lands, and American Samoa) with the Secretary of 

5 the Interior)’’. 

6 (2) 2-FISCAL-YEAR TRANSITION.—Notwith7 standing any other provision of law, during fiscal 

8 years 2012 and 2013, the Federal medical assist9 ance percentage established under section 1905(b) of 

10 the Social Security Act (42 U.S.C. 1396d(b)) for 

11 Puerto Rico, the United States Virgin Islands, 

12 Guam, the Commonwealth of the Northern Mariana 

13 Islands, and American Samoa shall be the highest 

14 such Federal medical assistance percentage applica15 ble to any of the 50 States or the District of Colum16 bia for the fiscal year involved, taking into account 

17 the application of subsections (a) and (b)(1) of 5001 

18 of division B of the American Recovery and Rein19 vestment Act of 2009 (Public Law 111–5) to such 

20 States and District of Columbia for calendar quar21 ters during such fiscal years for which such sub22 sections apply respectively. 

23 (3) PER CAPITA INCOME DATA.— 

24 (A) REPORT TO CONGRESS.—Not later 

25 than October 1, 2012, the Secretary of Health 


emcdonald on DSK5VPTVN1PROD with BILLS
202 

•HR 2954 IH

1 and Human Services shall submit to Congress 

2 a report that describes the per capita income 

3 data used to promulgate the Federal medical 

4 assistance percentage in the territories and how 

5 such data differ from the per capita income 

6 data used to promulgate Federal medical assist7 ance percentages for the 50 States and the Dis8 trict of Columbia. The report should include 

9 recommendations on how the Federal medical 

10 assistance percentages can be calculated for the 

11 territories to ensure parity with the 50 States 

12 and the District of Columbia. 

13 (B) APPLICATION.—Section 1101(a)(8)(B) 

14 of the Social Security Act (42 U.S.C. 

15 1308(a)(8)(B)) is amended— 

16 (i) by striking ‘‘(other than Puerto 

17 Rico, the United States Virgin Islands, and 

18 Guam)’’ and inserting ‘‘(including Puerto 

19 Rico, the United States Virgin Islands, 

20 Guam, the Commonwealth of the Northern 

21 Mariana Islands, and American Samoa)’’; 

22 and 

23 (ii) by inserting ‘‘(or, if such satisfac24 tory data are not available in the case of 

25 the Virgin Islands, Guam, the Northern 


emcdonald on DSK5VPTVN1PROD with BILLS
203 

•HR 2954 IH

1 Mariana Islands, or American Samoa, sat2 isfactory data available from the Depart3 ment of the Interior for the same period, 

4 or if such satisfactory data are not avail5 able in the case of Puerto Rico, satisfac6 tory data available from the government of 

7 the Commonwealth of Puerto Rico for the 

8 same period)’’ after ‘‘Department of Com9 merce’’. 

10 (4) RELATION TO AMERICAN RECOVERY AND

11 REINVESTMENT ACT OF 2009.—For any period and 

12 territory in which the provisions of this subsection 

13 apply to a territory, the provisions of section 

14 5001(b)(2) of division B of the American Recovery 

15 and Reinvestment Act of 2009 (Public Law 111–5) 

16 shall not apply (except as otherwise specifically pro17 vided in paragraph (2)). 

18 SEC. 415. CLARIFICATION OF MEDICAID COVERAGE FOR 

19 CITIZENS OF FREELY ASSOCIATED STATES. 

20 (a) IN GENERAL.—Section 402(b)(2) of the Personal 

21 Responsibility and Work Opportunity Reconciliation Act 

22 of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 

23 the end the following: 

24 ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS

25 OF FREELY ASSOCIATED STATES.—With respect 


emcdonald on DSK5VPTVN1PROD with BILLS
204 

•HR 2954 IH

1 to eligibility for benefits for the program de2 fined in paragraph (3)(C) (relating to the Med3 icaid program), paragraph (1) shall not apply 

4 to any individual who lawfully resides in the 

5 United States (including territories and posses6 sions of the United States) in accordance with 

7 the Compacts of Free Association between the 

8 Government of the United States and the Gov9 ernments of the Federated States of Micro10 nesia, the Republic of the Marshall Islands, and 

11 the Republic of Palau.’’. 

12 (b) CONFORMING DEFINITION OF QUALIFIED

13 ALIEN.—Section 431(b) of such Act (8 U.S.C. 1641(b)) 

14 is amended— 

15 (1) in paragraph (6), by striking ‘‘or’’ at the 

16 end; 

17 (2) in paragraph (7), by striking the period at 

18 the end and inserting ‘‘; or’’; and 

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

20 ‘‘(8) an individual who lawfully resides in the 

21 United States (including territories and possessions 

22 of the United States) in accordance with a Compact 

23 of Free Association referred to in section 

24 402(b)(2)(G), but only with respect to the program 


emcdonald on DSK5VPTVN1PROD with BILLS
205 

•HR 2954 IH

1 defined in section 402(b)(3)(C) (relating to the Med2 icaid program).’’. 

3 (c) SETTING FMAP AT 100 PERCENT.—The third 

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

5 U.S.C. 1396d(b)) is amended by inserting before the pe6 riod at the end the following: ‘‘; with respect to medical 

7 assistance for individuals described in section 

8 402(b)(2)(G) of the Personal Responsibility and Work Op9 portunity Reconciliation Act of 1996’’. 

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

11 this Act take effect on October 1, 2011, and apply to bene12 fits and assistance provided on or after that date. 

13 SEC. 416. EXTENSION OF MEDICARE SECONDARY PAYER. 

14 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So15 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend16 ed— 

17 (1) in the last sentence, by inserting ‘‘, and be18 fore January 1, 2012’’ after ‘‘prior to such date)’’; 

19 and 

20 (2) by adding at the end the following new sen21 tence: ‘‘Effective for items and services furnished on 

22 or after January 1, 2012 (with respect to periods 

23 beginning on or after the date that is 42 months 

24 prior to such date), clauses (i) and (ii) shall be apVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00205 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
206 

•HR 2954 IH

1 plied by substituting ‘42-month’ for ‘12-month’ each 

2 place it appears in the first sentence.’’. 

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

4 this subsection shall take effect on the date of enactment 

5 of this Act. For purposes of determining an individual’s 

6 status under section 1862(b)(1)(C) of the Social Security 

7 Act (42 U.S.C. 1395y(b)(1)(C)), as amended by para8 graph (1), an individual who is within the coordinating 

9 period as of the date of enactment of this Act shall have 

10 that period extended to the full 42 months described in 

11 the last sentence of such section, as added by the amend12 ment made by paragraph (1)(B). 

13 SEC. 417. BORDER HEALTH GRANTS. 

14 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

15 the term ‘‘eligible entity’’ means a State, public institution 

16 of higher education, local government, tribal government, 

17 nonprofit health organization, community health center, or 

18 community clinic receiving assistance under section 330 

19 of the Public Health Service Act (42 U.S.C. 254b), that 

20 is located in the border area. 

21 (b) AUTHORIZATION.—From funds appropriated 

22 under subsection (f), the Secretary of Health and Human 

23 Services (in this section referred to as the ‘‘Secretary’’), 

24 acting through the United States members of the United 

25 States-Mexico Border Health Commission, shall award 


emcdonald on DSK5VPTVN1PROD with BILLS
207 

•HR 2954 IH

1 grants to eligible entities to address priorities and rec2 ommendations to improve the health of border area resi3 dents that are established 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) mental and behavioral health; 

23 (G) substance abuse; 

24 (H) health conditions that have a high 

25 prevalence in the border area; 


emcdonald on DSK5VPTVN1PROD with BILLS
208 

•HR 2954 IH

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 

23 are authorized to be appropriated to carry out this section, 

24 $200,000,000 for fiscal year 2012, and such sums as may 

25 be necessary for each succeeding fiscal year. 


emcdonald on DSK5VPTVN1PROD with BILLS
209 

•HR 2954 IH

1 SEC. 418. REMOVING MEDICARE BARRIER TO HEALTH 

2 CARE. 

3 Section 1818(a)(3) of the Social Security Act (42 

4 U.S.C. 1395i–2(a)(3)) is amended by amending subpara5 graph (B) to read as follows: ‘‘(B) an individual who is 

6 lawfully present in the United States’’. 

7 SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

8 PROVIDED BY URBAN INDIAN HEALTH CEN9 TERS. 

10 (a) IN GENERAL.—Section 1905(b) of the Social Se11 curity Act (42 U.S.C. 1396(b)), as amended by section 

12 415(c), is amended by inserting ‘‘or are received through 

13 a program operated by an urban Indian organization 

14 through a grant or contract under title V of such Act’’. 

15 (b) EFFECTIVE DATE.—The amendment made by 

16 this section shall apply to medical assistance provided on 

17 or after the date of enactment of this Act. 

18 SEC. 420. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 

19 PROVIDED TO A NATIVE HAWAIIAN THROUGH 

20 A FEDERALLY QUALIFIED HEALTH CENTER 

21 OR A NATIVE HAWAIIAN HEALTH CARE SYS22 TEM UNDER THE MEDICAID PROGRAM. 

23 (a) IN GENERAL.—The third sentence of section 

24 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 

25 as amended by section 419, is amended by inserting ‘‘; 

26 and, with respect to medical assistance provided to a NaVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
210 

•HR 2954 IH

1 tive Hawaiian (as defined in section 12(2) of the Native 

2 Hawaiian Health Care Improvement Act) through a feder3 ally qualified health center or a Native Hawaiian health 

4 care system (as defined in section 12(6) of such Act), 

5 whether directly, by referral, or under contract or other 

6 arrangement between such federally qualified health cen7 ter or Native Hawaiian health care system and another 

8 health care provider’’ before the period. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 this section shall apply to medical assistance provided on 

11 or after the date of enactment of this Act. 

12 CHAPTER 2—EXPANSION OF ACCESS 

13 SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

14 TO COMMUNITY HEALTH. 

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

16 provide for the awarding of grants to assist communities 

17 in mobilizing and organizing resources in support of effec18 tive and sustainable programs that will reduce or eliminate 

19 disparities in health and health care experienced by racial 

20 and ethnic minority individuals. 

21 (b) AUTHORITY TO AWARD GRANTS.—The Sec22 retary, acting through the Centers for Disease Control and 

23 Prevention, shall award grants to eligible entities to assist 

24 in designing, implementing, and evaluating culturally and 

25 linguistically appropriate, science-based, and communityVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00210 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
211 

•HR 2954 IH

1 driven sustainable strategies to eliminate racial and ethnic 

2 health and health care disparities. 

3 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

4 grant under this section, an entity shall— 

5 (1) represent a coalition— 

6 (A) whose principal purpose is to develop 

7 and implement interventions to reduce or elimi8 nate a health or health care disparity in a tar9 geted racial or ethnic minority group in the 

10 community served by the coalition; and 

11 (B) that includes— 

12 (i) members selected from among— 

13 (I) public health departments; 

14 (II) community-based organiza15 tions; 

16 (III) university and research or17 ganizations; 

18 (IV) American Indian tribal or19 ganizations, national American Indian 

20 organizations, Indian Health Service, 

21 or organizations serving Alaska Na22 tives; and 

23 (V) interested public or private 

24 health care providers or organizations 


emcdonald on DSK5VPTVN1PROD with BILLS
212 

•HR 2954 IH

1 as deemed appropriate by the Sec2 retary; and 

3 (ii) at least 1 member from a commu4 nity-based organization that represents the 

5 targeted racial or ethnic minority group; 

6 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, which shall 

10 include— 

11 (A) a description of the targeted racial or 

12 ethnic populations in the community to be 

13 served under the grant; 

14 (B) a description of at least 1 health dis15 parity that exists in the racial or ethnic tar16 geted populations, including health issues such 

17 as infant mortality, breast and cervical cancer 

18 screening and management, cardiovascular dis19 ease, diabetes, child and adult immunization 

20 levels, or other health priority areas as des21 ignated by the Secretary; and 

22 (C) a demonstration of a proven record of 

23 accomplishment of the coalition members in 

24 serving and working with the targeted commu25 nity. 


emcdonald on DSK5VPTVN1PROD with BILLS
213 

•HR 2954 IH

1 (d) SUSTAINABILITY.—The Secretary shall give pri2 ority to an eligible entity under this section if the entity 

3 agrees that, with respect to the costs to be incurred by 

4 the entity in carrying out the activities for which the grant 

5 was awarded, the entity (and each of the participating 

6 partners in the coalition represented by the entity) will 

7 maintain its expenditures of non-Federal funds for such 

8 activities at a level that is not less than the level of such 

9 expenditures during the fiscal year immediately preceding 

10 the first fiscal year for which the grant is awarded. 

11 (e) NONDUPLICATION.—Funds provided through this 

12 grant program should supplement, not supplant, existing 

13 Federal funding, and the funds should not be used to du14 plicate the activities of the other health disparity grant 

15 programs in this Act. 

16 (f) TECHNICAL ASSISTANCE.—The Secretary may, 

17 either directly or by grant or contract, provide any entity 

18 that receives a grant under this section with technical and 

19 other nonfinancial assistance necessary to meet the re20 quirements of this section. 

21 (g) DISSEMINATION.—The Secretary shall encourage 

22 and enable grantees to share best practices, evaluation re23 sults, and reports with communities not affiliated with 

24 grantees using the Internet, conferences, and other perti25 nent information regarding the projects funded by this 


emcdonald on DSK5VPTVN1PROD with BILLS
214 

•HR 2954 IH

1 section, including the outreach efforts of the Office of Mi2 nority Health and Health Disparity Elimination and the 

3 Centers for Disease Control and Prevention. 

4 (h) ADMINISTRATIVE BURDENS.—The Secretary 

5 shall make every effort to minimize duplicative or unneces6 sary administrative burdens on grantees. 

7 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated such sums as may be 

9 necessary to carry out this section. 

10 SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

11 (a) ELIMINATION OF ISOLATION TEST FOR COST12 BASED AMBULANCE REIMBURSEMENT.— 

13 (1) IN GENERAL.—Section 1834(l)(8) of the 

14 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

15 amended— 

16 (A) in subparagraph (B)— 

17 (i) by striking ‘‘owned and’’; and 

18 (ii) by inserting ‘‘(including when 

19 such services are provided by the entity 

20 under an arrangement with the hospital)’’ 

21 after ‘‘hospital’’; and 

22 (B) by striking the comma at the end of 

23 subparagraph (B) and all that follows and in24 serting a period. 


emcdonald on DSK5VPTVN1PROD with BILLS
215 

•HR 2954 IH

1 (2) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to services furnished 

3 on or after January 1, 2012. 

4 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

5 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

6 REQUIREMENT.— 

7 (1) IN GENERAL.—Section 1820(c)(2) of the 

8 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

9 amended— 

10 (A) in subparagraph (B)(iii), by striking 

11 ‘‘provides not more than’’ and inserting ‘‘sub12 ject to subparagraph (F), provides not more 

13 than’’; and 

14 (B) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

17 LIMIT REQUIREMENT.— 

18 ‘‘(i) IN GENERAL.—A State may elect 

19 to treat a facility, with respect to the des20 ignation of the facility for a cost reporting 

21 period, as satisfying the requirement of 

22 subparagraph (B)(iii) relating to a max23 imum number of acute care inpatient beds 

24 if the facility elects, in accordance with a 

25 method specified by the Secretary and beVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
216 

•HR 2954 IH

1 fore the beginning of the cost reporting pe2 riod, to meet the requirement under clause 

3 (ii). 

4 ‘‘(ii) ALTERNATE REQUIREMENT.— 

5 The requirement under this clause, with 

6 respect to a facility and a cost reporting 

7 period, is that the total number of inpa8 tient bed days described in subparagraph 

9 (B)(iii) during such period will not exceed 

10 7,300. For purposes of this subparagraph, 

11 an individual who is an inpatient in a bed 

12 in the facility for a single day shall be 

13 counted as one inpatient bed day. 

14 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

15 The option described in clause (i) shall not 

16 apply to a facility for a cost reporting pe17 riod if the facility (for any two consecutive 

18 cost-reporting periods during the previous 

19 5 cost-reporting periods) was treated under 

20 such option and had a total number of in21 patient bed days for each of such two cost22 reporting periods that exceeded the num23 ber specified in such clause.’’. 

24 (2) EFFECTIVE DATE.—The amendments made 

25 by paragraph (1) shall apply to cost-reporting periVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
217 

•HR 2954 IH

1 ods beginning on or after the date of the enactment 

2 of this Act. 

3 SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOS4 PITAL (RCH) PROGRAM. 

5 (a) IN GENERAL.—Section 1861 of the Social Secu6 rity Act (42 U.S.C. 1395x), as amended by section 

7 203(b)(1)(A), is amended by adding at the end of the fol8 lowing new subsection: 

9 ‘‘Rural Community Hospital; Rural Community Hospital 

10 Services 

11 ‘‘(jjj)(1) The term ‘rural community hospital’ means 

12 a hospital (as defined in subsection (e)) that— 

13 ‘‘(A) is located in a rural area (as defined in 

14 section 1886(d)(2)(D)) or treated as being so lo15 cated pursuant to section 1886(d)(8)(E); 

16 ‘‘(B) subject to paragraph (2), has less than 51 

17 acute care inpatient beds, as reported in its most re18 cent cost report; 

19 ‘‘(C) makes available 24-hour emergency care 

20 services; 

21 ‘‘(D) subject to paragraph (3), has a provider 

22 agreement in effect with the Secretary and is open 

23 to the public as of January 1, 2010; and 

24 ‘‘(E) applies to the Secretary for such designa25 tion. 


emcdonald on DSK5VPTVN1PROD with BILLS
218 

•HR 2954 IH

1 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

2 psychiatric or rehabilitation unit of the hospital which is 

3 a distinct part of the hospital shall not be counted. 

4 ‘‘(3) Paragraph (1)(D) shall not be construed to pro5 hibit any of the following from qualifying as a rural com6 munity hospital: 

7 ‘‘(A) A replacement facility (as defined by the 

8 Secretary in regulations in effect on January 1, 

9 2012) with the same service area (as defined by the 

10 Secretary in regulations in effect on such date). 

11 ‘‘(B) A facility obtaining a new provider num12 ber pursuant to a change of ownership. 

13 ‘‘(C) A facility which has a binding written 

14 agreement with an outside, unrelated party for the 

15 construction, reconstruction, lease, rental, or financ16 ing of a building as of January 1, 2012. 

17 ‘‘(4) Nothing in this subsection shall be construed as 

18 prohibiting a critical access hospital from qualifying as a 

19 rural community hospital if the critical access hospital 

20 meets the conditions otherwise applicable to hospitals 

21 under subsection (e) and section 1866. 

22 ‘‘(5) Nothing in this subsection shall be construed as 

23 prohibiting a rural community hospital participating in 

24 the demonstration program under section 410A of the 

25 Medicare Prescription Drug, Improvement, and ModVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00218 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
219 

•HR 2954 IH

1 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

2 2313) from qualifying as a rural community hospital if 

3 the rural community hospital meets the conditions other4 wise applicable to hospitals under subsection (e) and sec5 tion 1866.’’. 

6 (b) PAYMENT.— 

7 (1) INPATIENT HOSPITAL SERVICES.—Section 

8 1814 of the Social Security Act (42 U.S.C. 1395f) 

9 is amended by adding at the end the following new 

10 subsection: 

11 ‘‘Payment for Inpatient Services Furnished in Rural 

12 Community Hospitals 

13 ‘‘(m) The amount of payment under this part for in14 patient hospital services furnished in a rural community 

15 hospital, other than such services furnished in a psy16 chiatric or rehabilitation unit of the hospital which is a 

17 distinct part, is, at the election of the hospital in the appli18 cation referred to in section 1861(jjj)(1)(E)— 

19 ‘‘(1) 101 percent of the reasonable costs of pro20 viding such services, without regard to the amount 

21 of the customary or other charge, or 

22 ‘‘(2) the amount of payment provided for under 

23 the prospective payment system for inpatient hos24 pital services under section 1886(d).’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
220 

•HR 2954 IH

1 (2) OUTPATIENT SERVICES.—Section 1834 of 

2 such Act (42 U.S.C. 1395m) is amended by adding 

3 at the end the following new subsection: 

4 ‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR5 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

6 amount of payment under this part for outpatient services 

7 furnished in a rural community hospital is, at the election 

8 of the hospital in the application referred to in section 

9 1861(jjj)(1)(E)— 

10 ‘‘(1) 101 percent of the reasonable costs of pro11 viding such services, without regard to the amount 

12 of the customary or other charge and any limitation 

13 under section 1861(v)(1)(U), or 

14 ‘‘(2) the amount of payment provided for under 

15 the prospective payment system for covered OPD 

16 services under section 1833(t).’’. 

17 (3) EXEMPTION FROM 30-PERCENT REDUCTION

18 IN REIMBURSEMENT FOR BAD DEBT.—Section 

19 1861(v)(1)(T) of such Act (42 U.S.C. 

20 1395x(v)(1)(T)) is amended by inserting ‘‘(other 

21 than for a rural community hospital)’’ after ‘‘In de22 termining such reasonable costs for hospitals’’. 

23 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

24 SERVICES.—Section 1834(p) of such Act (as added by 

25 subsection (b)(2)) is amended— 


emcdonald on DSK5VPTVN1PROD with BILLS
221 

•HR 2954 IH

1 (1) by redesignating paragraphs (1) and (2) as 

2 subparagraphs (A) and (B), respectively; 

3 (2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 

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

5 ‘‘(2) The amounts of beneficiary costsharing for out6 patient services furnished in a rural community hospital 

7 under this part shall be as follows: 

8 ‘‘(A) For items and services that would have 

9 been paid under section 1833(t) if provided by a 

10 hospital, the amount of costsharing determined 

11 under paragraph (8) of such section. 

12 ‘‘(B) For items and services that would have 

13 been paid under section 1833(h) if furnished by a 

14 provider or supplier, no costsharing shall apply. 

15 ‘‘(C) For all other items and services, the 

16 amount of costsharing that would apply to the item 

17 or service under the methodology that would be used 

18 to determine payment for such item or service if pro19 vided by a physician, provider, or supplier, as the 

20 case may be.’’. 

21 (d) CONFORMING AMENDMENTS.— 

22 (1) PART A PAYMENT.—Section 1814(b) of 

23 such Act (42 U.S.C. 1395f(b)) is amended in the 

24 matter preceding paragraph (1) by inserting ‘‘other 

25 than inpatient hospital services furnished by a rural 


emcdonald on DSK5VPTVN1PROD with BILLS
222 

•HR 2954 IH

1 community hospital,’’ after ‘‘critical access hospital 

2 services,’’. 

3 (2) PART B PAYMENT.—Section 1833(a) of 

4 such Act (42 U.S.C. 1395l(a)), as amended by sec5 tion 203(b)(2), is amended— 

6 (A) in paragraph (2), in the matter before 

7 subparagraph (A), by striking ‘‘and (I)’’ and in8 serting ‘‘(I), and (K)’’; 

9 (B) by striking ‘‘and’’ at the end of para10 graph (9); 

11 (C) by striking the period at the end of 

12 paragraph (10) and inserting ‘‘; and’’; and 

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

14 ‘‘(11) in the case of outpatient services fur15 nished by a rural community hospital, the amounts 

16 described in section 1834(p).’’. 

17 (3) TECHNICAL AMENDMENTS.— 

18 (A) CONSULTATION WITH STATE AGEN19 CIES.—Section 1863 of such Act (42 U.S.C. 

20 1395z) is amended by striking ‘‘and (dd)(2)’’ 

21 and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 

22 (B) PROVIDER AGREEMENTS.—Section 

23 1866(a)(2)(A) of such Act (42 U.S.C. 

24 1395cc(a)(2)(A)) is amended by inserting ‘‘sec25 tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
223 

•HR 2954 IH

1 (e) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to items and services furnished on 

3 or after October 1, 2011. 

4 SEC. 424. MEDICARE REMOTE MONITORING PILOT 

5 PROJECTS. 

6 (a) PILOT PROJECTS.— 

7 (1) IN GENERAL.—Not later than 9 months 

8 after the date of enactment of this Act, the Sec9 retary of Health and Human Services (in this sec10 tion referred to as the ‘‘Secretary’’) shall conduct 

11 pilot projects under title XVIII of the Social Secu12 rity Act for the purpose of providing incentives to 

13 home health agencies to utilize home monitoring and 

14 communications technologies that— 

15 (A) enhance health outcomes for Medicare 

16 beneficiaries; and 

17 (B) reduce expenditures under such title. 

18 (2) SITE REQUIREMENTS.— 

19 (A) URBAN AND RURAL.—The Secretary 

20 shall conduct the pilot projects under this sec21 tion in both urban and rural areas. 

22 (B) SITE IN A SMALL STATE.—The Sec23 retary shall conduct at least 3 of the pilot 

24 projects in a State with a population of less 

25 than 1,000,000. 


emcdonald on DSK5VPTVN1PROD with BILLS
224 

•HR 2954 IH

1 (3) DEFINITION OF HOME HEALTH AGENCY.— 

2 In this section, the term ‘‘home health agency’’ has 

3 the meaning given that term in section 1861(o) of 

4 the Social Security Act (42 U.S.C. 1395x(o)). 

5 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

6 OF PROJECTS.—The Secretary shall specify the criteria 

7 for identifying those Medicare beneficiaries who shall be 

8 considered within the scope of the pilot projects under this 

9 section for purposes of the application of subsection (c) 

10 and for the assessment of the effectiveness of the home 

11 health agency in achieving the objectives of this section. 

12 Such criteria may provide for the inclusion in the projects 

13 of Medicare beneficiaries who begin receiving home health 

14 services under title XVIII of the Social Security Act after 

15 the date of the implementation of the projects. 

16 (c) INCENTIVES.— 

17 (1) PERFORMANCE TARGETS.—The Secretary 

18 shall establish for each home health agency partici19 pating in a pilot project under this section a per20 formance target using one of the following meth21 odologies, as determined appropriate by the Sec22 retary: 

23 (A) ADJUSTED HISTORICAL PERFORMANCE

24 TARGET.—The Secretary shall establish for the 

25 agency— 


emcdonald on DSK5VPTVN1PROD with BILLS
225 

•HR 2954 IH

1 (i) a base expenditure amount equal 

2 to the average total payments made to the 

3 agency under parts A and B of title XVIII 

4 of the Social Security Act for Medicare 

5 beneficiaries determined to be within the 

6 scope of the pilot project in a base period 

7 determined by the Secretary; and 

8 (ii) an annual per capita expenditure 

9 target for such beneficiaries, reflecting the 

10 base expenditure amount adjusted for risk 

11 and adjusted growth rates. 

12 (B) COMPARATIVE PERFORMANCE TAR13 GET.—The Secretary shall establish for the 

14 agency a comparative performance target equal 

15 to the average total payments under such parts 

16 A and B during the pilot project for comparable 

17 individuals in the same geographic area that 

18 are not determined to be within the scope of the 

19 pilot project. 

20 (2) INCENTIVE.—Subject to paragraph (3), the 

21 Secretary shall pay to each participating home care 

22 agency an incentive payment for each year under the 

23 pilot project equal to a portion of the Medicare sav24 ings realized for such year relative to the perform25 ance target under paragraph (1). 


emcdonald on DSK5VPTVN1PROD with BILLS
226 

•HR 2954 IH

1 (3) LIMITATION ON EXPENDITURES.—The Sec2 retary shall limit incentive payments under this sec3 tion in order to ensure that the aggregate expendi4 tures under title XVIII of the Social Security Act 

5 (including incentive payments under this subsection) 

6 do not exceed the amount that the Secretary esti7 mates would have been expended if the pilot projects 

8 under this section had not been implemented. 

9 (d) WAIVER AUTHORITY.—The Secretary may waive 

10 such provisions of titles XI and XVIII of the Social Secu11 rity Act as the Secretary determines to be appropriate for 

12 the conduct of the pilot projects under this section. 

13 (e) REPORT TO CONGRESS.—Not later than 5 years 

14 after the date that the first pilot project under this section 

15 is implemented, the Secretary shall submit to Congress a 

16 report on the pilot projects. Such report shall contain a 

17 detailed description of issues related to the expansion of 

18 the projects under subsection (f) and recommendations for 

19 such legislation and administrative actions as the Sec20 retary considers appropriate. 

21 (f) EXPANSION.—If the Secretary determines that 

22 any of the pilot projects under this section enhance health 

23 outcomes for Medicare beneficiaries and reduce expendi24 tures under title XVIII of the Social Security Act, the SecVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00226 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
227 

•HR 2954 IH

1 retary may initiate comparable projects in additional 

2 areas. 

3 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

4 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen5 tive payment under this section— 

6 (1) shall be in addition to the payments that a 

7 home health agency would otherwise receive under 

8 title XVIII of the Social Security Act for the provi9 sion of home health services; and 

10 (2) shall have no effect on the amount of such 

11 payments. 

12 SEC. 425. RURAL HEALTH QUALITY ADVISORY COMMISSION 

13 AND DEMONSTRATION PROJECTS. 

14 (a) RURAL HEALTH QUALITY ADVISORY COMMIS15 SION.— 

16 (1) ESTABLISHMENT.—Not later than 6 

17 months after the date of the enactment of this sec18 tion, the Secretary of Health and Human Services 

19 (in this section referred to as the ‘‘Secretary’’) shall 

20 establish a commission to be known as the Rural 

21 Health Quality Advisory Commission (in this section 

22 referred to as the ‘‘Commission’’). 

23 (2) DUTIES OF COMMISSION.— 

24 (A) NATIONAL PLAN.—The Commission 

25 shall develop, coordinate, and facilitate impleVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00227 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
228 

•HR 2954 IH

1 mentation of a national plan for rural health 

2 quality improvement. The national plan shall— 

3 (i) identify objectives for rural health 

4 quality improvement; 

5 (ii) identify strategies to eliminate 

6 known gaps in rural health system capacity 

7 and improve rural health quality; and 

8 (iii) provide for Federal programs to 

9 identify opportunities for strengthening 

10 and aligning policies and programs to im11 prove rural health quality. 

12 (B) DEMONSTRATION PROJECTS.—The 

13 Commission shall design demonstration projects 

14 to test alternative models for rural health qual15 ity improvement, including with respect to both 

16 personal and population health. 

17 (C) MONITORING.—The Commission shall 

18 monitor progress toward the objectives identi19 fied pursuant to paragraph (1)(A). 

20 (3) MEMBERSHIP.— 

21 (A) NUMBER.—The Commission shall be 

22 composed of 11 members appointed by the Sec23 retary. 

24 (B) SELECTION.—The Secretary shall se25 lect the members of the Commission from 


emcdonald on DSK5VPTVN1PROD with BILLS
229 

•HR 2954 IH

1 among individuals with significant rural health 

2 care and health care quality expertise, including 

3 expertise in clinical health care, health care 

4 quality research, population or public health, or 

5 purchaser organizations. 

6 (4) CONTRACTING AUTHORITY.—Subject to the 

7 availability of funds, the Commission may enter into 

8 contracts and make other arrangements, as may be 

9 necessary to carry out the duties described in para10 graph (2). 

11 (5) STAFF.—Upon the request of the Commis12 sion, the Secretary may detail, on a reimbursable 

13 basis, any of the personnel of the Office of Rural 

14 Health Policy of the Health Resources and Services 

15 Administration, the Agency for Health care Quality 

16 and Research, or the Centers for Medicare & Med17 icaid Services to the Commission to assist in car18 rying out this subsection. 

19 (6) REPORTS TO CONGRESS.—Not later than 1 

20 year after the establishment of the Commission, and 

21 annually thereafter, the Commission shall submit a 

22 report to the Congress on rural health quality. Each 

23 such report shall include the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
230 

•HR 2954 IH

1 (A) An inventory of relevant programs and 

2 recommendations for improved coordination and 

3 integration of policy and programs. 

4 (B) An assessment of achievement of the 

5 objectives identified in the national plan devel6 oped under paragraph (2) and recommenda7 tions for realizing such objectives. 

8 (C) Recommendations on Federal legisla9 tion, regulations, or administrative policies to 

10 enhance rural health quality and outcomes. 

11 (b) RURAL HEALTH QUALITY DEMONSTRATION

12 PROJECTS.— 

13 (1) IN GENERAL.—Not later than 270 days 

14 after the date of the enactment of this section, the 

15 Secretary, in consultation with the Rural Health 

16 Quality Advisory Commission, the Office of Rural 

17 Health Policy of the Health Resources and Services 

18 Administration, the Agency for Healthcare Research 

19 and Quality, and the Centers for Medicare & Med20 icaid Services, shall make grants to eligible entities 

21 for 5 demonstration projects to implement and 

22 evaluate methods for improving the quality of health 

23 care in rural communities. Each such demonstration 

24 project shall include— 

25 (A) alternative community models that— 


emcdonald on DSK5VPTVN1PROD with BILLS
231 

•HR 2954 IH

1 (i) will achieve greater integration of 

2 personal and population health services; 

3 and 

4 (ii) address safety, effectiveness, 

5 patient- or community-centeredness, timeli6 ness, efficiency, and equity (the 6 aims 

7 identified by the Institute of Medicine of 

8 the National Academies in its report enti9 tled ‘‘Crossing the Quality Chasm: A New 

10 Health System for the 21st Century’’ re11 leased on March 1, 2001); 

12 (B) innovative approaches to the financing 

13 and delivery of health services to achieve rural 

14 health quality goals; and 

15 (C) development of quality improvement 

16 support structures to assist rural health sys17 tems and professionals (such as workforce sup18 port structures, quality monitoring and report19 ing, clinical care protocols, and information 

20 technology applications). 

21 (2) ELIGIBLE ENTITIES.—In this subsection, 

22 the term ‘‘eligible entity’’ means a consortium 

23 that— 

24 (A) shall include— 


emcdonald on DSK5VPTVN1PROD with BILLS
232 

•HR 2954 IH

1 (i) at least one health care provider or 

2 health care delivery system located in a 

3 rural area; and 

4 (ii) at least one organization rep5 resenting multiple community stakeholders; 

6 and 

7 (B) may include other partners such as 

8 rural research centers. 

9 (3) CONSULTATION.—In developing the pro10 gram for awarding grants under this subsection, the 

11 Secretary shall consult with the Administrator of the 

12 Agency for Healthcare Research and Quality, rural 

13 health care providers, rural health care researchers, 

14 and private and nonprofit groups (including national 

15 associations) which are undertaking similar efforts. 

16 (4) EXPEDITED WAIVERS.—The Secretary shall 

17 expedite the processing of any waiver that— 

18 (A) is authorized under title XVIII or XIX 

19 of the Social Security Act (42 U.S.C. 1395 et 

20 seq.); and 

21 (B) is necessary to carry out a demonstra22 tion project under this subsection. 

23 (5) DEMONSTRATION PROJECT SITES.—The 

24 Secretary shall ensure that the 5 demonstration 

25 projects funded under this subsection are conducted 


emcdonald on DSK5VPTVN1PROD with BILLS
233 

•HR 2954 IH

1 at a variety of sites representing the diversity of 

2 rural communities in the Nation. 

3 (6) DURATION.—Each demonstration project 

4 under this subsection shall be for a period of 4 

5 years. 

6 (7) INDEPENDENT EVALUATION.—The Sec7 retary shall enter into an arrangement with an enti8 ty that has experience working directly with rural 

9 health systems for the conduct of an independent 

10 evaluation of the program carried out under this 

11 subsection. 

12 (8) REPORT.—Not later than 1 year after the 

13 conclusion of all of the demonstration projects fund14 ed under this subsection, the Secretary shall submit 

15 a report to the Congress on the results of such 

16 projects. The report shall include— 

17 (A) an evaluation of patient access to care, 

18 patient outcomes, and an analysis of the cost 

19 effectiveness of each such project; and 

20 (B) recommendations on Federal legisla21 tion, regulations, or administrative policies to 

22 enhance rural health quality and outcomes. 

23 (c) APPROPRIATION.— 

24 (1) IN GENERAL.—Out of funds in the Treas25 ury not otherwise appropriated, there are approVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00233 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
234 

•HR 2954 IH

1 priated to the Secretary to carry out this section 

2 $30,000,000 for the period of fiscal years 2012 

3 through 2016. 

4 (2) AVAILABILITY.— 

5 (A) IN GENERAL.—Funds appropriated 

6 under paragraph (1) shall remain available for 

7 expenditure through fiscal year 2016. 

8 (B) REPORT.—For purposes of carrying 

9 out subsection (b)(8), funds appropriated under 

10 paragraph (1) shall remain available for ex11 penditure through fiscal year 2017. 

12 (3) RESERVATION.—Of the amount appro13 priated under paragraph (1), the Secretary shall re14 serve— 

15 (A) $5,000,000 to carry out subsection (a); 

16 and 

17 (B) $25,000,000 to carry out subsection 

18 (b), of which— 

19 (i) 2 percent shall be for the provision 

20 of technical assistance to grant recipients; 

21 and 

22 (ii) 5 percent shall be for independent 

23 evaluation under subsection (b)(7). 


emcdonald on DSK5VPTVN1PROD with BILLS
235 

•HR 2954 IH

1 SEC. 426. RURAL HEALTH CARE SERVICES. 

2 Section 330A of the Public Health Service Act (42 

3 U.S.C. 254c) is amended to read as follows: 

4 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

5 RURAL HEALTH NETWORK DEVELOPMENT, 

6 DELTA RURAL DISPARITIES AND HEALTH 

7 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

8 HEALTH CARE PROVIDER QUALITY IMPROVE9 MENT GRANT PROGRAMS. 

10 ‘‘(a) PURPOSE.—The purpose of this section is to 

11 provide for grants— 

12 ‘‘(1) under subsection (b), to promote rural 

13 health care services outreach; 

14 ‘‘(2) under subsection (c), to provide for the 

15 planning and implementation of integrated health 

16 care networks in rural areas; 

17 ‘‘(3) under subsection (d), to assist rural com18 munities in the Delta Region to reduce health dis19 parities and to promote and enhance health system 

20 development; and 

21 ‘‘(4) under subsection (e), to provide for the 

22 planning and implementation of small rural health 

23 care provider quality improvement activities. 

24 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

25 GRANTS.— 


emcdonald on DSK5VPTVN1PROD with BILLS
236 

•HR 2954 IH

1 ‘‘(1) GRANTS.—The Director of the Office of 

2 Rural Health Policy of the Health Resources and 

3 Services Administration may award grants to eligible 

4 entities to promote rural health care services out5 reach by expanding the delivery of health care serv6 ices to include new and enhanced services in rural 

7 areas. The Director may award the grants for peri8 ods of not more than 3 years. 

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

10 grant under this subsection for a project, an enti11 ty— 

12 ‘‘(A) shall be a rural public or rural non13 profit private entity, a facility that qualifies as 

14 a rural health clinic under title XVIII of the 

15 Social Security Act, a public or nonprofit entity 

16 existing exclusively to provide services to mi17 grant and seasonal farm workers in rural areas, 

18 or a tribal government whose grant-funded ac19 tivities will be conducted within federally recog20 nized tribal areas; 

21 ‘‘(B) shall represent a consortium com22 posed of members— 

23 ‘‘(i) that include 3 or more independ24 ently owned health care entities; and 


emcdonald on DSK5VPTVN1PROD with BILLS
237 

•HR 2954 IH

1 ‘‘(ii) that may be nonprofit or for2 profit entities; and 

3 ‘‘(C) shall not previously have received a 

4 grant under this subsection for the same or a 

5 similar project, unless the entity is proposing to 

6 expand the scope of the project or the area that 

7 will be served through the project. 

8 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

9 grant under this subsection, an eligible entity shall 

10 prepare and submit to the Director an application at 

11 such time, in such manner, and containing such in12 formation as the Director may require, including— 

13 ‘‘(A) a description of the project that the 

14 eligible entity will carry out using the funds 

15 provided under the grant; 

16 ‘‘(B) a description of the manner in which 

17 the project funded under the grant will meet 

18 the health care needs of rural populations in 

19 the local community or region to be served; 

20 ‘‘(C) a plan for quantifying how health 

21 care needs will be met through identification of 

22 the target population and benchmarks of service 

23 delivery or health status, such as— 


emcdonald on DSK5VPTVN1PROD with BILLS
238 

•HR 2954 IH

1 ‘‘(i) quantifiable measurements of 

2 health status improvement for projects fo3 cusing on health promotion; or 

4 ‘‘(ii) benchmarks of increased access 

5 to primary care, including tracking factors 

6 such as the number and type of primary 

7 care visits, identification of a medical 

8 home, or other general measures of such 

9 access; 

10 ‘‘(D) a description of how the local com11 munity or region to be served will be involved 

12 in the development and ongoing operations of 

13 the project; 

14 ‘‘(E) a plan for sustaining the project after 

15 Federal support for the project has ended; 

16 ‘‘(F) a description of how the project will 

17 be evaluated; 

18 ‘‘(G) the administrative capacity to submit 

19 annual performance data electronically as speci20 fied by the Director; and 

21 ‘‘(H) other such information as the Direc22 tor determines to be appropriate. 

23 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

24 GRANTS.— 

25 ‘‘(1) GRANTS.— 


emcdonald on DSK5VPTVN1PROD with BILLS
239 

•HR 2954 IH

1 ‘‘(A) IN GENERAL.—The Director may 

2 award rural health network development grants 

3 to eligible entities to promote, through planning 

4 and implementation, the development of inte5 grated health care networks that have combined 

6 the functions of the entities participating in the 

7 networks in order to— 

8 ‘‘(i) achieve efficiencies and economies 

9 of scale; 

10 ‘‘(ii) expand access to, coordinate, and 

11 improve the quality of the health care de12 livery system through development of orga13 nizational efficiencies; 

14 ‘‘(iii) implement health information 

15 technology to achieve efficiencies, reduce 

16 medical errors, and improve quality; 

17 ‘‘(iv) coordinate care and manage 

18 chronic illness; and 

19 ‘‘(v) strengthen the rural health care 

20 system as a whole in such a manner as to 

21 show a quantifiable return on investment 

22 to the participants in the network. 

23 ‘‘(B) GRANT PERIODS.—The Director may 

24 award such a rural health network development 

25 grant— 


emcdonald on DSK5VPTVN1PROD with BILLS
240 

•HR 2954 IH

1 ‘‘(i) for a period of 3 years for imple2 mentation activities; or 

3 ‘‘(ii) for a period of 1 year for plan4 ning activities to assist in the initial devel5 opment of an integrated health care net6 work, if the proposed participants in the 

7 network do not have a history of collabo8 rative efforts and a 3-year grant would be 

9 inappropriate. 

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

11 grant under this subsection, an entity— 

12 ‘‘(A) shall be a rural public or rural non13 profit private entity, a facility that qualifies as 

14 a rural health clinic under title XVIII of the 

15 Social Security Act, a public or nonprofit entity 

16 existing exclusively to provide services to mi17 grant and seasonal farm workers in rural areas, 

18 or a tribal government whose grant-funded ac19 tivities will be conducted within federally recog20 nized tribal areas; 

21 ‘‘(B) shall represent a network composed 

22 of participants— 

23 ‘‘(i) that include 3 or more independ24 ently owned health care entities; and 


emcdonald on DSK5VPTVN1PROD with BILLS
241 

•HR 2954 IH

1 ‘‘(ii) that may be nonprofit or for2 profit entities; and 

3 ‘‘(C) shall not previously have received a 

4 grant under this subsection (other than a 1- 

5 year grant for planning activities) for the same 

6 or a similar project. 

7 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

8 grant under this subsection, an eligible entity, in 

9 consultation with the appropriate State office of 

10 rural health or another appropriate State entity, 

11 shall prepare and submit to the Director an applica12 tion at such time, in such manner, and containing 

13 such information as the Director may require, in14 cluding— 

15 ‘‘(A) a description of the project that the 

16 eligible entity will carry out using the funds 

17 provided under the grant; 

18 ‘‘(B) an explanation of the reasons why 

19 Federal assistance is required to carry out the 

20 project; 

21 ‘‘(C) a description of— 

22 ‘‘(i) the history of collaborative activi23 ties carried out by the participants in the 

24 network; 


emcdonald on DSK5VPTVN1PROD with BILLS
242 

•HR 2954 IH

1 ‘‘(ii) the degree to which the partici2 pants are ready to integrate their func3 tions; and 

4 ‘‘(iii) how the local community or re5 gion to be served will benefit from and be 

6 involved in the activities carried out by the 

7 network; 

8 ‘‘(D) a description of how the local com9 munity or region to be served will experience in10 creased access to quality health care services 

11 across the continuum of care as a result of the 

12 integration activities carried out by the net13 work, including a description of— 

14 ‘‘(i) return on investment for the com15 munity and the network members; and 

16 ‘‘(ii) other quantifiable performance 

17 measures that show the benefit of the net18 work activities; 

19 ‘‘(E) a plan for sustaining the project after 

20 Federal support for the project has ended; 

21 ‘‘(F) a description of how the project will 

22 be evaluated; 

23 ‘‘(G) the administrative capacity to submit 

24 annual performance data electronically as speci25 fied by the Director; and 


emcdonald on DSK5VPTVN1PROD with BILLS
243 

•HR 2954 IH

1 ‘‘(H) other such information as the Direc2 tor determines to be appropriate. 

3 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS4 TEMS DEVELOPMENT GRANTS.— 

5 ‘‘(1) GRANTS.—The Director may award grants 

6 to eligible entities to support reduction of health dis7 parities, improve access to health care, and enhance 

8 rural health system development in the Delta Re9 gion. 

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

11 grant under this subsection, an entity shall be a 

12 rural public or rural nonprofit private entity, a facil13 ity that qualifies as a rural health clinic under title 

14 XVIII of the Social Security Act, a public or non15 profit entity existing exclusively to provide services 

16 to migrant and seasonal farm workers in rural 

17 areas, or a tribal government whose grant-funded 

18 activities will be conducted within federally recog19 nized tribal areas. 

20 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

21 grant under this subsection, an eligible entity shall 

22 prepare and submit to the Director an application at 

23 such time, in such manner, and containing such in24 formation as the Director may require, including— 


emcdonald on DSK5VPTVN1PROD with BILLS
244 

•HR 2954 IH

1 ‘‘(A) a description of the project that the 

2 eligible entity will carry out using the funds 

3 provided under the grant; 

4 ‘‘(B) an explanation of the reasons why 

5 Federal assistance is required to carry out the 

6 project; 

7 ‘‘(C) a description of the manner in which 

8 the project funded under the grant will meet 

9 the health care needs of the Delta Region; 

10 ‘‘(D) a description of how the local com11 munity or region to be served will experience in12 creased access to quality health care services as 

13 a result of the activities carried out by the enti14 ty; 

15 ‘‘(E) a description of how health dispari16 ties will be reduced or the health system will be 

17 improved; 

18 ‘‘(F) a plan for sustaining the project after 

19 Federal support for the project has ended; 

20 ‘‘(G) a description of how the project will 

21 be evaluated including process and outcome 

22 measures related to the quality of care provided 

23 or how the health care system improves its per24 formance; 


emcdonald on DSK5VPTVN1PROD with BILLS
245 

•HR 2954 IH

1 ‘‘(H) a description of how the grantee will 

2 develop an advisory group made up of rep3 resentatives of the communities to be served to 

4 provide guidance to the grantee to best meet 

5 community need; and 

6 ‘‘(I) other such information as the Director 

7 determines to be appropriate. 

8 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL9 ITY IMPROVEMENT GRANTS.— 

10 ‘‘(1) GRANTS.—The Director may award grants 

11 to provide for the planning and implementation of 

12 small rural health care provider quality improvement 

13 activities. The Director may award the grants for 

14 periods of 1 to 3 years. 

15 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

16 under this subsection, an entity— 

17 ‘‘(A) shall be— 

18 ‘‘(i) a rural public or rural nonprofit 

19 private health care provider or provider of 

20 health care services, such as a rural health 

21 clinic; or 

22 ‘‘(ii) another rural provider or net23 work of small rural providers identified by 

24 the Director as a key source of local care; 

25 and 


emcdonald on DSK5VPTVN1PROD with BILLS
246 

•HR 2954 IH

1 ‘‘(B) shall not previously have received a 

2 grant under this subsection for the same or a 

3 similar project. 

4 ‘‘(3) PREFERENCE.—In awarding grants under 

5 this subsection, the Director shall give preference to 

6 facilities that qualify as rural health clinics under 

7 title XVIII of the Social Security Act. 

8 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

9 grant under this subsection, an eligible entity shall 

10 prepare and submit to the Director an application at 

11 such time, in such manner, and containing such in12 formation as the Director may require, including— 

13 ‘‘(A) a description of the project that the 

14 eligible entity will carry out using the funds 

15 provided under the grant; 

16 ‘‘(B) an explanation of the reasons why 

17 Federal assistance is required to carry out the 

18 project; 

19 ‘‘(C) a description of the manner in which 

20 the project funded under the grant will assure 

21 continuous quality improvement in the provision 

22 of services by the entity; 

23 ‘‘(D) a description of how the local com24 munity or region to be served will experience in25 creased access to quality health care services as 


emcdonald on DSK5VPTVN1PROD with BILLS
247 

•HR 2954 IH

1 a result of the activities carried out by the enti2 ty; 

3 ‘‘(E) a plan for sustaining the project after 

4 Federal support for the project has ended; 

5 ‘‘(F) a description of how the project will 

6 be evaluated including process and outcome 

7 measures related to the quality of care pro8 vided; and 

9 ‘‘(G) other such information as the Direc10 tor determines to be appropriate. 

11 ‘‘(f) GENERAL REQUIREMENTS.— 

12 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

13 that receives a grant under this section may not use 

14 funds provided through the grant— 

15 ‘‘(A) to build or acquire real property; or 

16 ‘‘(B) for construction. 

17 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

18 The Director shall coordinate activities carried out 

19 under grant programs described in this section, to 

20 the extent practicable, with Federal and State agen21 cies and nonprofit organizations that are operating 

22 similar grant programs, to maximize the effect of 

23 public dollars in funding meritorious proposals. 

24 ‘‘(g) REPORT.—Not later than September 30, 2014, 

25 the Secretary shall prepare and submit to the appropriate 


emcdonald on DSK5VPTVN1PROD with BILLS
248 

•HR 2954 IH

1 committees of Congress a report on the progress and ac2 complishments of the grant programs described in sub3 sections (b), (c), (d), and (e). 

4 ‘‘(h) DEFINITIONS.—In this section: 

5 ‘‘(1) The term ‘Delta Region’ has the meaning 

6 given to the term ‘region’ in section 382A of the 

7 Consolidated Farm and Rural Development Act (7 

8 U.S.C. 2009aa). 

9 ‘‘(2) The term ‘Director’ means the Director of 

10 the Office of Rural Health Policy of the Health Re11 sources and Services Administration. 

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

13 are authorized to be appropriated to carry out this section 

14 $40,000,000 for fiscal year 2012, and such sums as may 

15 be necessary for each of fiscal years 2013 through 2016.’’. 

16 SEC. 427. COMMUNITY HEALTH CENTER COLLABORATIVE 

17 ACCESS EXPANSION. 

18 Section 330 of the Public Health Service Act (42 

19 U.S.C. 254b) is amended by adding at the end the fol20 lowing: 

21 ‘‘(t) MISCELLANEOUS PROVISIONS.— 

22 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT

23 TO RURAL HEALTH CLINICS.— 

24 ‘‘(A) IN GENERAL.—Nothing in this sec25 tion shall be construed to prevent a community 


emcdonald on DSK5VPTVN1PROD with BILLS
249 

•HR 2954 IH

1 health center from contracting with a federally 

2 certified rural health clinic (as defined by sec3 tion 1861(aa)(2) of the Social Security Act) for 

4 the delivery of primary health care services that 

5 are available at the rural health clinic to indi6 viduals who would otherwise be eligible for free 

7 or reduced cost care if that individual were able 

8 to obtain that care at the community health 

9 center. Such services may be limited in scope to 

10 those primary health care services available in 

11 that rural health clinic. 

12 ‘‘(B) ASSURANCES.—In order for a rural 

13 health clinic to receive funds under this section 

14 through a contract with a community health 

15 center under paragraph (1), such rural health 

16 clinic shall establish policies to ensure— 

17 ‘‘(i) nondiscrimination based upon the 

18 ability of a patient to pay; and 

19 ‘‘(ii) the establishment of a sliding fee 

20 scale for low-income patients.’’. 

21 SEC. 428. FACILITATING THE PROVISION OF TELEHEALTH 

22 SERVICES ACROSS STATE LINES. 

23 (a) IN GENERAL.—For purposes of expediting the 

24 provision of telehealth services, for which payment is made 

25 under the Medicare program, across State lines, the SecVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00249 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
250 

•HR 2954 IH

1 retary of Health and Human Services shall, in consulta2 tion with representatives of States, physicians, health care 

3 practitioners, and patient advocates, encourage and facili4 tate the adoption of provisions allowing for multistate 

5 practitioner practice across State lines. 

6 (b) DEFINITIONS.—In subsection (a): 

7 (1) TELEHEALTH SERVICE.—The term ‘‘tele8 health service’’ has the meaning given that term in 

9 subparagraph (F) of section 1834(m)(4) of the So10 cial Security Act (42 U.S.C. 1395m(m)(4)). 

11 (2) PHYSICIAN, PRACTITIONER.—The terms 

12 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

13 given those terms in subparagraphs (D) and (E), re14 spectively, of such section. 

15 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

16 program’’ means the program of health insurance 

17 administered by the Secretary of Health and Human 

18 Services under title XVIII of the Social Security Act 

19 (42 U.S.C. 1395 et seq.). 

20 SEC. 429. SCORING OF PREVENTIVE HEALTH SAVINGS. 

21 Section 202 of the Congressional Budget and Im22 poundment Control Act of 1974 (2 U.S.C. 602) is amend23 ed by adding at the end the following new subsection: 

24 ‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 


emcdonald on DSK5VPTVN1PROD with BILLS
251 

•HR 2954 IH

1 ‘‘(1) DETERMINATION BY THE DIRECTOR.— 

2 Upon a request by the chairman or ranking minority 

3 member of the Committee on the Budget of the Sen4 ate, or by the chairman or ranking minority member 

5 of the Committee on the Budget of the House of 

6 Representatives, the Director shall determine if a 

7 proposed measure would result in reductions in 

8 budget outlays in budgetary outyears through the 

9 use of preventive health and preventive health serv10 ices. 

11 ‘‘(2) PROJECTIONS.—If the Director determines 

12 that a measure would result in substantial reduc13 tions in budget outlays as described in paragraph 

14 (1), the Director— 

15 ‘‘(A) shall include, in any projection pre16 pared by the Director, a description and esti17 mate of the reductions in budget outlays in the 

18 budgetary outyears and a description of the 

19 basis for such conclusions; and 

20 ‘‘(B) may prepare a budget projection that 

21 includes some or all of the budgetary outyears, 

22 notwithstanding the time periods for projections 

23 described in subsection (e) and sections 308, 

24 402, and 424. 


emcdonald on DSK5VPTVN1PROD with BILLS
252 

•HR 2954 IH

1 ‘‘(3) DEFINITIONS.—As used in this sub2 section— 

3 ‘‘(A) the term ‘preventive health’ means an 

4 action that focuses on the health of the public, 

5 individuals, and defined populations in order to 

6 protect, promote, and maintain health, wellness, 

7 and functional ability, and prevent disease, dis8 ability, and premature death that is dem9 onstrated by credible and publicly available epi10 demiological projection models, incorporating 

11 clinical trials or observational studies in hu12 mans, to avoid future health care costs; and 

13 ‘‘(B) the term ‘budgetary outyears’ means 

14 the 2 consecutive 10-year periods beginning 

15 with the first fiscal year that is 10 years after 

16 the budget year provided for in the most re17 cently agreed to concurrent resolution on the 

18 budget.’’. 

19 SEC. 430. SENSE OF CONGRESS. 

20 It is the sense of the Congress that— 

21 (1) the maintenance of effort (MOE) provisions 

22 added to sections 1902 and 2105(d) of the Social 

23 Security Act by sections 2001(b) and 2101(b) of the 

24 Patient Protection and Affordable Care Act were 

25 written to maintain the eligibility standards for the 


emcdonald on DSK5VPTVN1PROD with BILLS
253 

•HR 2954 IH

1 Medicaid program and Children’s Health Insurance 

2 Program until the American Health Benefit Ex3 changes in the States are fully operational; 

4 (2) it is imperative that the MOE provisions are 

5 enforced to the strict standard intended by the Con6 gress; 

7 (3) waiving the MOE provisions should not be 

8 permitted, except in the case of a request for a waiv9 er that meets the explicit nonapplication require10 ments; 

11 (4) the MOE provisions ensure the continued 

12 success of the Medicaid program and CHIP and 

13 were written deliberately to specifically protect vul14 nerable and disabled individuals, children, and senior 

15 citizens, many of whom are also members of commu16 nities of color; and 

17 (5) the MOE provisions must be strictly en18 forced and proposals to weaken the MOE provisions 

19 must not be considered in this time of recession. 

20 SEC. 431. REPEAL OF REQUIREMENT FOR DOCUMENTA21 TION EVIDENCING CITIZENSHIP OR NATION22 ALITY UNDER THE MEDICAID PROGRAM. 

23 (a) REPEAL.—Subsections (i)(22) and (x) of section 

24 1903 of the Social Security Act (42 U.S.C. 1396b), as 


emcdonald on DSK5VPTVN1PROD with BILLS
254 

•HR 2954 IH

1 added by section 6036 of the Deficit Reduction Act of 

2 2005, are each repealed. 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) Section 1903 of the Social Security Act (42 

5 U.S.C. 1396b) is amended— 

6 (A) in subsection (i)— 

7 (i) in paragraph (20), by adding ‘‘or’’ 

8 after the semicolon at the end; and 

9 (ii) in paragraph (21), by striking ‘‘; 

10 or’’ and inserting a period; 

11 (B) by redesignating subsection (y), as 

12 added by section 6043(b) of the Deficit Reduc13 tion Act of 2005, as subsection (x); and 

14 (C) by redesignating subsection (z), as 

15 added by section 6081(a) of the Deficit Reduc16 tion Act of 2005, as subsection (y). 

17 (2) Subsection (c) of section 6036 of the Deficit 

18 Reduction Act of 2005 is repealed. 

19 (c) EFFECTIVE DATE.—The repeals and amend20 ments made by this section shall take effect as if included 

21 in the enactment of the Deficit Reduction Act of 2005. 


emcdonald on DSK5VPTVN1PROD with BILLS
255 

•HR 2954 IH

1 SEC. 432. OFFICE OF MINORITY HEALTH IN VETERANS 

2 HEALTH ADMINISTRATION OF DEPARTMENT 

3 OF VETERANS AFFAIRS. 

4 (a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 

5 I of chapter 73 of title 38, United States Code, is amended 

6 by adding at the end the following new section: 

7 ‘‘§ 7309. Office of Minority Health 

8 ‘‘(a) ESTABLISHMENT.—There is established in the 

9 Department within the Office of the Under Secretary for 

10 Health an office to be known as the ‘Office of Minority 

11 Health’ (in this section referred to as the ‘Office’). 

12 ‘‘(b) HEAD.—The Director of the Office of Minority 

13 Health shall be the head of the Office. The Director of 

14 the Office of Minority Health shall be appointed by the 

15 Under Secretary of Health from among individuals quali16 fied to perform the duties of the position. 

17 ‘‘(c) FUNCTIONS.—The functions of the Office are as 

18 follows: 

19 ‘‘(1) To establish short-range and long-range 

20 goals and objectives and coordinate all other activi21 ties within the Veterans Health Administration that 

22 relate to disease prevention, health promotion, health 

23 care services delivery, and health care research con24 cerning veterans who are members of a racial or eth25 nic minority group. 


emcdonald on DSK5VPTVN1PROD with BILLS
256 

•HR 2954 IH

1 ‘‘(2) To support research, demonstrations, and 

2 evaluations to test new and innovative models for 

3 the discharge of activities described in paragraph 

4 (1). 

5 ‘‘(3) To increase knowledge and understanding 

6 of health risk factors for veterans who are members 

7 of a racial or ethnic minority group. 

8 ‘‘(4) To develop mechanisms that support bet9 ter health care information dissemination, education, 

10 prevention, and services delivery to veterans from 

11 disadvantaged backgrounds, including veterans who 

12 are members of a racial or ethnic minority group. 

13 ‘‘(5) To enter into contracts or agreements with 

14 appropriate public and nonprofit private entities to 

15 develop and carry out programs to provide bilingual 

16 or interpretive services to assist veterans who are 

17 members of a racial or ethnic minority group and 

18 who lack proficiency in speaking the English lan19 guage in accessing and receiving health care services 

20 through the Veterans Health Administration. 

21 ‘‘(6) To carry out programs to improve access 

22 to health care services through the Veterans Health 

23 Administration for veterans with limited proficiency 

24 in speaking the English language, including the deVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00256 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
257 

•HR 2954 IH

1 velopment and evaluation of demonstration and pilot 

2 projects for that purpose. 

3 ‘‘(7) To advise the Under Secretary of Health 

4 on matters relating to the development, implementa5 tion, and evaluation of health professions education 

6 in decreasing disparities in health care outcomes be7 tween veterans who are members of a racial or eth8 nic minority group and other veterans, including 

9 cutural competency as a method of eliminating such 

10 health disparities. 

11 ‘‘(8) To perform such other functions and du12 ties as the Secretary or the Under Secretary for 

13 Health considers appropriate. 

14 ‘‘(d) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘racial or ethnic minority group’ 

16 means the following: 

17 ‘‘(A) American Indians (including Alaska 

18 Natives, Eskimos, and Aleuts). 

19 ‘‘(B) Asian Americans. 

20 ‘‘(C) Native Hawaiians and other Pacific 

21 Islanders. 

22 ‘‘(D) Blacks. 

23 ‘‘(E) Hispanics. 

24 ‘‘(2) The term ‘Hispanic’ means individuals 

25 whose origin is Mexican, Puerto Rican, Cuban, CenVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00257 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
258 

•HR 2954 IH

1 tral or South American, or any other Spanish-speak2 ing country.’’. 

3 SEC. 433. ACCESS FOR NATIVE AMERICANS UNDER PPACA. 

4 (a) IN GENERAL.—Title I of the Patient Protection 

5 and Affordable Care Act is amended— 

6 (1) in section 1311(c)(6)(D), by striking ‘‘(as 

7 defined in section 4 of the Indian Health Care Im8 provement Act)’’ and inserting ‘‘(as defined in sec9 tion 447.50(b)(1) of title 42 of the Code of Federal 

10 Regulations, as in effect on July 1, 2010)’’; and 

11 (2) in section 1402(d)(1), by striking ‘‘(as de12 fined in section 4(d) of the Indian Self-Determina13 tion and Education Assistance Act (25 U.S.C. 

14 450b(d)))’’ and inserting (f) ‘‘(as defined in section 

15 447.50(b)(1) of title 42 of the Code of Federal Reg16 ulations, as in effect on July 1, 2010)’’. 

17 (b) INDIVIDUAL MANDATE.—In section 5000A(e)(3) 

18 of the Internal Revenue Code of 1986, by striking ‘‘(as 

19 defined in section 45A(c)(6))’’ and inserting ‘‘(as defined 

20 in section 447.50(b)(1) of title 42 of the Code of Federal 

21 Regulations, as in effect on July 1, 2010)’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
259 

•HR 2954 IH

1 TITLE V—IMPROVING HEALTH 

2 OUTCOMES FOR WOMEN, 

3 CHILDREN, AND FAMILIES 

4 SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV5 IORS IN WOMEN AND CHILDREN. 

6 Part Q of title III of the Public Health Service Act 

7 (42 U.S.C. 280g et seq.) is amended by adding at the end 

8 the following: 

9 ‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH BE10 HAVIORS IN WOMEN AND CHILDREN. 

11 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col12 laboration with the Director of the Centers for Disease 

13 Control and Prevention and other Federal officials deter14 mined appropriate by the Secretary, is authorized to 

15 award grants to eligible entities to promote positive health 

16 behaviors for women and children in target populations, 

17 especially racial and ethnic minority women and children 

18 in medically underserved communities. 

19 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

20 subsection (a) may be used to support community health 

21 workers— 

22 ‘‘(1) to educate and provide outreach regarding 

23 enrollment in health insurance including the State 

24 Children’s Health Insurance Program under title 

25 XXI of the Social Security Act, Medicare under title 


emcdonald on DSK5VPTVN1PROD with BILLS
260 

•HR 2954 IH

1 XVIII of such Act, and Medicaid under title XIX of 

2 such Act; 

3 ‘‘(2) to educate, guide, and provide outreach in 

4 a community setting regarding health problems prev5 alent among women and children and especially 

6 among racial and ethnic minority women and chil7 dren; 

8 ‘‘(3) to educate, guide, and provide experiential 

9 learning opportunities that target behavioral risk 

10 factors including— 

11 ‘‘(A) poor nutrition; 

12 ‘‘(B) physical inactivity; 

13 ‘‘(C) being overweight or obese; 

14 ‘‘(D) tobacco use; 

15 ‘‘(E) alcohol and substance use; 

16 ‘‘(F) injury and violence; 

17 ‘‘(G) risky sexual behavior; 

18 ‘‘(H) mental health problems; 

19 ‘‘(I) musculoskeletal health; 

20 ‘‘(J) dental and oral health problems; and 

21 ‘‘(K) understanding informed consent; 

22 ‘‘(4) to educate and guide regarding effective 

23 strategies to promote positive health behaviors with24 in the family; 


emcdonald on DSK5VPTVN1PROD with BILLS
261 

•HR 2954 IH

1 ‘‘(5) to promote community wellness and aware2 ness; and 

3 ‘‘(6) to educate and refer target populations to 

4 appropriate health care agencies and community5 based programs and organizations in order to in6 crease access to quality health care services, includ7 ing preventive health services. 

8 ‘‘(c) APPLICATION.— 

9 ‘‘(1) IN GENERAL.—Each eligible entity that 

10 desires to receive a grant under subsection (a) shall 

11 submit an application to the Secretary, at such time, 

12 in such manner, and accompanied by such additional 

13 information as the Secretary may require. 

14 ‘‘(2) CONTENTS.—Each application submitted 

15 pursuant to paragraph (1) shall— 

16 ‘‘(A) describe the activities for which as17 sistance under this section is sought; 

18 ‘‘(B) contain an assurance that with re19 spect to each community health worker pro20 gram receiving funds under the grant awarded, 

21 such program provides training and supervision 

22 to community health workers to enable such 

23 workers to provide authorized program services; 

24 ‘‘(C) contain an assurance that the appli25 cant will evaluate the effectiveness of commuVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00261 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
262 

•HR 2954 IH

1 nity health worker programs receiving funds 

2 under the grant; 

3 ‘‘(D) contain an assurance that each com4 munity health worker program receiving funds 

5 under the grant will provide services in the cul6 tural context most appropriate for the individ7 uals served by the program; 

8 ‘‘(E) contain a plan to document and dis9 seminate project description and results to 

10 other States and organizations as identified by 

11 the Secretary; and 

12 ‘‘(F) describe plans to enhance the capac13 ity of individuals to utilize health services and 

14 health-related social services under Federal, 

15 State, and local programs by— 

16 ‘‘(i) assisting individuals in estab17 lishing eligibility under the programs and 

18 in receiving the services or other benefits 

19 of the programs; and 

20 ‘‘(ii) providing other services as the 

21 Secretary determines to be appropriate, 

22 that may include transportation and trans23 lation services. 


emcdonald on DSK5VPTVN1PROD with BILLS
263 

•HR 2954 IH

1 ‘‘(d) PRIORITY.—In awarding grants under sub2 section (a), the Secretary shall give priority to those appli3 cants— 

4 ‘‘(1) who propose to target geographic areas— 

5 ‘‘(A) with a high percentage of residents 

6 who are eligible for health insurance but are 

7 uninsured or underinsured; and 

8 ‘‘(B) with a high percentage of families for 

9 whom English is not their primary language; 

10 ‘‘(2) with experience in providing health or 

11 health-related social services to individuals who are 

12 underserved with respect to such services; and 

13 ‘‘(3) with documented community activity and 

14 experience with community health workers. 

15 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU16 TIONS.—The Secretary shall encourage community health 

17 worker programs receiving funds under this section to col18 laborate with academic institutions, including minority19 serving institutions. Nothing in this section shall be con20 strued to require such collaboration. 

21 ‘‘(f) QUALITY ASSURANCE AND

22 COSTEFFECTIVENESS.—The Secretary shall establish 

23 guidelines for assuring the quality of the training and su24 pervision of community health workers under the proVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00263 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
264 

•HR 2954 IH

1 grams funded under this section and for assuring the 

2 costeffectiveness of such programs. 

3 ‘‘(g) MONITORING.—The Secretary shall monitor 

4 community health worker programs identified in approved 

5 applications and shall determine whether such programs 

6 are in compliance with the guidelines established under 

7 subsection (f). 

8 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

9 provide technical assistance to community health worker 

10 programs identified in approved applications with respect 

11 to planning, developing, and operating programs under the 

12 grant. 

13 ‘‘(i) REPORT TO CONGRESS.— 

14 ‘‘(1) IN GENERAL.—Not later than 4 years 

15 after the date on which the Secretary first awards 

16 grants under subsection (a), the Secretary shall sub17 mit to Congress a report regarding the grant 

18 project. 

19 ‘‘(2) CONTENTS.—The report required under 

20 paragraph (1) shall include the following: 

21 ‘‘(A) A description of the programs for 

22 which grant funds were used. 

23 ‘‘(B) The number of individuals served. 

24 ‘‘(C) An evaluation of— 


emcdonald on DSK5VPTVN1PROD with BILLS
265 

•HR 2954 IH

1 ‘‘(i) the effectiveness of these pro2 grams; 

3 ‘‘(ii) the cost of these programs; and 

4 ‘‘(iii) the impact of the project on the 

5 health outcomes of the community resi6 dents. 

7 ‘‘(D) Recommendations for sustaining the 

8 community health worker programs developed 

9 or assisted under this section. 

10 ‘‘(E) Recommendations regarding training 

11 to enhance career opportunities for community 

12 health workers. 

13 ‘‘(j) DEFINITIONS.—In this section: 

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

15 ‘community health worker’ means an individual who 

16 promotes health or nutrition within the community 

17 in which the individual resides— 

18 ‘‘(A) by serving as a liaison between com19 munities and health care agencies; 

20 ‘‘(B) by providing guidance and social as21 sistance to community residents; 

22 ‘‘(C) by enhancing community residents’ 

23 ability to effectively communicate with health 

24 care providers; 


emcdonald on DSK5VPTVN1PROD with BILLS
266 

•HR 2954 IH

1 ‘‘(D) by providing culturally and linguis2 tically appropriate health or nutrition edu3 cation; 

4 ‘‘(E) by advocating for individual and com5 munity health, including dental, oral, mental, 

6 and environmental health, or nutrition needs; 

7 and 

8 ‘‘(F) by providing referral and followup 

9 services. 

10 ‘‘(2) COMMUNITY SETTING.—The term ‘commu11 nity setting’ means a home or a community organi12 zation located in the neighborhood in which a partic13 ipant resides. 

14 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en15 tity’ means— 

16 ‘‘(A) a unit of State, territorial, local, or 

17 tribal government (including a federally recog18 nized tribe or Alaska Native village); or 

19 ‘‘(B) a community-based organization. 

20 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

21 The term ‘medically underserved community’ means 

22 a community— 

23 ‘‘(A) that has a substantial number of in24 dividuals who are members of a medically unVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
267 

•HR 2954 IH

1 derserved population, as defined by section 

2 330(b)(3); and 

3 ‘‘(B) a significant portion of which is a 

4 health professional shortage area as designated 

5 under section 332. 

6 ‘‘(5) SUPPORT.—The term ‘support’ means the 

7 provision of training, supervision, and materials 

8 needed to effectively deliver the services described in 

9 subsection (b), reimbursement for services, and 

10 other benefits. 

11 ‘‘(6) TARGET POPULATION.—The term ‘target 

12 population’ means women of reproductive age, re13 gardless of their current childbearing status and 

14 children under 21 years of age. 

15 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section 

17 $15,000,000 for each of fiscal years 2012 through 2016.’’. 

18 SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU19 TRITION ASSISTANCE FOR CHILDREN, PREG20 NANT WOMEN, AND LAWFULLY PRESENT IN21 DIVIDUALS. 

22 (a) MEDICAID.—Section 1903(v) of the Social Secu23 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

24 paragraph (4) and inserting the following new paragraph: 


emcdonald on DSK5VPTVN1PROD with BILLS
268 

•HR 2954 IH

1 ‘‘(4)(A) Notwithstanding sections 401(a), 

2 402(b), 403, and 421 of the Personal Responsibility 

3 and Work Opportunity Reconciliation Act of 1996, 

4 payment shall be made under this section for care 

5 and services that are furnished to aliens, including 

6 those described in paragraph (1), if they otherwise 

7 meet the eligibility requirements for medical assist8 ance under the State plan approved under this sub9 chapter (other than the requirement of the receipt of 

10 aid or assistance under title IV, supplemental secu11 rity income benefits under title XVI, or a State sup12 plementary payment), and are— 

13 ‘‘(i) lawfully present in the United 

14 States; 

15 ‘‘(ii) children under 21 years of age, 

16 including any optional targeted low-income 

17 child (as such term is defined in section 

18 1905(u)(2)(B)); or 

19 ‘‘(iii) pregnant women during preg20 nancy and during the 60-day period begin21 ning on the last day of the pregnancy. 

22 ‘‘(B) No debt shall accrue under an affidavit of 

23 support against any sponsor of such an alien on the 

24 basis of provision of assistance to such alien under 


emcdonald on DSK5VPTVN1PROD with BILLS
269 

•HR 2954 IH

1 this paragraph and the cost of such assistance shall 

2 not be considered as an unreimbursed cost.’’. 

3 (b) SCHIP.—Section 2107(e)(1) of the Social Secu4 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by amend5 ing subparagraph (J) to read as follows: 

6 ‘‘(J) Paragraph (4) of section 1903(v) (re7 lating to individuals who, but for sections 

8 401(a), 403, and 421 of the Personal Responsi9 bility and Work Opportunity Reconciliation Act 

10 of 1996, would be eligible for medical assistance 

11 under title XXI).’’. 

12 (c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not13 withstanding sections 401(a), 402(a), and 403(a) of the 

14 Personal Responsibility and Work Opportunity Reconcili15 ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 

16 and section 6(f) of the Food and Nutrition Act of 2008 

17 (7 U.S.C. 2015(f)), persons who are lawfully present in 

18 the United States shall be not be ineligible for benefits 

19 under the supplemental nutrition assistance program on 

20 the basis of their immigration status or date of entry into 

21 the United States. 

22 (d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 

23 Section of the 421(d)(3) of the Personal Responsibility 

24 and Work Opportunity Reconciliation Act of 1996 (8 

25 U.S.C. 1631(d)(3)) is amended by striking ‘‘to the extent 


emcdonald on DSK5VPTVN1PROD with BILLS
270 

•HR 2954 IH

1 that a qualified alien is eligible under section 

2 402(a)(2)(J)’’ and inserting, ‘‘to the extent that a child 

3 is a member of a household under the supplemental nutri4 tion assistance program’’. 

5 (e) ENSURING PROPER SCREENING.—Section 

6 11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 

7 U.S.C. 2020(e)(2)(B)) is amended— 

8 (1) by redesignating clauses (vi) and (vii) as 

9 clauses (vii) and (viii); and 

10 (2) by inserting after clause (v) the following: 

11 ‘‘(vi) shall provide a method for imple12 menting section 421 of the Personal Re13 sponsibility and Work Opportunity Rec14 onciliation Act of 1996 (8 U.S.C. 1631) 

15 that does not require any unnecessary in16 formation from persons who may be ex17 empt from that provision;’’. 

18 SEC. 503. REPEAL OF DENIAL OF BENEFITS. 

19 Section 115 of the Personal Responsibility and Work 

20 Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 

21 is amended— 

22 (1) in subsection (a) by striking paragraph (2); 

23 (2) in subsection (b) by striking paragraph (2); 

24 and 

25 (3) in subsection (e) by striking paragraph (2). 


emcdonald on DSK5VPTVN1PROD with BILLS
271 

•HR 2954 IH

1 SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 

2 AND AWARENESS. 

3 (a) IN GENERAL.—The Secretary shall establish and 

4 implement a birth defects prevention and public awareness 

5 program, consisting of the activities described in sub6 sections (c) and (d). 

7 (b) DEFINITIONS.—In this section: 

8 (1) The term ‘‘pregnancy and breastfeeding in9 formation services’’ includes only— 

10 (A) information services to provide accu11 rate, evidence-based, clinical information re12 garding maternal exposures during pregnancy 

13 that may be associated with birth defects or 

14 other health risks, such as exposures to medica15 tions, chemicals, infections, foodborne patho16 gens, illnesses, nutrition, or lifestyle factors; 

17 (B) information services to provide accu18 rate, evidence-based, clinical information re19 garding maternal exposures during breast20 feeding that may be associated with health risks 

21 to a breast-fed infant, such as exposures to 

22 medications, chemicals, infections, foodborne 

23 pathogens, illnesses, nutrition, or lifestyle fac24 tors; 

25 (C) the provision of accurate, evidence26 based information weighing risks of exposures 


emcdonald on DSK5VPTVN1PROD with BILLS
272 

•HR 2954 IH

1 during breastfeeding against the benefits of 

2 breastfeeding; and 

3 (D) the provision of information described 

4 in subparagraph (A), (B), or (C) through coun5 selors, Web sites, fact sheets, telephonic or elec6 tronic communication, community outreach ef7 forts, or other appropriate means. 

8 (2) The term ‘‘Secretary’’ means the Secretary 

9 of Health and Human Services, acting through the 

10 Director of the Centers for Disease Control and Pre11 vention. 

12 (c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 

13 subsection (a), the Secretary shall conduct or support a 

14 nationwide media campaign to increase awareness among 

15 health care providers and at-risk populations about preg16 nancy and breastfeeding information services. 

17 (d) GRANTS FOR PREGNANCY AND BREASTFEEDING

18 INFORMATION SERVICES.— 

19 (1) IN GENERAL.—In carrying out subsection 

20 (a), the Secretary shall award grants to State or re21 gional agencies or organizations for any of the fol22 lowing: 

23 (A) INFORMATION SERVICES.—The provi24 sion of, or campaigns to increase awareness 


emcdonald on DSK5VPTVN1PROD with BILLS
273 

•HR 2954 IH

1 about, pregnancy and breastfeeding information 

2 services. 

3 (B) SURVEILLANCE AND RESEARCH.—The 

4 conduct or support of— 

5 (i) surveillance of or research on— 

6 (I) maternal exposures and ma7 ternal health conditions that may in8 fluence the risk of birth defects, pre9 maturity, or other adverse pregnancy 

10 outcomes; and 

11 (II) maternal exposures that may 

12 influence health risks to a breastfed 

13 infant; or 

14 (ii) networking to facilitate surveil15 lance or research described in this sub16 paragraph. 

17 (2) PREFERENCE FOR CERTAIN STATES.—The 

18 Secretary, in making any grant under this sub19 section, shall give preference to States, otherwise 

20 equally qualified, that have or had a pregnancy and 

21 breastfeeding information service in place on or after 

22 January 1, 2006. 

23 (3) MATCHING FUNDS.—The Secretary may 

24 only award a grant under this subsection to a State 

25 or regional agency or organization that agrees, with 


emcdonald on DSK5VPTVN1PROD with BILLS
274 

•HR 2954 IH

1 respect to the costs to be incurred in carrying out 

2 the grant activities, to make available (directly or 

3 through donations from public or private entities) 

4 non-Federal funds toward such costs in an amount 

5 equal to not less than 25 percent of the amount of 

6 the grant. 

7 (4) COORDINATION.—The Secretary shall en8 sure that activities funded through a grant under 

9 this subsection are coordinated, to the maximum ex10 tent practicable, with other birth defects prevention 

11 and environmental health activities of the Federal 

12 Government, including with respect to pediatric envi13 ronmental health specialty units and children’s envi14 ronmental health centers. 

15 (e) EVALUATION.—In furtherance of the program 

16 under subsection (a), the Secretary shall provide for an 

17 evaluation of pregnancy and breastfeeding information 

18 services to identify efficient and effective models of— 

19 (1) providing information; 

20 (2) raising awareness and increasing knowledge 

21 about birth defects prevention measures; 

22 (3) modifying risk behaviors; or 

23 (4) other outcome measures as determined ap24 propriate by the Secretary. 


emcdonald on DSK5VPTVN1PROD with BILLS
275 

•HR 2954 IH

1 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there are authorized to be appropriated 

3 $5,000,000 for fiscal year 2012, $6,000,000 for fiscal year 

4 2013, $7,000,000 for fiscal year 2014, $8,000,000 for fis5 cal year 2015, and $9,000,000 for fiscal year 2016. 

6 SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 

7 COMMITTEES ON PREGNANCY-RELATED 

8 DEATHS. 

9 (a) CONDITION OF RECEIPT OF PAYMENTS FROM

10 ALLOTMENT UNDER MATERNAL AND CHILD HEALTH

11 SERVICE BLOCK GRANT.—Title V of the Social Security 

12 Act (42 U.S.C. 701 et seq.) is amended by adding at the 

13 end the following new section: 

14 ‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE15 VIEW COMMITTEES ON PREGNANCY-RE16 LATED DEATHS. 

17 ‘‘(a) GRANTS.— 

18 ‘‘(1) IN GENERAL.—Notwithstanding any other 

19 provision of this title, for each of fiscal years 2012 

20 through 2018, in addition to payments from allot21 ments for States under section 502 for such year, 

22 the Secretary shall, subject to paragraph (3) and in 

23 accordance with the criteria established under para24 graph (2), award grants to States to— 


emcdonald on DSK5VPTVN1PROD with BILLS
276 

•HR 2954 IH

1 ‘‘(A) carry out the activities described in 

2 subsection (b)(1); 

3 ‘‘(B) establish a State maternal mortality 

4 review committee, in accordance with subsection 

5 (b)(2), to carry out the activities described in 

6 subsection (b)(2)(A), and to establish the proc7 esses described in subsection (b)(1); 

8 ‘‘(C) ensure the State department of 

9 health carries out the applicable activities de10 scribed in subsection (b)(3), with respect to 

11 pregnancy-related deaths occurring within the 

12 State during such fiscal year; 

13 ‘‘(D) implement and use the comprehensive 

14 case abstraction form developed under sub15 section (c), in accordance with such subsection; 

16 and 

17 ‘‘(E) provide for public disclosure of infor18 mation, in accordance with subsection (e). 

19 ‘‘(2) CRITERIA.—The Secretary shall establish 

20 criteria for determining eligibility for and the 

21 amount of a grant awarded to a State under para22 graph (1). Such criteria shall provide that in the 

23 case of a State that receives such a grant for a fiscal 

24 year and is determined by the Secretary to have not 

25 used such grant in accordance with this section, 


emcdonald on DSK5VPTVN1PROD with BILLS
277 

•HR 2954 IH

1 such State shall not be eligible for such a grant for 

2 any subsequent fiscal year. 

3 ‘‘(3) AUTHORIZATION OF APPROPRIATIONS.— 

4 For purposes of carrying out the grant program 

5 under this section, including for administrative pur6 poses, there is authorized to be appropriated 

7 $10,000,000 for each of fiscal years 2012 through 

8 2018. 

9 ‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 

10 ‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH

11 AND PREGNANCY-ASSOCIATED DEATH CASES.—For 

12 purposes of subsection (a), with respect to a State 

13 that receives a grant under subsection (a), the fol14 lowing shall apply: 

15 ‘‘(A) MANDATORY REPORTING OF PREG16 NANCY-RELATED DEATHS.— 

17 ‘‘(i) IN GENERAL.—The State shall, 

18 through the State maternal mortality re19 view committee, develop a process, sepa20 rate from any reporting process established 

21 by the State department of health prior to 

22 the date of the enactment of this section, 

23 that provides for mandatory and confiden24 tial case reporting by individuals and enti25 ties described in clause (ii) of pregnancyVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00277 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
278 

•HR 2954 IH

1 related deaths to the State department of 

2 health. 

3 ‘‘(ii) INDIVIDUALS AND ENTITIES DE4 SCRIBED.—Individuals and entities de5 scribed in this clause include each of the 

6 following: 

7 ‘‘(I) Health care providers. 

8 ‘‘(II) Medical examiners. 

9 ‘‘(III) Medical coroners. 

10 ‘‘(IV) Hospitals. 

11 ‘‘(V) Free-standing birth centers. 

12 ‘‘(VI) Other health care facilities. 

13 ‘‘(VII) Any other individuals re14 sponsible for completing death certifi15 cates. 

16 ‘‘(VIII) Any other appropriate in17 dividuals or entities specified by the 

18 Secretary. 

19 ‘‘(B) VOLUNTARY REPORTING OF PREG20 NANCY-RELATED AND PREGNANCY-ASSOCIATED

21 DEATHS.— 

22 ‘‘(i) The State shall, through the 

23 State maternal mortality review committee, 

24 develop a process for and encourage, sepa25 rate from any reporting process established 


emcdonald on DSK5VPTVN1PROD with BILLS
279 

•HR 2954 IH

1 by the State department of health prior to 

2 the date of the enactment of this section, 

3 voluntary and confidential case reporting 

4 by individuals described in clause (ii) of 

5 pregnancy-associated deaths to the State 

6 department of health. 

7 ‘‘(ii) The State shall, through the 

8 State maternal mortality review committee, 

9 develop a process for voluntary and con10 fidential reporting by family members of 

11 the deceased and by other individuals on 

12 possible pregnancy-related and pregnancy13 associated deaths to the State department 

14 of health. Such process shall include— 

15 ‘‘(I) making publicly available on 

16 the Internet Web site of the State de17 partment of health a telephone num18 ber, Internet Web link, and email ad19 dress for such reporting; and 

20 ‘‘(II) publicizing to local profes21 sional organizations, community orga22 nizations, and social services agencies 

23 the availability of the telephone num24 ber, Internet Web link, and email adVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
280 

•HR 2954 IH

1 dress made available under subclause 

2 (I). 

3 ‘‘(C) DEVELOPMENT OF CASE-FINDING.— 

4 The State, through the vital statistics unit of 

5 the State, shall annually identify pregnancy-re6 lated and pregnancy-associated deaths occur7 ring in such State during the year involved 

8 by— 

9 ‘‘(i) matching all death records, with 

10 respect to such year, for women of child11 bearing age to live birth certificates and in12 fant death certificates to identify deaths of 

13 women that occurred during pregnancy 

14 and within one year after the end of a 

15 pregnancy; 

16 ‘‘(ii) identifying deaths reported dur17 ing such year as having an underlying or 

18 contributing cause of death related to 

19 pregnancy, regardless of the time that has 

20 passed between the end of the pregnancy 

21 and the death; 

22 ‘‘(iii) collecting data from medical ex23 aminer and coroner reports; and 

24 ‘‘(iv) any other methods the States 

25 may devise to identify maternal deaths, 


emcdonald on DSK5VPTVN1PROD with BILLS
281 

•HR 2954 IH

1 such as through review of a random sam2 ple of reported deaths of women of child3 bearing age to ascertain cases of preg4 nancy-related and pregnancy-associated 

5 deaths that are not discernable from a re6 view of death certificates alone. 

7 When feasible and for purposes of effectively 

8 collecting and obtaining data on pregnancy-re9 lated and pregnancy-associated deaths, the 

10 State shall adopt the most recent standardized 

11 birth and death certificates, as issued by the 

12 National Center for Vital Health Statistics, in13 cluding the recommended checkbox section for 

14 pregnancy on the death certificates. 

15 ‘‘(D) CASE INVESTIGATION AND DEVELOP16 MENT OF CASE SUMMARIES.—Following receipt 

17 of reports by the State department of health 

18 pursuant to subparagraph (A) or (B) and col19 lection by the vital statistics unit of the State 

20 of possible cases of pregnancy-related and preg21 nancy-associated deaths pursuant to subpara22 graph (C), the State, through the State mater23 nal mortality review committee established 

24 under subsection (a), shall investigate each 

25 case, utilizing the case abstraction form deVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00281 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
282 

•HR 2954 IH

1 scribed in subsection (c), and prepare de-identi2 fied case summaries, which shall be reviewed by 

3 the committee and included in applicable re4 ports. For purposes of subsection (a), under the 

5 processes established under subparagraphs (A), 

6 (B), and (C), a State department of health or 

7 vital statistics unit of a State shall provide to 

8 the State maternal mortality review committee 

9 access to information collected pursuant to such 

10 subparagraphs as necessary to carry out this 

11 subparagraph. Data and information collected 

12 for the case summary and review are for pur13 poses of public health activities, in accordance 

14 with HIPAA privacy and security law (as de15 fined in section 3009(a)(2) of the Public Health 

16 Service Act). Such case investigations shall in17 clude data and information obtained through— 

18 ‘‘(i) medical examiner and autopsy re19 ports of the woman involved; 

20 ‘‘(ii) medical records of the woman, 

21 including such records related to health 

22 care prior to pregnancy, prenatal and post23 natal care, labor and delivery care, emer24 gency room care, hospital discharge 

25 records, and any care delivered up until 


emcdonald on DSK5VPTVN1PROD with BILLS
283 

•HR 2954 IH

1 the time of death of the woman for pur2 poses of public health activities, in accord3 ance with HIPAA privacy and security law 

4 (as defined in section 3009(a)(2) of the 

5 Public Health Service Act); 

6 ‘‘(iii) oral and written interviews of in7 dividuals directly involved in the maternal 

8 care of the woman during and immediately 

9 following the pregnancy of the woman, in10 cluding health care, mental health, and so11 cial service providers, as applicable; 

12 ‘‘(iv) optional oral or written inter13 views of the family of the woman; 

14 ‘‘(v) socioeconomic and other relevant 

15 background information about the woman; 

16 ‘‘(vi) information collected in subpara17 graph (C)(i); and 

18 ‘‘(vii) other information on the cause 

19 of death of the woman, such as social serv20 ices and child welfare reports. 

21 ‘‘(2) STATE MATERNAL MORTALITY REVIEW

22 COMMITTEES.— 

23 ‘‘(A) DUTIES.— 

24 ‘‘(i) REQUIRED COMMITTEE ACTIVI25 TIES.—For purposes of subsection (a), a 


emcdonald on DSK5VPTVN1PROD with BILLS
284 

•HR 2954 IH

1 maternal mortality review committee estab2 lished by a State pursuant to a grant 

3 under such subsection shall carry out the 

4 following pregnancy-related death and 

5 pregnancy-associated death review activi6 ties and shall include all information rel7 evant to the death involved on the case ab8 straction form developed under subsection 

9 (d): 

10 ‘‘(I) With respect to a case of 

11 pregnancy-related or pregnancy-asso12 ciated death of a woman, review the 

13 case summaries prepared under sub14 paragraphs (A), (B), (C), and (D) of 

15 paragraph (1). 

16 ‘‘(II) Review aggregate statistical 

17 reports developed by the vital statis18 tics unit of the State under paragraph 

19 (1)(C) regarding pregnancy-related 

20 and pregnancy-associated deaths to 

21 identify trends, patterns, and dispari22 ties in adverse outcomes and address 

23 medical, non-medical, and system-re24 lated factors that may have contrib25 uted to such pregnancy-related and 


emcdonald on DSK5VPTVN1PROD with BILLS
285 

•HR 2954 IH

1 pregnancy-associated deaths and dis2 parities. 

3 ‘‘(III) Develop recommendations, 

4 based on the review of the case sum5 maries under paragraph (1)(D) and 

6 aggregate statistical reports under 

7 subclause (II), to improve maternal 

8 care, social and health services, and 

9 public health policy and institutions, 

10 including with respect to improving 

11 access to maternal care, improving the 

12 availability of social services, and 

13 eliminating disparities in maternal 

14 care and outcomes. 

15 ‘‘(ii) OPTIONAL COMMITTEE ACTIVI16 TIES.—For purposes of subsection (a), a 

17 maternal mortality review committee estab18 lished by a State under such subsection 

19 may present findings and recommendations 

20 regarding a specific case or set of cir21 cumstances directly to a health care facil22 ity or its local or State professional organi23 zation for the purpose of instituting policy 

24 changes, educational activities, or otherVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
286 

•HR 2954 IH

1 wise improving the quality of care provided 

2 by the facilities. 

3 ‘‘(B) COMPOSITION OF MATERNAL MOR4 TALITY REVIEW COMMITTEES.— 

5 ‘‘(i) IN GENERAL.—Each State mater6 nal mortality review committee established 

7 pursuant to a grant under subsection (a) 

8 shall be multi-disciplinary, consisting of 

9 health care and social service providers, 

10 public health officials, other persons with 

11 professional expertise on maternal health 

12 and mortality, and patient and community 

13 advocates who represent those communities 

14 within such State that are the most af15 fected by maternal mortality. Membership 

16 on such a committee of a State shall be re17 viewed annually by the State department 

18 of health to ensure that membership rep19 resentation requirements are being fulfilled 

20 in accordance with this paragraph. 

21 ‘‘(ii) REQUIRED MEMBERSHIP.—Each 

22 such review committee shall include— 

23 ‘‘(I) representatives from medical 

24 specialities providing care to pregnant 

25 and postpartum patients, including 


emcdonald on DSK5VPTVN1PROD with BILLS
287 

•HR 2954 IH

1 obstetricians (including generalists 

2 and maternal fetal medicine special3 ists), and family practice physicians; 

4 ‘‘(II) certified nurse midwives, 

5 certified midwives, and advanced prac6 tice nurses; 

7 ‘‘(III) hospital-based nurses; 

8 ‘‘(IV) representatives of the State 

9 department of health maternal and 

10 child health department; 

11 ‘‘(V) social service providers or 

12 social workers; 

13 ‘‘(VI) the chief medical exam14 iners or designees; 

15 ‘‘(VII) facility representatives, 

16 such as from hospitals or free-stand17 ing birth centers; and 

18 ‘‘(VIII) community or patient ad19 vocates who represent those commu20 nities within the State that are the 

21 most affected by maternal mortality. 

22 ‘‘(iii) ADDITIONAL MEMBERS.—Each 

23 such review committee may also include 

24 representatives from other relevant aca25 demic, health, social service, or policy proVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00287 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
288 

•HR 2954 IH

1 fessions, or community organizations, on 

2 an ongoing basis, or as needed, as deter3 mined beneficial by the review committee, 

4 including— 

5 ‘‘(I) anesthesiologists; 

6 ‘‘(II) emergency physicians; 

7 ‘‘(III) pathologists; 

8 ‘‘(IV) epidemiologists or biostat9 isticians; 

10 ‘‘(V) intensivists; 

11 ‘‘(VI) vital statistics officers; 

12 ‘‘(VII) nutritionists; 

13 ‘‘(VIII) mental health profes14 sionals; 

15 ‘‘(IX) substance abuse treatment 

16 specialists; 

17 ‘‘(X) representatives of relevant 

18 advocacy groups; 

19 ‘‘(XI) academics; 

20 ‘‘(XII) representatives of bene21 ficiaries of the State plan under the 

22 Medicaid program under title XIX; 

23 ‘‘(XIII) paramedics; 

24 ‘‘(XIV) lawyers; 


emcdonald on DSK5VPTVN1PROD with BILLS
289 

•HR 2954 IH

1 ‘‘(XV) risk management special2 ists; 

3 ‘‘(XVI) representatives of the de4 partments of health or public health 

5 of major cities in the State involved; 

6 and 

7 ‘‘(XVII) policy makers. 

8 ‘‘(iv) DIVERSE COMMUNITY MEMBER9 SHIP.—The composition of such a com10 mittee, with respect to a State, shall in11 clude— 

12 ‘‘(I) representatives from diverse 

13 communities, particularly those com14 munities within such State most se15 verely affected by pregnancy-related 

16 deaths or pregnancy-associated deaths 

17 and by a lack of access to relevant 

18 maternal care services, from commu19 nity maternal child health organiza20 tions, and from minority advocacy 

21 groups; 

22 ‘‘(II) members, including health 

23 care providers, from different geo24 graphic regions in the State, including 


emcdonald on DSK5VPTVN1PROD with BILLS
290 

•HR 2954 IH

1 any rural, urban, and tribal areas; 

2 and 

3 ‘‘(III) health care and social serv4 ice providers who work in commu5 nities that are diverse with regard to 

6 race, ethnicity, immigration status, 

7 Indigenous status, and English pro8 ficiency. 

9 ‘‘(v) MATERNAL MORTALITY REVIEW

10 STAFF.—Staff of each such review com11 mittee shall include— 

12 ‘‘(I) vital health statisticians, ma13 ternal child health statisticians, or 

14 epidemiologists; 

15 ‘‘(II) a coordinator of the State 

16 maternal mortality review committee, 

17 to be designated by the State; and 

18 ‘‘(III) administrative staff. 

19 ‘‘(C) OPTION FOR STATES TO FORM RE20 GIONAL MATERNAL MORTALITY REVIEWS.— 

21 States with a low rate of occurrence of preg22 nancy-associated or pregnancy-related deaths 

23 may choose to partner with one or more neigh24 boring States to fulfill the activities described in 

25 paragraph (1)(C). In such a case, with respect 


emcdonald on DSK5VPTVN1PROD with BILLS
291 

•HR 2954 IH

1 to States in such a partnership, any require2 ment under this section relating to the report3 ing of information related to such activities 

4 shall be deemed to be fulfilled by each such 

5 State if a single such report is submitted for 

6 the partnership. 

7 ‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI8 TIES.—For purposes of subsection (a), a State de9 partment of health of a State receiving a grant 

10 under such subsection shall— 

11 ‘‘(A) in consultation with the maternal 

12 mortality review committee of the State and in 

13 conjunction with relevant professional organiza14 tions, develop a plan for ongoing health care 

15 provider education, based on the findings and 

16 recommendations of the committee, in order to 

17 improve the quality of maternal care; and 

18 ‘‘(B) take steps to widely disseminate the 

19 findings and recommendations of the State ma20 ternal mortality review committees of the State 

21 and to implement the recommendations of such 

22 committee. 

23 ‘‘(c) CASE ABSTRACTION FORM.— 

24 ‘‘(1) DEVELOPMENT.—The Director of the Cen25 ters for Disease Control and Prevention shall deVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00291 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
292 

•HR 2954 IH

1 velop a uniform, comprehensive case abstraction 

2 form and make such form available to States for 

3 State maternal mortality review committees for use 

4 by such committees in order to— 

5 ‘‘(A) ensure that the cases and information 

6 collected and reviewed by such committees can 

7 be pooled for review by the Department of 

8 Health and Human Services and its agencies; 

9 and 

10 ‘‘(B) preserve the uniformity of the infor11 mation and its use for Federal public health 

12 purposes. 

13 ‘‘(2) PERMISSIBLE STATE MODIFICATION.— 

14 Each State may modify the form developed under 

15 paragraph (1) for implementation and use by such 

16 State or by the State maternal mortality review com17 mittee of such State by including on such form addi18 tional information to be collected, but may not alter 

19 the standard questions on such form, in order to en20 sure that the information can be collected and re21 viewed centrally at the Federal level. 

22 ‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY

23 FOR PURPOSES OF HIPAA.—For purposes of applying 

24 HIPAA privacy and security law (as defined in section 

25 3009(a)(2) of the Public Health Service Act), a State maVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00292 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
293 

•HR 2954 IH

1 ternal mortality review committee of a State established 

2 pursuant to this section to carry out activities described 

3 in subsection (b)(2)(A) shall be deemed to be a public 

4 health authority described in section 164.501 (and ref5 erenced in section 164.512(b)(1)(i)) of title 45, Code of 

6 Federal Regulations (or any successor regulation), car7 rying out public health activities and purposes described 

8 in such section 164.512(b)(1)(i) (or any such successor 

9 regulation). 

10 ‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 

11 ‘‘(1) IN GENERAL.—For fiscal year 2012 or a 

12 subsequent fiscal year, each State receiving a grant 

13 under this section for such year shall, subject to 

14 paragraph (3), provide for the public disclosure, and 

15 submission to the information clearinghouse estab16 lished under paragraph (2), of the information in17 cluded in the report of the State under section 

18 506(a)(2)(F) for such year (relating to the findings 

19 for such year of the State maternal mortality review 

20 committee established by the State under this sec21 tion). 

22 ‘‘(2) INFORMATION CLEARINGHOUSE.—The 

23 Secretary of Health and Human Services shall es24 tablish an information clearinghouse, that shall be 

25 administered by the Director of the Centers for DisVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00293 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
294 

•HR 2954 IH

1 ease Control and Prevention, that will maintain find2 ings and recommendations submitted pursuant to 

3 paragraph (1) and provide such findings and rec4 ommendations for public review and research pur5 poses by State health departments, maternal mor6 tality review committees, and health providers and 

7 institutions. 

8 ‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 

9 no case shall any individually identifiable health in10 formation be provided to the public, or submitted to 

11 the information clearinghouse, under paragraph (1). 

12 ‘‘(f) CONFIDENTIALITY OF REVIEW COMMITTEE

13 PROCEEDINGS.— 

14 ‘‘(1) IN GENERAL.—All proceedings and activi15 ties of a State maternal mortality review committee 

16 under this section, opinions of members of such a 

17 committee formed as a result of such proceedings 

18 and activities, and records obtained, created, or 

19 maintained pursuant to this section, including 

20 records of interviews, written reports, and state21 ments procured by the Department of Health and 

22 Human Services or by any other person, agency, or 

23 organization acting jointly with the Department, in 

24 connection with morbidity and mortality reviews 

25 under this section, shall be confidential, and not subVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00294 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
295 

•HR 2954 IH

1 ject to discovery, subpoena, or introduction into evi2 dence in any civil, criminal, legislative, or other pro3 ceeding. Such records shall not be open to public in4 spection. 

5 ‘‘(2) TESTIMONY OF MEMBERS OF COM6 MITTEE.— 

7 ‘‘(A) IN GENERAL.—Members of a State 

8 maternal mortality review committee under this 

9 section may not be questioned in any civil, 

10 criminal, legislative, or other proceeding regard11 ing information presented in, or opinions 

12 formed as a result of, a meeting or communica13 tion of the committee. 

14 ‘‘(B) CLARIFICATION.—Nothing in this 

15 subsection shall be construed to prevent a mem16 ber of such a committee from testifying regard17 ing information that was obtained independent 

18 of such member’s participation on the com19 mittee, or that is public information. 

20 ‘‘(3) AVAILABILITY OF INFORMATION FOR RE21 SEARCH PURPOSES.—Nothing in this subsection 

22 shall prohibit the publishing by such a committee or 

23 the Department of Health and Human Services of 

24 statistical compilations and research reports that— 


emcdonald on DSK5VPTVN1PROD with BILLS
296 

•HR 2954 IH

1 ‘‘(A) are based on confidential information, 

2 relating to morbidity and mortality review; and 

3 ‘‘(B) do not contain identifying informa4 tion or any other information that could be 

5 used to ultimately identify the individuals con6 cerned. 

7 ‘‘(g) DEFINITIONS.—For purposes of this section: 

8 ‘‘(1) The term ‘pregnancy-associated death’ 

9 means the death of a woman while pregnant or dur10 ing the one-year period following the date of the end 

11 of pregnancy, irrespective of the cause of such death. 

12 ‘‘(2) The term ‘pregnancy-related death’ means 

13 the death of a woman while pregnant or during the 

14 one-year period following the date of the end of 

15 pregnancy, irrespective of the duration or site of the 

16 pregnancy, from any cause related to or aggravated 

17 by the pregnancy or its management, but not from 

18 any accidental or incidental cause. 

19 ‘‘(3) The term ‘woman of childbearing age’ 

20 means a woman who is at least 10 years of age and 

21 not more than 54 years of age.’’. 

22 (b) INCLUSION OF FINDINGS OF REVIEW COMMIT23 TEES IN REQUIRED REPORTS.— 

24 (1) STATE TRIENNIAL REPORTS.—Paragraph 

25 (2) of section 506(a) of such Act (42 U.S.C. 706(a)) 


emcdonald on DSK5VPTVN1PROD with BILLS
297 

•HR 2954 IH

1 is amended by inserting after subparagraph (E) the 

2 following new subparagraph: 

3 ‘‘(F) In the case of a State receiving a 

4 grant under section 514, beginning for the first 

5 fiscal year beginning after 3 years after the 

6 date of establishment of the State maternal 

7 mortality review committee established by the 

8 State pursuant to such grant and once every 3 

9 years thereafter, information containing the 

10 findings and recommendations of such com11 mittee and information on the implementation 

12 of such recommendations during the period in13 volved.’’. 

14 (2) ANNUAL REPORTS TO CONGRESS.—Para15 graph (3) of such section is amended— 

16 (A) in subparagraph (D), at the end, by 

17 striking ‘‘and’’; 

18 (B) in subparagraph (E), at the end, by 

19 striking the period and inserting ‘‘; and’’; and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(F) For fiscal year 2012 and each subse23 quent fiscal year, taking into account the find24 ings, recommendations, and implementation in25 formation submitted by States pursuant to 


emcdonald on DSK5VPTVN1PROD with BILLS
298 

•HR 2954 IH

1 paragraph (2)(F), on the status of pregnancy2 related deaths and pregnancy-associated deaths 

3 in the United States and including rec4 ommendations on methods to prevent such 

5 deaths in the United States.’’. 

6 SEC. 506. ELIMINATING DISPARITIES IN MATERNITY 

7 HEALTH OUTCOMES. 

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

9 is amended by inserting after section 317V, as added, the 

10 following new section: 

11 ‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 

12 HEALTH OUTCOMES. 

13 ‘‘(a) IN GENERAL.—The Secretary shall, in consulta14 tion with relevant national stakeholder organizations, such 

15 as national medical specialty organizations, national ma16 ternal child health organizations, and national health dis17 parity organizations, carry out the following activities to 

18 eliminate disparities in maternal health outcomes: 

19 ‘‘(1) Conduct research into the determinants 

20 and the distribution of disparities in maternal care, 

21 health risks, and health outcomes, and improve the 

22 capacity of the performance measurement infrastruc23 ture to measure such disparities. 


emcdonald on DSK5VPTVN1PROD with BILLS
299 

•HR 2954 IH

1 ‘‘(2) Expand access to services that have been 

2 demonstrated to improve the quality and outcomes 

3 of maternity care for vulnerable populations. 

4 ‘‘(3) Establish a demonstration project to com5 pare the effectiveness of interventions to reduce dis6 parities in maternity services and outcomes, and im7 plement and assess effective interventions. 

8 ‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM9 ONSTRATION PROJECT.—The demonstration project 

10 under subsection (a)(3) shall be conducted in no more 

11 than 8 States, which shall be selected by the Secretary 

12 based on— 

13 ‘‘(1) applications submitted by States, which 

14 specify which regions and populations the State in15 volved will serve under the demonstration project; 

16 ‘‘(2) criteria designed by the Secretary to en17 sure that, as a whole, the demonstration project is, 

18 to the greatest extent possible, representative of the 

19 demographic and geographic composition of commu20 nities most affected by disparities; 

21 ‘‘(3) criteria designed by the Secretary to en22 sure that a variety of type of models are tested 

23 through the demonstration project and that such 

24 models include interventions that have an existing 

25 evidence base for effectiveness; and 


emcdonald on DSK5VPTVN1PROD with BILLS
300 

•HR 2954 IH

1 ‘‘(4) criteria designed by the Secretary to as2 sure that the demonstration projects and models will 

3 be carried out in consultation with local and regional 

4 provider organizations, such as community health 

5 centers, hospital systems, and medical societies rep6 resenting providers of maternity services. 

7 ‘‘(c) DURATION OF DEMONSTRATION PROJECT.— 

8 The demonstration project under subsection (a)(3) shall 

9 begin on January 1, 2012, and end on December 31, 

10 2016. 

11 ‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 

12 The Secretary may make grants to States and health care 

13 providers participating in the demonstration project under 

14 subsection (a)(3) for the purpose of collecting data nec15 essary for the evaluation and monitoring of such project. 

16 ‘‘(e) REPORTS.— 

17 ‘‘(1) STATE REPORTS.—Each State that par18 ticipates in the demonstration project under sub19 section (a)(3) shall report to the Secretary, in a 

20 time, form, and manner specified by the Secretary, 

21 the data necessary to— 

22 ‘‘(A) monitor the— 

23 ‘‘(i) outcomes of the project; 

24 ‘‘(ii) costs of the project; and 


emcdonald on DSK5VPTVN1PROD with BILLS
301 

•HR 2954 IH

1 ‘‘(iii) quality of maternity care pro2 vided under the project; and 

3 ‘‘(B) evaluate the rationale for the selec4 tion of the items and services included in any 

5 bundled payment made by the State under the 

6 project. 

7 ‘‘(2) FINAL REPORT.—Not later than December 

8 31, 2017, the Secretary shall submit to Congress a 

9 report on the results of the demonstration project 

10 under subsection (a)(3).’’. 

11 SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 

12 UNEXPECTED INFANT DEATH AND SUDDEN 

13 UNEXPLAINED DEATH IN CHILDHOOD. 

14 (a) ESTABLISHMENT.—The Secretary of Health and 

15 Human Services acting through the Administrator of the 

16 Health Resources and Services Administration and in con17 sultation with the Director of the Centers for Disease Con18 trol and Prevention and the Director of the National Insti19 tutes of Health (in this section referred to as the ‘‘Sec20 retary’’) shall establish and implement a culturally com21 petent public health awareness and education campaign 

22 to provide information that is focused on decreasing the 

23 risk factors for sudden unexpected infant death and sud24 den unexplained death in childhood, including educating 

25 individuals about safe sleep environments, sleep positions, 


emcdonald on DSK5VPTVN1PROD with BILLS
302 

•HR 2954 IH

1 and reducing exposure to smoking during pregnancy and 

2 after birth. 

3 (b) TARGETED POPULATIONS.—The campaign under 

4 subsection (a) shall be designed to reduce health dispari5 ties through the targeting of populations with high rates 

6 of sudden unexpected infant death and sudden unex7 plained death in childhood. 

8 (c) CONSULTATION.—In establishing and imple9 menting the campaign under subsection (a), the Secretary 

10 shall consult with national organizations representing 

11 health care providers, including nurses and physicians, 

12 parents, child care providers, children’s advocacy and safe13 ty organizations, maternal and child health programs and 

14 women’s, infants, and children nutrition professionals, and 

15 other individuals and groups determined necessary by the 

16 Secretary for such establishment and implementation. 

17 (d) GRANTS.— 

18 (1) IN GENERAL.—In carrying out the cam19 paign under subsection (a), the Secretary shall 

20 award grants to national organizations, State and 

21 local health departments, and community-based or22 ganizations for the conduct of education and out23 reach programs for nurses, parents, child care pro24 viders, public health agencies, and community orga25 nizations. 


emcdonald on DSK5VPTVN1PROD with BILLS
303 

•HR 2954 IH

1 (2) APPLICATION.—To be eligible to receive a 

2 grant under paragraph (1), an entity shall submit to 

3 the Secretary an application at such time, in such 

4 manner, and containing such information as the Sec5 retary may require. 

6 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

7 authorized to be appropriated to carry out this section 

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

9 2012 through 2016. 

10 SEC. 508. REDUCING TEENAGE PREGNANCIES. 

11 Title III of the Public Health Service Act (42 U.S.C. 

12 241 et seq.) is amended by adding at the end the following 

13 new part: 

14 ‘‘PART W—YOUTH PREGNANCY PREVENTION 

15 PROGRAMS 

16 ‘‘SEC. 399OO. PURPOSE. 

17 ‘‘It is the purpose of this part to develop and carry 

18 out research and demonstration projects on new and exist19 ing program interventions to provide youth in racial or 

20 ethnic minority or immigrant communities the information 

21 and skills needed to reduce teenage pregnancies, build 

22 healthy relationships, and improve overall health and well23 being. 


emcdonald on DSK5VPTVN1PROD with BILLS
304 

•HR 2954 IH

1 ‘‘SEC. 399OO–1. DEMONSTRATION GRANTS TO REDUCE 

2 TEENAGE PREGNANCIES. 

3 ‘‘(a) IN GENERAL.—The Secretary shall award com4 petitive grants to eligible entities for establishing or ex5 panding programs to provide youth in racial or ethnic mi6 nority or immigrant communities the information and 

7 skills needed to avoid teenage pregnancy and develop 

8 healthy relationships. 

9 ‘‘(b) PRIORITY.—In awarding grants under this sec10 tion, the Secretary shall give priority to applicants— 

11 ‘‘(1) proposing to carry out projects in racial or 

12 ethnic minority or immigrant communities; 

13 ‘‘(2) that have a demonstrated history of effec14 tively working with such targeted communities; or 

15 ‘‘(3) that have a demonstrated history of engag16 ing in a meaningful and significant partnership with 

17 such targeted communities. 

18 ‘‘(c) PROGRAM SETTINGS.—Programs funded 

19 through a grant under subsection (a) shall be provided— 

20 ‘‘(1) through classroom-based settings, such as 

21 school health education, humanities, language arts, 

22 or family and consumer science education; after23 school programs; community-based programs; work24 force development programs; and health care set25 tings; or 


emcdonald on DSK5VPTVN1PROD with BILLS
305 

•HR 2954 IH

1 ‘‘(2) in collaboration with systems that serve 

2 large numbers of at-risk youth such as juvenile jus3 tice or foster care systems. 

4 ‘‘(d) PROJECT REQUIREMENTS.—As a condition of 

5 receipt of a grant under this section, an entity shall agree 

6 that, with respect to information and skills provided 

7 through the grant— 

8 ‘‘(1) such information and skills will be— 

9 ‘‘(A) age-appropriate; 

10 ‘‘(B) evidence-based or evidence-informed; 

11 ‘‘(C) provided in accordance with section 

12 399OO–5(b); and 

13 ‘‘(D) culturally sensitive and relevant to 

14 the target populations; and 

15 ‘‘(2) any information provided about contracep16 tives shall include the health benefits and side ef17 fects of all contraceptives and barrier methods. 

18 ‘‘(e) EVALUATION.—Of the total amount made avail19 able to carry out this section for a fiscal year, the Sec20 retary, acting through the Director of the Centers for Dis21 ease Control and Prevention and other agencies as appro22 priate, shall allot up to 10 percent of such amount to carry 

23 out a rigorous, independent evaluation to determine the 

24 extent and the effectiveness of activities funded through 

25 this section during such fiscal year in changing attitudes 


emcdonald on DSK5VPTVN1PROD with BILLS
306 

•HR 2954 IH

1 and behavior of teenagers with respect to healthy relation2 ships and childbearing. 

3 ‘‘(f) GRANTS FOR INDIAN TRIBES OR TRIBAL ORGA4 NIZATIONS.—Of the total amount made available to carry 

5 out this section for a fiscal year, the Secretary shall re6 serve 5 percent of such amount to award grants under 

7 this section to Indian tribes and tribal organizations in 

8 such manner, and subject to such requirements, as the 

9 Secretary, in consultation with Indian tribes and tribal or10 ganizations, determines appropriate. 

11 ‘‘(g) ELIGIBLE ENTITY DEFINED.— 

12 ‘‘(1) IN GENERAL.—In this section, the term 

13 ‘eligible entity’ means a State, local, or tribal agen14 cy; a school or postsecondary institution; an after15 school program; a nonprofit organization; or a com16 munity or faith-based organization. 

17 ‘‘(2) PREVENTING EXCLUSION OF SMALLER

18 COMMUNITY-BASED ORGANIZATIONS.—In carrying 

19 out this section, the Secretary shall ensure that the 

20 amounts and requirements of grants provided under 

21 this section do not preclude receipt of such grants 

22 by community-based organizations with a dem23 onstrated history of effectively working with adoles24 cents in racial or ethnic minority or immigrant comVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00306 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
307 

•HR 2954 IH

1 munities or engaged in meaningful and significant 

2 partnership with such communities. 

3 ‘‘SEC. 399OO–2. MULTIMEDIA CAMPAIGNS TO REDUCE 

4 TEENAGE PREGNANCIES. 

5 ‘‘(a) IN GENERAL.—The Secretary shall award com6 petitive grants to public and private entities to carry out 

7 multimedia campaigns to provide public education and in8 crease public awareness regarding teenage pregnancy and 

9 related social and emotional issues, such as violence pre10 vention. 

11 ‘‘(b) PRIORITY.—In awarding grants under this sec12 tion, the Secretary shall give priority to applicants pro13 posing to carry out campaigns developed for racial or eth14 nic minority or immigrant communities. 

15 ‘‘(c) INFORMATION TO BE PROVIDED.—As a condi16 tion of receipt of a grant under this section, an entity shall 

17 agree to use the grant to carry out multimedia campaigns 

18 described in subsection (a) that— 

19 ‘‘(1) at a minimum, shall provide information 

20 on— 

21 ‘‘(A) the prevention of teenage pregnancy; 

22 and 

23 ‘‘(B) healthy relationship development; and 

24 ‘‘(2) may provide information on the prevention 

25 of dating violence. 


emcdonald on DSK5VPTVN1PROD with BILLS
308 

•HR 2954 IH

1 ‘‘SEC. 399OO–3. RESEARCH ON REDUCING TEENAGE PREG2 NANCIES AND TEENAGE DATING VIOLENCE 

3 AND IMPROVING HEALTHY RELATIONSHIPS. 

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

5 the Director of the Centers for Disease Control and Pre6 vention, shall make grants to public and private entities 

7 to conduct, support, or coordinate research on teenage 

8 pregnancy, dating violence, and healthy relationships 

9 among racial or ethnic minority or immigrant communities 

10 that— 

11 ‘‘(1) improves data collection on— 

12 ‘‘(A) sexual and reproductive health, in13 cluding teenage pregnancies and births, among 

14 all minority communities and subpopulations in 

15 which such data are not collected, including 

16 American Indian and Alaska Native youth; 

17 ‘‘(B) sexual behavior, sexual or reproduc18 tive coercion, and teenage contraceptive use 

19 patterns at the State level, as appropriate; and 

20 ‘‘(C) teenage pregnancies among youth in 

21 and aging out of foster care or juvenile justice 

22 systems and the underlying factors that lead to 

23 teenage pregnancy among youth in foster care 

24 or juvenile justice systems; 

25 ‘‘(2) investigates— 


emcdonald on DSK5VPTVN1PROD with BILLS
309 

•HR 2954 IH

1 ‘‘(A) the variance in the rates of teenage 

2 pregnancy by— 

3 ‘‘(i) racial and ethnic group (such as 

4 Hispanic, Asian-American, African-Amer5 ican, Pacific Islander, American Indian, 

6 and Alaska Native); and 

7 ‘‘(ii) socioeconomic status, including 

8 as based on the income of the family and 

9 education attainment; 

10 ‘‘(B) factors affecting the risk for youth of 

11 teenage pregnancy or dating abuse, including 

12 the physical and social environment, level of ac13 culturation, access to health care, aspirations 

14 for the future, and history of physical or sexual 

15 violence or abuse; 

16 ‘‘(C) the role that violence and abuse play 

17 in teenage sex, pregnancy, and childbearing; 

18 ‘‘(D) strategies to address the dispropor19 tionate rates of teenage pregnancies and dating 

20 violence in racial or ethnic minority or immi21 grant communities; 

22 ‘‘(E) how effective interventions can be 

23 replicated or adapted in other settings to serve 

24 racial or ethnic minority or immigrant commu25 nities; and 


emcdonald on DSK5VPTVN1PROD with BILLS
310 

•HR 2954 IH

1 ‘‘(F) the effectiveness of media campaigns 

2 in addressing healthy relationship development, 

3 dating violence prevention, and teenage preg4 nancy; and 

5 ‘‘(3) tests research-based strategies for address6 ing high rates of unintended teenage pregnancy 

7 through programs that emphasize healthy relation8 ships and violence prevention. 

9 ‘‘(b) PRIORITY.—In carrying out this section, the 

10 Secretary shall give priority to research that incor11 porates— 

12 ‘‘(1) interdisciplinary approaches; 

13 ‘‘(2) a strong emphasis on community-based 

14 participatory research; or 

15 ‘‘(3) translational research. 

16 ‘‘SEC. 399OO–4. HHS ADOLESCENT HEALTH WORK GROUP. 

17 ‘‘(a) PURPOSE.—Not later than 30 days after the 

18 date of the enactment of this part, the Secretary shall di19 rect the interagency adolescent health workgroup within 

20 the Office of Adolescent Health of the Department of 

21 Health and Human Services to— 

22 ‘‘(1) include in the work of the group strategies 

23 for teenage dating violence prevention and healthy 

24 teenage relationships with a particular focus among 


emcdonald on DSK5VPTVN1PROD with BILLS
311 

•HR 2954 IH

1 racial or ethnic minority or immigrant communities; 

2 and 

3 ‘‘(2) with respect to including such strategies, 

4 consult, to the greatest extent possible, with the 

5 Federal Interagency Workgroup on Teen Dating Vi6 olence formed under the leadership of the National 

7 Institute of Justice of the Department of Justice. 

8 ‘‘(b) REPORT REQUIREMENT.—The Secretary, 

9 through the Office of Adolescent Health, shall periodically 

10 submit to Congress a report that— 

11 ‘‘(1) includes a review of the evidence-based 

12 programs on preventing teenage pregnancy, which 

13 are carried out and identified by the Office; and 

14 ‘‘(2) identifies the programs of the Department 

15 of Health and Human Services that include teenage 

16 dating violence prevention and the promotion of 

17 healthy teenage relationships as part of a strategy to 

18 prevent teenage pregnancy. 

19 ‘‘SEC. 399OO–5. GENERAL GRANT PROVISIONS. 

20 ‘‘(a) APPLICATIONS.—To seek a grant under this 

21 part, an entity shall submit an application to the Secretary 

22 in such form, in such manner, and containing such agree23 ments, assurances, and information as the Secretary may 

24 require. 


emcdonald on DSK5VPTVN1PROD with BILLS
312 

•HR 2954 IH

1 ‘‘(b) ADDITIONAL REQUIREMENTS.—A grant may be 

2 made under this part only if the applicant involved agrees 

3 that information, activities, and services provided under 

4 the grant— 

5 ‘‘(1) will be evidence-based or evidence in6 formed; 

7 ‘‘(2) will be factually and medically accurate 

8 and complete; and 

9 ‘‘(3) if directed to a particular population 

10 group, will be provided in an appropriate language 

11 and cultural context. 

12 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.— 

13 ‘‘(1) IN GENERAL.—Of the total amount made 

14 available to carry out this part for a fiscal year, the 

15 Secretary shall use 10 percent to provide, directly or 

16 through a competitive grant process, training and 

17 technical assistance to the grant recipients under 

18 this part, including by disseminating research and 

19 information regarding effective and promising prac20 tices, providing consultation and resources on a 

21 broad array of teenage and unintended pregnancy 

22 and violence prevention strategies, and developing 

23 resources and materials. 

24 ‘‘(2) COLLABORATION.—In carrying out this 

25 subsection, the Secretary shall collaborate with entiVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00312 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
313 

•HR 2954 IH

1 ties that have expertise in the prevention of teenage 

2 pregnancy, healthy relationship development, minor3 ity health and health disparities, and violence pre4 vention. 

5 ‘‘SEC. 399OO–6. DEFINITIONS. 

6 ‘‘In this part: 

7 ‘‘(1) MEDICALLY ACCURATE AND COMPLETE.— 

8 The term ‘medically accurate and complete’ means, 

9 with respect to information, activities, or services, 

10 verified or supported by the weight of research con11 ducted in compliance with accepted scientific meth12 ods and— 

13 ‘‘(A) published in peer-reviewed journals, 

14 where applicable; or 

15 ‘‘(B) comprising information that leading 

16 professional organizations and agencies with 

17 relevant expertise in the field recognize as accu18 rate, objective, and complete. 

19 ‘‘(2) RACIAL OR ETHNIC MINORITY OR IMMI20 GRANT COMMUNITIES.—The term ‘racial or ethnic 

21 minority or immigrant communities’ means commu22 nities with a substantial number of residents who 

23 are members of racial or ethnic minority groups or 

24 who are immigrants. 


emcdonald on DSK5VPTVN1PROD with BILLS
314 

•HR 2954 IH

1 ‘‘(3) REPRODUCTIVE COERCION.—The term ‘re2 productive coercion’ means, with respect to a person, 

3 coercive behavior that interferes with the ability of 

4 such person to control the reproductive decision5 making of such person, such as intentionally expos6 ing such person to sexually transmitted infections; in 

7 the case such person is a female, attempting to im8 pregnate such person against her will; intentionally 

9 interfering with the person’s birth control; or threat10 ening or acting violent if the person does not comply 

11 with the perpetrator’s wishes regarding contracep12 tion or the decision whether to terminate or continue 

13 a pregnancy. 

14 ‘‘(4) YOUTH.—The term ‘youth’ means individ15 uals who are 11 to 19 years of age. 

16 ‘‘SEC. 399OO–7. REPORTS. 

17 ‘‘(a) REPORT ON USE OF FUNDS.—Not later than 

18 1 year after the date of the enactment of this part, the 

19 Secretary shall submit to Congress a report on the use 

20 of funds provided pursuant to this part. 

21 ‘‘(b) REPORT ON IMPACT OF PROGRAMS.—Not later 

22 than March 1, 2016, the Secretary shall submit to Con23 gress a report on the impact that the programs under this 

24 part had on reducing teenage pregnancies. 


emcdonald on DSK5VPTVN1PROD with BILLS
315 

•HR 2954 IH

1 ‘‘SEC. 399OO–8. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘(a) IN GENERAL.—There are authorized to be ap3 propriated to carry out this part such sums as may be 

4 necessary for each of the fiscal years 2012 through 2016. 

5 ‘‘(b) AVAILABILITY.—Amounts appropriated pursu6 ant to subsection (a)— 

7 ‘‘(1) are authorized to remain available until ex8 pended; and 

9 ‘‘(2) are in addition to amounts otherwise made 

10 available for such purposes.’’. 

11 SEC. 509. GESTATIONAL DIABETES. 

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

13 (42 U.S.C. 243 et seq.) is amended by adding after section 

14 317H the following: 

15 ‘‘SEC. 317H–1. GESTATIONAL DIABETES. 

16 ‘‘(a) UNDERSTANDING AND MONITORING GESTA17 TIONAL DIABETES.— 

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

19 through the Director of the Centers for Disease 

20 Control and Prevention, in consultation with the Di21 abetes Mellitus Interagency Coordinating Committee 

22 established under section 429 and representatives of 

23 appropriate national health organizations, shall de24 velop a multisite gestational diabetes research 

25 project within the diabetes program of the Centers 

26 for Disease Control and Prevention to expand and 


emcdonald on DSK5VPTVN1PROD with BILLS
316 

•HR 2954 IH

1 enhance surveillance data and public health research 

2 on gestational diabetes. 

3 ‘‘(2) AREAS TO BE ADDRESSED.—The research 

4 project developed under paragraph (1) shall ad5 dress— 

6 ‘‘(A) procedures to establish accurate and 

7 efficient systems for the collection of gestational 

8 diabetes data within each State and common9 wealth, territory, or possession of the United 

10 States; 

11 ‘‘(B) the progress of collaborative activities 

12 with the National Vital Statistics System, the 

13 National Center for Health Statistics, and 

14 State health departments with respect to the 

15 standard birth certificate, in order to improve 

16 surveillance of gestational diabetes; 

17 ‘‘(C) postpartum methods of tracking 

18 women with gestational diabetes after delivery 

19 as well as targeted interventions proven to 

20 lower the incidence of type 2 diabetes in that 

21 population; 

22 ‘‘(D) variations in the distribution of diag23 nosed and undiagnosed gestational diabetes, 

24 and of impaired fasting glucose tolerance and 


emcdonald on DSK5VPTVN1PROD with BILLS
317 

•HR 2954 IH

1 impaired fasting glucose, within and among 

2 groups of women; and 

3 ‘‘(E) factors and culturally sensitive inter4 ventions that influence risks and reduce the in5 cidence of gestational diabetes and related com6 plications during childbirth, including cultural, 

7 behavioral, racial, ethnic, geographic, demo8 graphic, socioeconomic, and genetic factors. 

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

10 date of the enactment of this section, and annually 

11 thereafter, the Secretary shall generate a report on 

12 the findings and recommendations of the research 

13 project including prevalence of gestational diabetes 

14 in the multisite area and disseminate the report to 

15 the appropriate Federal and non-Federal agencies. 

16 ‘‘(b) EXPANSION OF GESTATIONAL DIABETES RE17 SEARCH.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall expand 

19 and intensify public health research regarding gesta20 tional diabetes. Such research may include— 

21 ‘‘(A) developing and testing novel ap22 proaches for improving postpartum diabetes 

23 testing or screening and for preventing type 2 

24 diabetes in women with a history of gestational 

25 diabetes; and 


emcdonald on DSK5VPTVN1PROD with BILLS
318 

•HR 2954 IH

1 ‘‘(B) conducting public health research to 

2 further understanding of the epidemiologic, 

3 socioenvironmental, behavioral, translation, and 

4 biomedical factors and health systems that in5 fluence the risk of gestational diabetes and the 

6 development of type 2 diabetes in women with 

7 a history of gestational diabetes. 

8 ‘‘(2) AUTHORIZATION OF APPROPRIATIONS.— 

9 There is authorized to be appropriated to carry out 

10 this subsection $5,000,000 for each of fiscal years 

11 2012 through 2016. 

12 ‘‘(c) DEMONSTRATION GRANTS TO LOWER THE

13 RATE OF GESTATIONAL DIABETES.— 

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

15 through the Director of the Centers for Disease 

16 Control and Prevention, shall award grants, on a 

17 competitive basis, to eligible entities for demonstra18 tion projects that implement evidence-based inter19 ventions to reduce the incidence of gestational diabe20 tes, the recurrence of gestational diabetes in subse21 quent pregnancies, and the development of type 2 di22 abetes in women with a history of gestational diabe23 tes. 


emcdonald on DSK5VPTVN1PROD with BILLS
319 

•HR 2954 IH

1 ‘‘(2) PRIORITY.—In making grants under this 

2 subsection, the Secretary shall give priority to 

3 projects focusing on— 

4 ‘‘(A) helping women who have 1 or more 

5 risk factors for developing gestational diabetes; 

6 ‘‘(B) working with women with a history of 

7 gestational diabetes during a previous preg8 nancy; 

9 ‘‘(C) providing postpartum care for women 

10 with gestational diabetes; 

11 ‘‘(D) tracking cases where women with a 

12 history of gestational diabetes developed type 2 

13 diabetes; 

14 ‘‘(E) educating mothers with a history of 

15 gestational diabetes about the increased risk of 

16 their child developing diabetes; 

17 ‘‘(F) working to prevent gestational diabe18 tes and prevent or delay the development of 

19 type 2 diabetes in women with a history of ges20 tational diabetes; and 

21 ‘‘(G) achieving outcomes designed to assess 

22 the efficacy and cost-effectiveness of interven23 tions that can inform decisions on long-term 

24 sustainability, including third-party reimburse25 ment. 


emcdonald on DSK5VPTVN1PROD with BILLS
320 

•HR 2954 IH

1 ‘‘(3) APPLICATION.—An eligible entity desiring 

2 to receive a grant under this subsection shall submit 

3 to the Secretary— 

4 ‘‘(A) an application at such time, in such 

5 manner, and containing such information as the 

6 Secretary may require; and 

7 ‘‘(B) a plan to— 

8 ‘‘(i) lower the rate of gestational dia9 betes during pregnancy; or 

10 ‘‘(ii) develop methods of tracking 

11 women with a history of gestational diabe12 tes and develop effective interventions to 

13 lower the incidence of the recurrence of 

14 gestational diabetes in subsequent preg15 nancies and the development of type 2 dia16 betes. 

17 ‘‘(4) USES OF FUNDS.—An eligible entity re18 ceiving a grant under this subsection shall use the 

19 grant funds to carry out demonstration projects de20 scribed in paragraph (1), including— 

21 ‘‘(A) expanding community-based health 

22 promotion education, activities, and incentives 

23 focused on the prevention of gestational diabe24 tes and development of type 2 diabetes in 

25 women with a history of gestational diabetes; 


emcdonald on DSK5VPTVN1PROD with BILLS
321 

•HR 2954 IH

1 ‘‘(B) aiding State- and tribal-based diabe2 tes prevention and control programs to collect, 

3 analyze, disseminate, and report surveillance 

4 data on women with, and at risk for, gesta5 tional diabetes, the recurrence of gestational di6 abetes in subsequent pregnancies, and, for 

7 women with a history of gestational diabetes, 

8 the development of type 2 diabetes; and 

9 ‘‘(C) training and encouraging health care 

10 providers— 

11 ‘‘(i) to promote risk assessment, high12 quality care, and self-management for ges13 tational diabetes and the recurrence of ges14 tational diabetes in subsequent preg15 nancies; and 

16 ‘‘(ii) to prevent the development of 

17 type 2 diabetes in women with a history of 

18 gestational diabetes, and its complications 

19 in the practice settings of the health care 

20 providers. 

21 ‘‘(5) REPORT.—Not later than 4 years after the 

22 date of the enactment of this section, the Secretary 

23 shall prepare and submit to the Congress a report 

24 concerning the results of the demonstration projects 


emcdonald on DSK5VPTVN1PROD with BILLS
322 

•HR 2954 IH

1 conducted through the grants awarded under this 

2 subsection. 

3 ‘‘(6) DEFINITION OF ELIGIBLE ENTITY.—In 

4 this subsection, the term ‘eligible entity’ means a 

5 nonprofit organization (such as a nonprofit academic 

6 center or community health center) or a State, trib7 al, or local health agency. 

8 ‘‘(7) AUTHORIZATION OF APPROPRIATIONS.— 

9 There is authorized to be appropriated to carry out 

10 this subsection $5,000,000 for each of fiscal years 

11 2012 through 2016. 

12 ‘‘(d) POSTPARTUM FOLLOW-UP REGARDING GESTA13 TIONAL DIABETES.—The Secretary, acting through the 

14 Director of the Centers for Disease Control and Preven15 tion, shall work with the State- and tribal-based diabetes 

16 prevention and control programs assisted by the Centers 

17 to encourage postpartum follow-up after gestational diabe18 tes, as medically appropriate, for the purpose of reducing 

19 the incidence of gestational diabetes, the recurrence of 

20 gestational diabetes in subsequent pregnancies, the devel21 opment of type 2 diabetes in women with a history of ges22 tational diabetes, and related complications.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
323 

•HR 2954 IH

1 SEC. 510. EMERGENCY CONTRACEPTION EDUCATION AND 

2 INFORMATION PROGRAMS. 

3 (a) EMERGENCY CONTRACEPTION PUBLIC EDU4 CATION PROGRAM.— 

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

6 through the Director of the Centers for Disease 

7 Control and Prevention, shall develop and dissemi8 nate to the public information on emergency contra9 ception. 

10 (2) DISSEMINATION.—The Secretary may dis11 seminate information under paragraph (1) directly 

12 or through arrangements with nonprofit organiza13 tions, consumer groups, institutions of higher edu14 cation, clinics, the media, and Federal, State, and 

15 local agencies. 

16 (3) INFORMATION.—The information dissemi17 nated under paragraph (1) shall include, at a min18 imum, a description of emergency contraception and 

19 an explanation of the use, safety, efficacy, and avail20 ability of such contraception. 

21 (b) EMERGENCY CONTRACEPTION INFORMATION

22 PROGRAM FOR HEALTH CARE PROVIDERS.— 

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

24 through the Administrator of the Health Resources 

25 and Services Administration and in consultation 

26 with major medical and public health organizations, 


emcdonald on DSK5VPTVN1PROD with BILLS
324 

•HR 2954 IH

1 shall develop and disseminate to health care pro2 viders information on emergency contraception. 

3 (2) INFORMATION.—The information dissemi4 nated under paragraph (1) shall include, at a min5 imum— 

6 (A) information describing the use, safety, 

7 efficacy, and availability of emergency contra8 ception; 

9 (B) a recommendation regarding the use of 

10 such contraception in appropriate cases; and 

11 (C) information explaining how to obtain 

12 copies of the information developed under sub13 section (a) for distribution to the patients of 

14 the providers. 

15 (c) DEFINITIONS.—In this section: 

16 (1) EMERGENCY CONTRACEPTION.—The term 

17 ‘‘emergency contraception’’ means a drug or device 

18 (as the terms are defined in section 201 of the Fed19 eral Food, Drug, and Cosmetic Act (21 U.S.C. 321)) 

20 or a drug regimen that— 

21 (A) is used postcoitally; 

22 (B) prevents pregnancy primarily by pre23 venting or delaying ovulation, and does not ter24 minate an established pregnancy; and 


emcdonald on DSK5VPTVN1PROD with BILLS
325 

•HR 2954 IH

1 (C) is approved by the Food and Drug Ad2 ministration. 

3 (2) HEALTH CARE PROVIDER.—The term 

4 ‘‘health care provider’’ means an individual who is li5 censed or certified under State law to provide health 

6 care services and who is operating within the scope 

7 of such license. Such term shall include a phar8 macist. 

9 (3) INSTITUTION OF HIGHER EDUCATION.—The 

10 term ‘‘institution of higher education’’ has the same 

11 meaning given such term in section 101(a) of the 

12 Higher Education Act of 1965 (20 U.S.C. 1001(a)). 

13 (4) SECRETARY.—The term ‘‘Secretary’’ means 

14 the Secretary of Health and Human Services. 

15 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

16 are authorized to be appropriated to carry out this section 

17 such sums as may be necessary for each of the fiscal years 

18 2012 through 2016. 

19 SEC. 511. SUPPORTING HEALTHY ADOLESCENT DEVELOP20 MENT. 

21 (a) IN GENERAL.—The Secretary may award a grant 

22 to each eligible State to conduct programs of sex education 

23 described in subsection (b), including education on both 

24 abstinence and contraception for the prevention of teenage 


emcdonald on DSK5VPTVN1PROD with BILLS
326 

•HR 2954 IH

1 pregnancy and sexually transmitted diseases, including 

2 HIV/AIDS. 

3 (b) REQUIREMENTS FOR SEX EDUCATION PRO4 GRAMS.—A program of sex education described in this 

5 subsection is a program that— 

6 (1) is age appropriate and medically accurate; 

7 (2) stresses the value of abstinence while not ig8 noring those young people who have been or are sex9 ually active; 

10 (3) provides information about the health bene11 fits and side effects of contraceptive and barrier 

12 methods used— 

13 (A) as a means to prevent pregnancy; and 

14 (B) to reduce the risk of contracting sexu15 ally transmitted disease, including HIV/AIDS; 

16 (4) encourages family communication between 

17 parent and child about sexuality; 

18 (5) cultivates a respectful dialogue about sexu19 ality, including sexual orientation and gender iden20 tity, and embraces the principles of nondiscrimina21 tion based on sexual orientation and gender identity; 

22 (6) counters the perpetuation of narrow gender 

23 roles, including the sexualization of female children, 

24 adolescents, and adults; 


emcdonald on DSK5VPTVN1PROD with BILLS
327 

•HR 2954 IH

1 (7) teaches young people the skills to make re2 sponsible decisions about sexuality, including how to 

3 avoid unwanted verbal, physical, and sexual ad4 vances and how to avoid making verbal, physical, 

5 and sexual advances that are not wanted by the 

6 other party; 

7 (8) develops healthy relationships, including the 

8 prevention of dating and sexual violence; 

9 (9) teaches young people how alcohol and drug 

10 use can affect responsible decisionmaking; and 

11 (10) does not teach or promote religion. 

12 (c) ADDITIONAL ACTIVITIES.—In carrying out a pro13 gram of sex education, a State may expend grant funds 

14 awarded under subsection (a) to carry out educational and 

15 motivational activities that help young people— 

16 (1) gain knowledge about the physical, emo17 tional, biological, and hormonal changes of adoles18 cence and subsequent stages of human maturation; 

19 (2) develop the knowledge and skills necessary 

20 to ensure and protect their sexual and reproductive 

21 health from unintended pregnancy and sexually 

22 transmitted disease, including HIV/AIDS, through23 out their lifespan; 


emcdonald on DSK5VPTVN1PROD with BILLS
328 

•HR 2954 IH

1 (3) gain knowledge about the specific involve2 ment and responsibility of each individual in sexual 

3 decisionmaking; 

4 (4) develop healthy attitudes and values about 

5 adolescent growth and development, body image, 

6 gender roles, racial and ethnic diversity, sexual ori7 entation and gender identity, and other subjects; 

8 (5) develop and practice healthy life skills in9 cluding goal-setting, decisionmaking, negotiation, 

10 communication, and stress management; and 

11 (6) promote self-esteem and positive inter12 personal skills focusing on relationship dynamics, in13 cluding friendships, dating, romantic involvement, 

14 marriage, and family interactions. 

15 (d) MATCHING FUNDS.—The Secretary may not 

16 make payments to a State under this section in an amount 

17 exceeding Federal medical assistance percentage for such 

18 State (as such term is defined in section 1905(b) of the 

19 Social Security Act (42 U.S.C. 1396d(b))) of the costs of 

20 the programs conducted by the State under this section. 

21 (e) EVALUATION OF PROGRAMS.— 

22 (1) IN GENERAL.—For the purpose of evalu23 ating the effectiveness of programs of sex education 

24 carried out with a grant under this section, evaluaVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
329 

•HR 2954 IH

1 tions shall be carried out in accordance with para2 graphs (2) and (3). 

3 (2) NATIONAL EVALUATION.— 

4 (A) METHOD.—The Secretary shall pro5 vide for a national evaluation of a representa6 tive sample of programs of sex education car7 ried out with grants under this section to deter8 mine— 

9 (i) the effectiveness of such programs 

10 in helping to delay the initiation of sexual 

11 intercourse and other high-risk behaviors; 

12 (ii) the effectiveness of such programs 

13 in preventing adolescent pregnancy; 

14 (iii) the effectiveness of such pro15 grams in preventing sexually transmitted 

16 disease, including HIV/AIDS; 

17 (iv) the effectiveness of such programs 

18 in increasing contraceptive knowledge and 

19 contraceptive behaviors when sexual inter20 course occurs; and 

21 (v) a list of best practices based upon 

22 essential programmatic components of 

23 evaluated programs that have led to suc24 cess described in clauses (i) through (iv). 


emcdonald on DSK5VPTVN1PROD with BILLS
330 

•HR 2954 IH

1 (B) GRANT CONDITION.—A condition for 

2 the receipt of a grant to a State under this sec3 tion is that the State cooperate with the evalua4 tion under subparagraph (A). 

5 (C) REPORT.—The Secretary shall submit 

6 to the Congress— 

7 (i) not later than the end of each fis8 cal year during the 5-year period beginning 

9 with fiscal year 2012, an interim report on 

10 the national evaluation under subpara11 graph (A); and 

12 (ii) not later than March 31, 2017, a 

13 final report providing the results of such 

14 national evaluation. 

15 (3) INDIVIDUAL STATE EVALUATIONS.—A con16 dition for the receipt of a grant under this section 

17 is that the State evaluate of the programs of sex 

18 education funded through such grant in accordance 

19 with the following requirements: 

20 (A) The evaluation will be conducted by an 

21 external, independent entity. 

22 (B) The purposes of the evaluation will be 

23 the determination of— 


emcdonald on DSK5VPTVN1PROD with BILLS
331 

•HR 2954 IH

1 (i) the effectiveness of such programs 

2 in helping to delay the initiation of sexual 

3 intercourse and other high-risk behaviors; 

4 (ii) the effectiveness of such programs 

5 in preventing adolescent pregnancy; 

6 (iii) the effectiveness of such pro7 grams in preventing sexually transmitted 

8 disease, including HIV/AIDS; and 

9 (iv) the effectiveness of such programs 

10 in increasing contraceptive and barrier 

11 method knowledge and contraceptive be12 haviors when sexual intercourse occurs. 

13 (f) LIMITATIONS ON USE OF FUNDS.— 

14 (1) LIMITATIONS ON SECRETARY.—Of the 

15 amounts appropriated for a fiscal year for purposes 

16 of this section, the Secretary may not use more 

17 than— 

18 (A) 7 percent of such amounts for admin19 istrative expenses related to carrying out this 

20 section for that fiscal year; and 

21 (B) 10 percent of such amounts for the 

22 national evaluation under subsection (e)(2). 

23 (2) LIMITATIONS TO STATES.—Of amounts pro24 vided to an eligible State under this subsection, the 

25 State may not use more than 10 percent of the 


emcdonald on DSK5VPTVN1PROD with BILLS
332 

•HR 2954 IH

1 grant to conduct any evaluation under subsection 

2 (e)(3). 

3 (g) NONDISCRIMINATION REQUIRED.—Programs 

4 funded under this section shall not discriminate on the 

5 basis of sex, race, ethnicity, national origin, disability, reli6 gion, marital status, familial status, sexual orientation, or 

7 gender identity. Nothing in this section shall be construed 

8 to invalidate or limit rights, remedies, procedures, or legal 

9 standards available to victims of discrimination under any 

10 other Federal law or any law of a State or a political sub11 division of a State, including title VI of the Civil Rights 

12 Act of 1964 (42 U.S.C. 2000d et seq.), title IX of the 

13 Education Amendments of 1972 (20 U.S.C. 1681 et seq.), 

14 section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 

15 794), and the Americans with Disabilities Act of 1990 (42 

16 U.S.C. 12101 et seq.). 

17 (h) DEFINITIONS.—For purposes of this section: 

18 (1) The term ‘‘age appropriate’’ means, with re19 spect to topics, messages, and teaching methods, 

20 those suitable to particular ages or age groups of 

21 children, adolescents, and adults, based on devel22 oping cognitive, emotional, and behavioral capacity 

23 typical for the age or age group. 

24 (2) The term ‘‘eligible State’’ means a State 

25 that submits to the Secretary an application for a 


emcdonald on DSK5VPTVN1PROD with BILLS
333 

•HR 2954 IH

1 grant under this section that is in such form, is 

2 made in such manner, and contains such agree3 ments, assurances, and information as the Secretary 

4 determines to be necessary to carry out this section. 

5 (3) The term ‘‘HIV/AIDS’’ means the human 

6 immunodeficiency virus, and includes acquired im7 mune deficiency syndrome. 

8 (4) The term ‘‘medically accurate’’, with respect 

9 to information, means information that is supported 

10 by research, recognized as accurate and objective by 

11 leading medical, psychological, psychiatric, and pub12 lic health organizations and agencies, and, published 

13 in journals that are peer reviewed. 

14 (5) The term ‘‘State’’ means the 50 States, the 

15 District of Columbia, the Commonwealth of Puerto 

16 Rico, the Commonwealth of the Northern Mariana 

17 Islands, American Samoa, Guam, the United States 

18 Virgin Islands, and any other territory or possession 

19 of the United States. 

20 (i) AUTHORIZATION OF APPROPRIATIONS.—For the 

21 purpose of carrying out this section, there is authorized 

22 to be appropriated $50,000,000 for each of the fiscal years 

23 2012 through 2016. 


emcdonald on DSK5VPTVN1PROD with BILLS
334 

•HR 2954 IH

1 TITLE VI—MENTAL HEALTH 

2 SEC. 601. COVERAGE OF MARRIAGE AND FAMILY THERA3 PIST SERVICES AND MENTAL HEALTH COUN4 SELOR SERVICES UNDER PART B OF THE 

5 MEDICARE PROGRAM. 

6 (a) COVERAGE OF SERVICES.— 

7 (1) IN GENERAL.—Section 1861(s)(2) of the 

8 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

9 amended— 

10 (A) in subparagraph (EE), by striking 

11 ‘‘and’’ at the end; 

12 (B) in subparagraph (FF), by inserting 

13 ‘‘and’’ at the end; and 

14 (C) by adding at the end the following new 

15 subparagraph: 

16 ‘‘(GG) marriage and family therapist services 

17 (as defined in subsection (kkk)(1)) and mental 

18 health counselor services (as defined in subsection 

19 (kkk)(3));’’. 

20 (2) DEFINITIONS.—Section 1861 of such Act 

21 (42 U.S.C. 1395x), as amended by sections 

22 202(b)(1)(A) and 423(a), is amended by adding at 

23 the end the following new subsection: 


emcdonald on DSK5VPTVN1PROD with BILLS
335 

•HR 2954 IH

1 ‘‘Marriage and Family Therapist Services; Marriage and 

2 Family Therapist; Mental Health Counselor Serv3 ices; Mental Health Counselor 

4 ‘‘(kkk)(1) The term ‘marriage and family therapist 

5 services’ means services performed by a marriage and 

6 family therapist (as defined in paragraph (2)) for the diag7 nosis and treatment of mental illnesses, which the mar8 riage and family therapist is legally authorized to perform 

9 under State law (or the State regulatory mechanism pro10 vided by State law) of the State in which such services 

11 are performed, as would otherwise be covered if furnished 

12 by a physician or as an incident to a physician’s profes13 sional service, but only if no facility or other provider 

14 charges or is paid any amounts with respect to the fur15 nishing of such services. 

16 ‘‘(2) The term ‘marriage and family therapist’ means 

17 an individual who— 

18 ‘‘(A) possesses a master’s or doctoral degree 

19 which qualifies for licensure or certification as a 

20 marriage and family therapist pursuant to State 

21 law; 

22 ‘‘(B) after obtaining such degree has performed 

23 at least 2 years of clinical supervised experience in 

24 marriage and family therapy; and 


emcdonald on DSK5VPTVN1PROD with BILLS
336 

•HR 2954 IH

1 ‘‘(C) in the case of an individual performing 

2 services in a State that provides for licensure or cer3 tification of marriage and family therapists, is li4 censed or certified as a marriage and family thera5 pist in such State. 

6 ‘‘(3) The term ‘mental health counselor services’ 

7 means services performed by a mental health counselor (as 

8 defined in paragraph (4)) for the diagnosis and treatment 

9 of mental illnesses which the mental health counselor is 

10 legally authorized to perform under State law (or the 

11 State regulatory mechanism provided by the State law) of 

12 the State in which such services are performed, as would 

13 otherwise be covered if furnished by a physician or as inci14 dent to a physician’s professional service, but only if no 

15 facility or other provider charges or is paid any amounts 

16 with respect to the furnishing of such services. 

17 ‘‘(4) The term ‘mental health counselor’ means an 

18 individual who— 

19 ‘‘(A) possesses a master’s or doctor’s degree in 

20 mental health counseling or a related field; 

21 ‘‘(B) after obtaining such a degree has per22 formed at least 2 years of supervised mental health 

23 counselor practice; and 

24 ‘‘(C) in the case of an individual performing 

25 services in a State that provides for licensure or cerVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
337 

•HR 2954 IH

1 tification of mental health counselors or professional 

2 counselors, is licensed or certified as a mental health 

3 counselor or professional counselor in such State.’’. 

4 (3) PROVISION FOR PAYMENT UNDER PART

5 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 

6 1395k(a)(2)(B)) is amended by adding at the end 

7 the following new clause: 

8 ‘‘(v) marriage and family therapist 

9 services and mental health counselor serv10 ices;’’. 

11 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

12 of such Act (42 U.S.C. 1395l(a)(1)) is amended— 

13 (A) by striking ‘‘and (Z)’’ and inserting 

14 ‘‘(Z)’’; and 

15 (B) by inserting before the semicolon at 

16 the end the following: ‘‘, and (AA) with respect 

17 to marriage and family therapist services and 

18 mental health counselor services under section 

19 1861(s)(2)(GG), the amounts paid shall be 80 

20 percent of the lesser of the actual charge for 

21 the services or 75 percent of the amount deter22 mined for payment of a psychologist under sub23 paragraph (L)’’. 

24 (5) EXCLUSION OF MARRIAGE AND FAMILY

25 THERAPIST SERVICES AND MENTAL HEALTH COUNVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
338 

•HR 2954 IH

1 SELOR SERVICES FROM SKILLED NURSING FACILITY

2 PROSPECTIVE PAYMENT SYSTEM.—Section 

3 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 

4 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar5 riage and family therapist services (as defined in 

6 section 1861(kkk)(1)), mental health counselor serv7 ices (as defined in section 1861(kkk)(3)),’’ after 

8 ‘‘qualified psychologist services,’’. 

9 (6) INCLUSION OF MARRIAGE AND FAMILY

10 THERAPISTS AND MENTAL HEALTH COUNSELORS AS

11 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec12 tion 1842(b)(18)(C) of such Act (42 U.S.C. 

13 1395u(b)(18)(C)) is amended by adding at the end 

14 the following new clauses: 

15 ‘‘(vii) A marriage and family therapist (as de16 fined in section 1861(kkk)(2)). 

17 ‘‘(viii) A mental health counselor (as defined in 

18 section 1861(kkk)(4)).’’. 

19 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV20 ICES PROVIDED IN CERTAIN SETTINGS.— 

21 (1) RURAL HEALTH CLINICS AND FEDERALLY

22 QUALIFIED HEALTH CENTERS.—Section 

23 1861(aa)(1)(B) of the Social Security Act (42 

24 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

25 by a clinical social worker (as defined in subsection 


emcdonald on DSK5VPTVN1PROD with BILLS
339 

•HR 2954 IH

1 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 

2 (as defined in subsection (hh)(1)), by a marriage 

3 and family therapist (as defined in subsection 

4 (kkk)(2)), or by a mental health counselor (as de5 fined in subsection (kkk)(4)),’’. 

6 (2) HOSPICE PROGRAMS.—Section 

7 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 

8 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 

9 one marriage and family therapist (as defined in 

10 subsection (kkk)(2))’’ after ‘‘social worker’’. 

11 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

12 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST13 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So14 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 

15 by inserting ‘‘marriage and family therapist (as defined 

16 in subsection (kkk)(2)),’’ after ‘‘social worker,’’. 

17 (d) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply with respect to services furnished 

19 on or after January 1, 2012. 

20 SEC. 602. COMMUNITY MENTAL HEALTH AND ADDICTION 

21 SAFETY NET EQUITY ACT. 

22 (a) FEDERALLY QUALIFIED BEHAVIORAL HEALTH

23 CENTERS.—Section 1913 of the Public Health Service Act 

24 (42 U.S.C. 300x–3) is amended— 


emcdonald on DSK5VPTVN1PROD with BILLS
340 

•HR 2954 IH

1 (1) in subsection (a)(2)(A), by striking ‘‘com2 munity mental health services’’ and inserting ‘‘be3 havioral health services (of the type offered by feder4 ally qualified behavioral health centers consistent 

5 with subsection (c)(3))’’; 

6 (2) in subsection (b)— 

7 (A) by striking paragraph (1) and insert8 ing the following: 

9 ‘‘(1) services under the plan will be provided 

10 only through appropriate, qualified community pro11 grams (which may include federally qualified behav12 ioral health centers, child mental health programs, 

13 psychosocial rehabilitation programs, mental health 

14 peer-support programs, and mental health primary 

15 consumer-directed programs); and’’; and 

16 (B) in paragraph (2), by striking ‘‘commu17 nity mental health centers’’ and inserting ‘‘fed18 erally qualified behavioral health centers’’; and 

19 (3) by striking subsection (c) and inserting the 

20 following: 

21 ‘‘(c) CRITERIA FOR FEDERALLY QUALIFIED BEHAV22 IORAL HEALTH CENTERS.— 

23 ‘‘(1) IN GENERAL.—The Administrator shall 

24 certify, and recertify at least every 5 years, federally 


emcdonald on DSK5VPTVN1PROD with BILLS
341 

•HR 2954 IH

1 qualified behavioral health centers as meeting the 

2 criteria specified in this subsection. 

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

4 after the date of the enactment of this section, the 

5 Administrator shall issue final regulations for certi6 fying nonprofit or local government centers as cen7 ters under paragraph (1). 

8 ‘‘(3) CRITERIA.—The criteria referred to in 

9 subsection (b)(2) are that the center performs each 

10 of the following: 

11 ‘‘(A) Provide services in locations that en12 sure services will be promptly available, be 

13 physically accessible, provide reasonable policy 

14 modifications, and be provided in a manner 

15 which preserves human dignity and assures con16 tinuity of care. 

17 ‘‘(B) Provide services in a mode of service 

18 delivery appropriate for the target population. 

19 ‘‘(C) Provide individuals with a choice of 

20 service options where there is more than one ef21 ficacious treatment. 

22 ‘‘(D) Employ a core staff of clinical staff 

23 that is multidisciplinary and culturally and lin24 guistically competent. 


emcdonald on DSK5VPTVN1PROD with BILLS
342 

•HR 2954 IH

1 ‘‘(E) Provide services, within the limits of 

2 the capacities of the center, to any individual 

3 residing or employed in the service area of the 

4 center, regardless of the ability of the individual 

5 to pay. 

6 ‘‘(F) Provide, directly or through contract, 

7 to the extent covered for adults in the State 

8 Medicaid plan under title XIX of the Social Se9 curity Act and for children in accordance with 

10 section 1905(r) of such Act regarding early and 

11 periodic screening, diagnosis, and treatment, 

12 each of the following services: 

13 ‘‘(i) Screening, assessment, and diag14 nosis, including risk assessment. 

15 ‘‘(ii) Person-centered treatment plan16 ning or similar processes, including risk as17 sessment and crisis planning. 

18 ‘‘(iii) Outpatient clinic mental health 

19 services, including screening, assessment, 

20 diagnosis, psychotherapy, substance abuse 

21 counseling, medication management, and 

22 integrated treatment for mental illness and 

23 substance abuse which shall be evidence24 based (including cognitive behavioral therVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00342 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
343 

•HR 2954 IH

1 apy and other such therapies which are 

2 evidence-based). 

3 ‘‘(iv) Outpatient clinic primary care 

4 services, including screening and moni5 toring of key health indicators and health 

6 risk (including screening for diabetes, hy7 pertension, and cardiovascular disease and 

8 monitoring of weight, height, body mass 

9 index (BMI), blood pressure, blood glucose 

10 or HbA1C, and lipid profile). 

11 ‘‘(v) Crisis mental health services, in12 cluding 24-hour mobile crisis teams, emer13 gency crisis intervention services, and cri14 sis stabilization. 

15 ‘‘(vi) Targeted case management 

16 (services to assist individuals gaining ac17 cess to needed medical, social, educational, 

18 and other home- and community-based 

19 services and applying for income security 

20 and other benefits to which they may be 

21 entitled). 

22 ‘‘(vii) Psychiatric rehabilitation serv23 ices including skills training, assertive com24 munity treatment, family psychoeducation, 

25 disability self-management, supported emVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00343 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
344 

•HR 2954 IH

1 ployment, supported housing services, 

2 therapeutic foster care services, and such 

3 other evidence-based practices as the Sec4 retary may require. 

5 ‘‘(viii) Peer support and counselor 

6 services and family supports. 

7 ‘‘(G) Maintain linkages, and where possible 

8 enter into formal contracts with the following: 

9 ‘‘(i) Inpatient psychiatric facilities and 

10 substance abuse detoxification and residen11 tial programs. 

12 ‘‘(ii) Adult and youth peer support 

13 and counselor services. 

14 ‘‘(iii) Family support services for fam15 ilies of children with serious mental dis16 orders. 

17 ‘‘(iv) Other home- and community18 based or regional services, supports, and 

19 providers, including schools, child welfare 

20 agencies, juvenile and criminal justice 

21 agencies and facilities, housing agencies 

22 and programs, employers, and other social 

23 services. 

24 ‘‘(v) Onsite or offsite access to pri25 mary care services. 


emcdonald on DSK5VPTVN1PROD with BILLS
345 

•HR 2954 IH

1 ‘‘(vi) Enabling services, including out2 reach, transportation, and translation. 

3 ‘‘(vii) Health and wellness services, in4 cluding services for tobacco cessation.’’. 

5 (b) MEDICAID COVERAGE AND PAYMENT FOR FED6 ERALLY QUALIFIED BEHAVIORAL HEALTH CENTER

7 SERVICES.— 

8 (1) PAYMENT FOR SERVICES PROVIDED BY

9 FEDERALLY QUALIFIED BEHAVIORAL HEALTH CEN10 TERS.—Section 1902(bb) of the Social Security Act 

11 (42 U.S.C. 1396a(bb)) is amended— 

12 (A) in the heading, by striking ‘‘AND

13 RURAL HEALTH CLINICS’’ and inserting ‘‘, 

14 FEDERALLY QUALIFIED BEHAVIORAL HEALTH

15 CENTERS, AND RURAL HEALTH CLINICS’’; 

16 (B) in paragraph (1), by inserting ‘‘(and 

17 beginning with fiscal year 2012 with respect to 

18 services furnished on or after January 1, 2012, 

19 and each succeeding fiscal year, for services de20 scribed in section 1905(a)(2)(D) furnished by a 

21 federally qualified behavioral health center)’’ 

22 after ‘‘by a rural health clinic’’; 

23 (C) in paragraph (2)— 

24 (i) by striking the heading and insert25 ing ‘‘INITIAL FISCAL YEAR’’; 


emcdonald on DSK5VPTVN1PROD with BILLS
346 

•HR 2954 IH

1 (ii) by inserting ‘‘(or, in the case of 

2 services described in section 1905(a)(2)(D) 

3 furnished by a federally qualified behav4 ioral health center, for services furnished 

5 on and after January 1, 2012, during fis6 cal year 2012)’’ after ‘‘January 1, 2001, 

7 during fiscal year 2001’’; 

8 (iii) by inserting ‘‘(or, in the case of 

9 services described in section 1905(a)(2)(D) 

10 furnished by a federally qualified behav11 ioral health center, during fiscal years 

12 2010 and 2011)’’ after ‘‘1999 and 2000’’; 

13 and 

14 (iv) by inserting ‘‘(or, in the case of 

15 services described in section 1905(a)(2)(D) 

16 furnished by a federally qualified behav17 ioral health center, during fiscal year 

18 2012)’’ before the period; 

19 (D) in paragraph (3)— 

20 (i) in the heading, by striking ‘‘FIS21 CAL YEAR 2002 AND SUCCEEDING’’ and in22 serting ‘‘SUCCEEDING’’; and 

23 (ii) by inserting ‘‘(or, in the case of 

24 services described in section 1905(a)(2)(D) 

25 furnished by a federally qualified behavVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
347 

•HR 2954 IH

1 ioral health center, for services furnished 

2 during fiscal year 2013 or a succeeding fis3 cal year)’’ after ‘‘2002 or a succeeding fis4 cal year’’; 

5 (E) in paragraph (4)— 

6 (i) by inserting ‘‘(or as a federally 

7 qualified behavioral health center after fis8 cal year 2011’’ after ‘‘or rural health clinic 

9 after fiscal year 2000’’; 

10 (ii) by striking ‘‘furnished by the cen11 ter or’’ and inserting ‘‘furnished by the 

12 federally qualified health center, services 

13 described in section 1905(a)(2)(D) fur14 nished by the federally qualified behavioral 

15 health center, or’’; 

16 (iii) in the second sentence, by strik17 ing ‘‘or rural health clinic’’ and inserting 

18 ‘‘, federally qualified behavioral health cen19 ter, or rural health clinic’’; 

20 (F) in paragraph (5), in each of subpara21 graphs (A) and (B), by striking ‘‘or rural 

22 health clinic’’ and inserting ‘‘, federally quali23 fied behavioral health center, or rural health 

24 clinic’’; and 


emcdonald on DSK5VPTVN1PROD with BILLS
348 

•HR 2954 IH

1 (G) in paragraph (6), by striking ‘‘or to a 

2 rural health clinic’’ and inserting ‘‘, to a feder3 ally qualified behavioral health center for serv4 ices described in section 1905(a)(2)(D), or to a 

5 rural health clinic’’. 

6 (2) INCLUSION OF FEDERALLY QUALIFIED BE7 HAVIORAL HEALTH CENTER SERVICES IN THE TERM

8 MEDICAL ASSISTANCE.—Section 1905(a)(2) of the 

9 Social Security Act (42 U.S.C. 1396d(a)(2)) is 

10 amended— 

11 (A) by striking ‘‘and’’ before ‘‘(C)’’; and 

12 (B) by inserting before the semicolon at 

13 the end the following: ‘‘, and (D) federally 

14 qualified behavioral health center services (as 

15 defined in subsection (l)(4))’’. 

16 (3) DEFINITION OF FEDERALLY QUALIFIED BE17 HAVIORAL HEALTH CENTER SERVICES.—Section 

18 1905(l) of the Social Security Act (42 U.S.C. 

19 1396d(l)) is amended by adding at the end the fol20 lowing paragraph: 

21 ‘‘(4)(A) The term ‘federally qualified behavioral 

22 health center services’ means services furnished to 

23 an individual at a federally qualified behavioral 

24 health center (as defined by subparagraph (B)). 


emcdonald on DSK5VPTVN1PROD with BILLS
349 

•HR 2954 IH

1 ‘‘(B) The term ‘federally qualified behavioral 

2 health center’ means an entity that is certified under 

3 section 1913(c) of the Public Health Service Act as 

4 meeting the criteria described in paragraph (3) of 

5 such section.’’. 

6 (c) MENTAL HEALTH AND ADDICTION SAFETY NET

7 STUDIES.— 

8 (1) PAPERWORK REDUCTION STUDY.— 

9 (A) IN GENERAL.—Not later than 12 

10 months after the date of the enactment of this 

11 Act, the Institute of Medicine shall submit to 

12 the appropriate committees of Congress a re13 port that evaluates the combined paperwork 

14 burden of federally qualified behavioral health 

15 centers certified section 1913(c) of the Public 

16 Health Service Act, as inserted by subsection 

17 (a). 

18 (B) SCOPE.—In preparing the report 

19 under subparagraph (A), the Institute of Medi20 cine shall examine licensing, certification, serv21 ice definitions, claims payment, billing codes, 

22 and financial auditing requirements utilized by 

23 the Office of Management and Budget, the 

24 Centers for Medicare & Medicaid Services, the 

25 Health Resources and Services Administration, 


emcdonald on DSK5VPTVN1PROD with BILLS
350 

•HR 2954 IH

1 the Substance Abuse and Mental Health Serv2 ices Administration, the Office of the Inspector 

3 General, State Medicaid agencies, State depart4 ments of health, State departments of edu5 cation, and State and local juvenile justice and 

6 social services agencies to— 

7 (i) establish an estimate of the com8 bined nationwide cost of complying with 

9 the requirements described in this subpara10 graph, in terms of both administrative 

11 funding and staff time; 

12 (ii) establish an estimate of the per 

13 capita cost to each federally qualified be14 havioral health center certified under sec15 tion 1913(c) of the Public Health Service 

16 Act to comply with the requirements de17 scribed in this subparagraph, in terms of 

18 both administrative funding and staff time; 

19 and 

20 (iii) make administrative and statu21 tory recommendations to Congress, which 

22 may include a uniform methodology, to re23 duce the paperwork burden experienced by 

24 such federally qualified behavioral health 

25 centers. 


emcdonald on DSK5VPTVN1PROD with BILLS
351 

•HR 2954 IH

1 (C) AUTHORIZATION OF APPROPRIA2 TIONS.—There are authorized to be appro3 priated to carry out this subsection $550,000 

4 for each of the fiscal years 2012 and 2013. 

5 (2) WAGE STUDY.— 

6 (A) IN GENERAL.—Not later than 12 

7 months after the date of the enactment of this 

8 Act, the Institute of Medicine shall conduct a 

9 nationwide analysis, and submit a report to the 

10 appropriate committees of Congress, concerning 

11 the compensation structure of professional and 

12 paraprofessional personnel employed by feder13 ally qualified behavioral health centers certified 

14 under section 1913(c) of the Public Health 

15 Service Act, as inserted by subsection (a), as 

16 compared with the compensation structure of 

17 comparable health safety net providers and rel18 evant private sector health care employers. 

19 (B) SCOPE.—In preparing the report 

20 under subparagraph (A), the Institute of Medi21 cine shall examine compensation disparities, if 

22 such disparities are determined to exist, by type 

23 of personnel, type of provider or private sector 

24 employer, and by geographic region. 


emcdonald on DSK5VPTVN1PROD with BILLS
352 

•HR 2954 IH

1 (C) AUTHORIZATION OF APPROPRIA2 TIONS.—There are authorized to be appro3 priated to carry out this paragraph, $550,000 

4 for each of the fiscal years 2012 and 2013. 

5 SEC. 603. MINORITY FELLOWSHIP PROGRAM. 

6 Title V of the Public Health Service Act is amended 

7 by inserting after section 506B of such Act (42 U.S.C. 

8 290aa–5b) the following: 

9 ‘‘SEC. 506C. MINORITY FELLOWSHIP PROGRAM. 

10 ‘‘(a) FELLOWSHIPS.—The Administrator shall main11 tain a program, to be known as the Minority Fellowship 

12 Program, under which the Administrator awards grants 

13 or contracts to national associations or other appropriate 

14 entities for the financial support of graduate students, 

15 postdoctoral fellows, and residents in the professions of 

16 psychology, psychiatry, social work, psychiatric advance17 practice nursing, and marriage and family therapy to stu18 dents who demonstrate a commitment to clinical or re19 search careers focused on racial and ethnic minority popu20 lations. 

21 ‘‘(b) TERM OF FINANCIAL SUPPORT.—Financial sup22 port provided to an individual pursuant to subsection (a) 

23 shall be for a term of not more than 12 months and may 

24 be renewed thereafter. 


emcdonald on DSK5VPTVN1PROD with BILLS
353 

•HR 2954 IH

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

2 carry out this section, there is authorized to be appro3 priated $10,000,000 for each of fiscal years 2012 through 

4 2016’’. 

5 SEC. 604. INTEGRATED HEALTH CARE DEMONSTRATION 

6 PROGRAM. 

7 Part D of title V of the Public Health Service Act 

8 (42 U.S.C. 290dd et seq.) is amended by adding at the 

9 end the following: 

10 ‘‘SEC. 544. INTERPROFESSIONAL HEALTH CARE TEAMS FOR 

11 PROVISION OF BEHAVIORAL HEALTH CARE 

12 IN PRIMARY CARE SETTINGS. 

13 ‘‘(a) GRANTS.—The Secretary, acting through the 

14 Director of the Office of Minority Health of the Adminis15 tration, shall award grants to eligible entities for the pur16 pose of providing technical assistance and training regard17 ing the effective development and implementation of inte18 grated interprofessional health care teams that provide be19 havioral health care. 

20 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

21 a grant under this section, an entity shall be a federally 

22 qualified health center (as defined in section 1861(aa) of 

23 the Social Security Act) serving a high proportion of indi24 viduals from racial and ethnic minority groups (as defined 

25 in section 1707(g)). 


emcdonald on DSK5VPTVN1PROD with BILLS
354 

•HR 2954 IH

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

2 carry out this section, there is authorized to be appro3 priated $20,000,000 for each of fiscal years 2012 through 

4 2014.’’. 

5 SEC. 605. ADDRESSING RACIAL AND ETHNIC MINORITY 

6 MENTAL HEALTH DISPARITIES RESEARCH 

7 GAPS. 

8 Not later than 6 months after the date of the enact9 ment of this Act, the Director of the National Institute 

10 on Minority Health and Health Disparities shall enter into 

11 an arrangement with the Institute of Medicine (or, if the 

12 Institute declines to enter into such an arrangement, an13 other appropriate entity)— 

14 (1) to conduct a study with respect to mental 

15 and behavioral health disparities in racial and ethnic 

16 minority groups (as defined in section 1707(g) of 

17 the Public Health Service Act (42 U.S.C. 300u– 

18 6(g)); and 

19 (2) to submit to the Congress a report on the 

20 results of such study, including— 

21 (A) a compilation of information on the dy22 namics of mental disorders in such racial and 

23 ethnic minority groups; 

24 (B) an identification of gaps in knowledge 

25 and research needs; and 


emcdonald on DSK5VPTVN1PROD with BILLS
355 

•HR 2954 IH

1 (C) recommendations for an interprofes2 sional research agenda at the National Insti3 tutes of Health aimed at reducing and ulti4 mately eliminating mental and behavioral health 

5 disparities in such racial and ethnic minority 

6 groups. 

7 TITLE VII—ADDRESSING HIGH 

8 IMPACT MINORITY DISEASES 

9 Subtitle A—Cancer 

10 SEC. 701. LUNG CANCER MORTALITY REDUCTION. 

11 (a) SHORT TITLE.—This section may be cited as the 

12 ‘‘Lung Cancer Mortality Reduction Act of 2011’’. 

13 (b) FINDINGS.—Congress makes the following find14 ings: 

15 (1) Lung cancer is the leading cause of cancer 

16 death for both men and women, accounting for 28 

17 percent of all cancer deaths. 

18 (2) Lung cancer kills more people annually 

19 than breast cancer, prostate cancer, colon cancer, 

20 liver cancer, melanoma, and kidney cancer combined. 

21 (3) Since the National Cancer Act of 1971 

22 (Public Law 92–218; 85 Stat. 778), coordinated and 

23 comprehensive research has raised the 5-year sur24 vival rates for breast cancer to 88 percent, for prosVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00355 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
356 

•HR 2954 IH

1 tate cancer to 99 percent, and for colon cancer to 

2 64 percent. 

3 (4) However, the 5-year survival rate for lung 

4 cancer is still only 15 percent and a similar coordi5 nated and comprehensive research effort is required 

6 to achieve increases in lung cancer survivability 

7 rates. 

8 (5) Sixty percent of lung cancer cases are now 

9 diagnosed nonsmokers or former smokers. 

10 (6) Two-thirds of nonsmokers diagnosed with 

11 lung cancer are women. 

12 (7) Certain minority populations, such as Afri13 can-American males, have disproportionately high 

14 rates of lung cancer incidence and mortality, not15 withstanding their similar smoking rate. 

16 (8) Members of the baby boomer generation are 

17 entering their sixties, the most common age at which 

18 people develop lung cancer. 

19 (9) Tobacco addiction and exposure to other 

20 lung cancer carcinogens such as Agent Orange and 

21 other herbicides and battlefield emissions are serious 

22 problems among military personnel and war vet23 erans. 

24 (10) Significant and rapid improvements in 

25 lung cancer mortality can be expected through greatVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00356 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
357 

•HR 2954 IH

1 er use and access to lung cancer screening tests for 

2 at-risk individuals. 

3 (11) Additional strategies are necessary to fur4 ther enhance the existing tests and therapies avail5 able to diagnose and treat lung cancer in the future. 

6 (12) The August 2001 Report of the Lung 

7 Cancer Progress Review Group of the National Can8 cer Institute stated that funding for lung cancer re9 search was ‘‘far below the levels characterized for 

10 other common malignancies and far out of propor11 tion to its massive health impact’’. 

12 (13) The Report of the Lung Cancer Progress 

13 Review Group identified as its ‘‘highest priority’’ the 

14 creation of integrated, multidisciplinary, multi-insti15 tutional research consortia organized around the 

16 problem of lung cancer rather than around specific 

17 research disciplines. 

18 (14) The United States must enhance its re19 sponse to the issues raised in the Report of the 

20 Lung Cancer Progress Review Group, and this can 

21 be accomplished through the establishment of a co22 ordinated effort designed to reduce the lung cancer 

23 mortality rate by 50 percent by 2015 and targeted 

24 funding to support this coordinated effort. 


emcdonald on DSK5VPTVN1PROD with BILLS
358 

•HR 2954 IH

1 (c) SENSE OF CONGRESS CONCERNING INVESTMENT

2 IN LUNG CANCER RESEARCH.—It is the sense of the Con3 gress that— 

4 (1) lung cancer mortality reduction should be 

5 made a national public health priority; and 

6 (2) a comprehensive mortality reduction pro7 gram coordinated by the Secretary of Health and 

8 Human Services is justified and necessary to ade9 quately address and reduce lung cancer mortality. 

10 (d) LUNG CANCER MORTALITY REDUCTION PRO11 GRAM.— 

12 (1) IN GENERAL.—Subpart 1 of part C of title 

13 IV of the Public Health Service Act (42 U.S.C. 285 

14 et seq.) is amended by adding at the end the fol15 lowing: 

16 ‘‘SEC. 417H. LUNG CANCER MORTALITY REDUCTION PRO17 GRAM. 

18 ‘‘(a) IN GENERAL.—Not later than 6 months after 

19 the date of the enactment of this section, the Secretary, 

20 in consultation with the Secretary of Defense, the Sec21 retary of Veterans Affairs, the Director of the National 

22 Institutes of Health, the Director of the Centers for Dis23 ease Control and Prevention, the Commissioner of Food 

24 and Drugs, the Administrator of the Centers for Medicare 

25 & Medicaid Services, the Director of the National Institute 


emcdonald on DSK5VPTVN1PROD with BILLS
359 

•HR 2954 IH

1 on Minority Health and Health Disparities, and other 

2 members of the Lung Cancer Advisory Board established 

3 under section 546 of the Lung Cancer Mortality Reduc4 tion Act of 2011, shall implement a comprehensive pro5 gram, to be known as the Lung Cancer Mortality Reduc6 tion Program, to achieve a reduction of at least 25 percent 

7 in the mortality rate of lung cancer by 2017. 

8 ‘‘(b) REQUIREMENTS.—The Program shall include at 

9 least the following: 

10 ‘‘(1) With respect to the National Institutes of 

11 Health— 

12 ‘‘(A) a strategic review and prioritization 

13 by the National Cancer Institute of research 

14 grants to achieve the goal of the Lung Cancer 

15 Mortality Reduction Program in reducing lung 

16 cancer mortality; 

17 ‘‘(B) the provision of funds to enable the 

18 Airway Biology and Disease Branch of the Na19 tional Heart, Lung, and Blood Institute to ex20 pand its research programs to include pre21 dispositions to lung cancer, the interrelationship 

22 between lung cancer and other pulmonary and 

23 cardiac disease, and the diagnosis and treat24 ment of these interrelationships; 


emcdonald on DSK5VPTVN1PROD with BILLS
360 

•HR 2954 IH

1 ‘‘(C) the provision of funds to enable the 

2 National Institute of Biomedical Imaging and 

3 Bioengineering to expedite the development of 

4 computer assisted diagnostic, surgical, treat5 ment, and drug-testing innovations to reduce 

6 lung cancer mortality, such as through expan7 sion of the Institute’s Quantum Grant Program 

8 and Image-Guided Interventions programs; and 

9 ‘‘(D) the provision of funds to enable the 

10 National Institute of Environmental Health 

11 Sciences to implement research programs rel12 ative to the lung cancer incidence. 

13 ‘‘(2) With respect to the Food and Drug Ad14 ministration— 

15 ‘‘(A) activities under section 529 of the 

16 Federal Food, Drug, and Cosmetic Act; and 

17 ‘‘(B) activities under section 561 of the 

18 Federal Food, Drug, and Cosmetic Act to ex19 pand access to investigational drugs and devices 

20 for the diagnosis, monitoring, or treatment of 

21 lung cancer. 

22 ‘‘(3) With respect to the Centers for Disease 

23 Control and Prevention, the establishment of an 

24 early disease research and management program 

25 under section 1511. 


emcdonald on DSK5VPTVN1PROD with BILLS
361 

•HR 2954 IH

1 ‘‘(4) With respect to the Agency for Healthcare 

2 Research and Quality, the conduct of a biannual re3 view of lung cancer screening, diagnostic, and treat4 ment protocols, and the issuance of updated guide5 lines. 

6 ‘‘(5) The cooperation and coordination of all 

7 minority and health disparity programs within the 

8 Department of Health and Human Services to en9 sure that all aspects of the Lung Cancer Mortality 

10 Reduction Program under this section adequately 

11 address the burden of lung cancer on minority and 

12 rural populations. 

13 ‘‘(6) The cooperation and coordination of all to14 bacco control and cessation programs within agen15 cies of the Department of Health and Human Serv16 ices to achieve the goals of the Lung Cancer Mor17 tality Reduction Program under this section with 

18 particular emphasis on the coordination of drug and 

19 other cessation treatments with early detection pro20 tocols.’’. 

21 (2) FEDERAL FOOD, DRUG, AND COSMETIC

22 ACT.—Subchapter B of chapter V of the Federal 

23 Food, Drug, and Cosmetic Act (21 U.S.C. 360aaa et 

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


emcdonald on DSK5VPTVN1PROD with BILLS
362 

•HR 2954 IH

1 ‘‘DRUGS RELATING TO LUNG CANCER

2 ‘‘SEC. 529. (a) IN GENERAL.—The provisions of this 

3 subchapter shall apply to a drug described in subsection 

4 (b) to the same extent and in the same manner as such 

5 provisions apply to a drug for a rare disease or condition. 

6 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

7 subsection is— 

8 ‘‘(1) a chemoprevention drug for precancerous 

9 conditions of the lung; 

10 ‘‘(2) a drug for targeted therapeutic treat11 ments, including any vaccine, for lung cancer; and 

12 ‘‘(3) a drug to curtail or prevent nicotine addic13 tion. 

14 ‘‘(c) BOARD.—The Board established under the Lung 

15 Cancer Mortality Reduction Act of 2011 shall monitor the 

16 program implemented under this section.’’. 

17 (3) ACCESS TO UNAPPROVED THERAPIES.—Sec18 tion 561(e) of the Federal Food, Drug, and Cos19 metic Act (21 U.S.C. 360bbb(e)) is amended by in20 serting before the period the following: ‘‘and shall 

21 include expanding access to drugs under section 

22 529, with substantial consideration being given to 

23 whether the totality of information available to the 

24 Secretary regarding the safety and effectiveness of 

25 an investigational drug, as compared to the risk of 


emcdonald on DSK5VPTVN1PROD with BILLS
363 

•HR 2954 IH

1 morbidity and death from the disease, indicates that 

2 a patient may obtain more benefit than risk if treat3 ed with the drug’’. 

4 (4) CDC.—Title XV of the Public Health Serv5 ice Act (42 U.S.C. 300k et seq.) is amended by add6 ing at the end the following: 

7 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

8 PROGRAM. 

9 ‘‘The Secretary shall establish and implement an 

10 early disease research and management program targeted 

11 at the high incidence and mortality rates of lung cancer 

12 among minority and low-income populations.’’. 

13 (e) DEPARTMENT OF DEFENSE AND THE DEPART14 MENT OF VETERANS AFFAIRS.—The Secretary of Defense 

15 and the Secretary of Veterans Affairs shall coordinate 

16 with the Secretary of Health and Human Services— 

17 (1) in the development of the Lung Cancer 

18 Mortality Reduction Program under section 417H; 

19 (2) in the implementation within the Depart20 ment of Defense and the Department of Veterans 

21 Affairs of an early detection and disease manage22 ment research program for military personnel and 

23 veterans whose smoking history and exposure to car24 cinogens during active duty service has increased 

25 their risk for lung cancer; and 


emcdonald on DSK5VPTVN1PROD with BILLS
364 

•HR 2954 IH

1 (3) in the implementation of coordinated care 

2 programs for military personnel and veterans diag3 nosed with lung cancer. 

4 (f) LUNG CANCER ADVISORY BOARD.— 

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

6 Human Services shall convene a Lung Cancer Advi7 sory Board (referred to in this section as the 

8 ‘‘Board’’)— 

9 (A) to monitor the programs established 

10 under this section (and the amendments made 

11 by this section); and 

12 (B) to provide annual reports to the Con13 gress concerning benchmarks, expenditures, 

14 lung cancer statistics, and the public health im15 pact of such programs. 

16 (2) COMPOSITION.—The Board shall be com17 posed of— 

18 (A) the Secretary of Health and Human 

19 Services; 

20 (B) the Secretary of Defense; 

21 (C) the Secretary of Veterans Affairs; and 

22 (D) two representatives each from the 

23 fields of clinical medicine focused on lung can24 cer, lung cancer research, imaging, drug devel25 opment, and lung cancer advocacy, to be apVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
365 

•HR 2954 IH

1 pointed by the Secretary of Health and Human 

2 Services. 

3 (g) AUTHORIZATION OF APPROPRIATIONS.— 

4 (1) IN GENERAL.—To carry out this section 

5 (and the amendments made by this section), there 

6 are authorized to be appropriated such sums as may 

7 be necessary for each of fiscal years 2012 through 

8 2016. 

9 (2) LUNG CANCER MORTALITY REDUCTION PRO10 GRAM.—Of the amounts authorized to be appro11 priated by subsection (a), there are authorized to be 

12 appropriated— 

13 (A) $25,000,000 for fiscal year 2012, and 

14 such sums as may be necessary for each of fis15 cal years 2013 through 2016, for the activities 

16 described in section 417H(b)(1)(B) of the Pub17 lic Health Service Act, as added by subsection 

18 (d)(1); 

19 (B) $25,000,000 for fiscal year 2012, and 

20 such sums as may be necessary for each of fis21 cal years 2013 through 2016, for the activities 

22 described in section 417H(b)(1)(C) of such Act; 

23 (C) $10,000,000 for fiscal year 2012, and 

24 such sums as may be necessary for each of fis25 cal years 2013 through 2016, for the activities 


emcdonald on DSK5VPTVN1PROD with BILLS
366 

•HR 2954 IH

1 described in section 417H(b)(1)(D) of such Act; 

2 and 

3 (D) $15,000,000 for fiscal year 2012, and 

4 such sums as may be necessary for each of fis5 cal years 2013 through 2016, for the activities 

6 described in section 417H(b)(3) of such Act. 

7 SEC. 702. EXPANDING PROSTATE CANCER RESEARCH, OUT8 REACH, SCREENING, TESTING, ACCESS, AND 

9 TREATMENT EFFECTIVENESS. 

10 (a) SHORT TITLE.—This section may be cited as the 

11 ‘‘Prostate Research, Outreach, Screening, Testing, Access, 

12 and Treatment Effectiveness Act of 2011’’ or the ‘‘PROS13 TATE Act’’. 

14 (b) FINDINGS.—Congress makes the following find15 ings: 

16 (1) Prostate cancer is the second leading cause 

17 of cancer death among men. 

18 (2) In 2010, more than 217,730 new patients 

19 were diagnosed with prostate cancer and more than 

20 32,000 men died from this disease. 

21 (3) Roughly 2,000,000 Americans are living 

22 with a diagnosis of prostate cancer and its con23 sequences. 

24 (4) While prostate cancer generally affects older 

25 individuals, younger men are also at risk for the disVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00366 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
367 

•HR 2954 IH

1 ease, and when prostate cancer appears in early 

2 middle age it frequently takes on a more aggressive 

3 form. 

4 (5) There are significant racial and ethnic dis5 parities that demand attention, namely African6 Americans have prostate cancer mortality rates that 

7 are more than double those in the White population. 

8 (6) Underserved rural populations have higher 

9 rates of mortality compared to their urban counter10 parts, and innovative and cost-efficient methods to 

11 improve rural access to high quality care should take 

12 advantage of advances in telehealth to diagnose and 

13 treat prostate cancer when appropriate. 

14 (7) Certain veterans populations may have 

15 nearly twice the incidence of prostate cancer as the 

16 general population of the United States. 

17 (8) Urologists may constitute the specialists 

18 who diagnose and treat the vast majority of prostate 

19 cancer patients. 

20 (9) Although much basic and translational re21 search has been completed and much is currently 

22 known, there are still many unanswered questions. 

23 For example, it is not fully understood how much of 

24 known disparities are attributable to disease etiVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
368 

•HR 2954 IH

1 ology, access to care, or education and awareness in 

2 the community. 

3 (10) Causes of prostate cancer are not known. 

4 There is not good information regarding how to dif5 ferentiate accurately, early on, between aggressive 

6 and indolent forms of the disease. As a result, there 

7 is significant overtreatment in prostate cancer. 

8 There are no treatments that can durably arrest 

9 growth or cure prostate cancer once it has metasta10 sized. 

11 (11) A significant proportion (roughly 23 to 54 

12 percent) of cases may be clinically indolent and 

13 ‘‘overdiagnosed’’, resulting in significant overtreat14 ment. More accurate tests will allow men and their 

15 families to face less physical, psychological, financial, 

16 and emotional trauma and billions of dollars could 

17 be saved in private and public health care systems 

18 in an area that has been identified by the Medicare 

19 program as one of eight high-volume, high-cost areas 

20 in the Resource Utilization Report program author21 ized by Congress under the Medicare Improvements 

22 for Patients and Providers Act of 2008. 

23 (12) Prostate cancer research and health care 

24 programs across Federal agencies should be coordi25 nated to improve accountability and actively encourVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00368 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
369 

•HR 2954 IH

1 age the translation of research into practice, to iden2 tify and implement best practices, in order to foster 

3 an integrated and consistent focus on effective pre4 vention, diagnosis, and treatment of this disease. 

5 (c) PROSTATE CANCER COORDINATION AND EDU6 CATION.— 

7 (1) INTERAGENCY PROSTATE CANCER COORDI8 NATION AND EDUCATION TASK FORCE.—Not later 

9 than 180 days after the date of the enactment of 

10 this section, the Secretary of Veterans Affairs, in co11 operation with the Secretary of Defense and the Sec12 retary of Health and Human Services, shall estab13 lish an Interagency Prostate Cancer Coordination 

14 and Education Task Force (in this section referred 

15 to as the ‘‘Prostate Cancer Task Force’’). 

16 (2) DUTIES.—The Prostate Cancer Task Force 

17 shall— 

18 (A) develop a summary of advances in 

19 prostate cancer research supported or con20 ducted by Federal agencies relevant to the diag21 nosis, prevention, and treatment of prostate 

22 cancer, including psychosocial impairments re23 lated to prostate cancer treatment, and compile 

24 a list of best practices that warrant broader 

25 adoption in health care programs; 


emcdonald on DSK5VPTVN1PROD with BILLS
370 

•HR 2954 IH

1 (B) consider establishing, and advocating 

2 for, a guidance to enable physicians to allow 

3 screening of men who are over age 74, on a 

4 case-by-case basis, taking into account quality 

5 of life and family history of prostate cancer; 

6 (C) share and coordinate information on 

7 Federal research and health care program ac8 tivities, including activities related to— 

9 (i) determining how to improve re10 search and health care programs, including 

11 psychosocial impairments related to pros12 tate cancer treatment; 

13 (ii) identifying any gaps in the overall 

14 research inventory and in health care pro15 grams; 

16 (iii) identifying opportunities to pro17 mote translation of research into practice; 

18 and 

19 (iv) maximizing the effects of Federal 

20 efforts by identifying opportunities for col21 laboration and leveraging of resources in 

22 research and health care programs that 

23 serve those susceptible to or diagnosed 

24 with prostate cancer; 


emcdonald on DSK5VPTVN1PROD with BILLS
371 

•HR 2954 IH

1 (D) develop a comprehensive interagency 

2 strategy and advise relevant Federal agencies in 

3 the solicitation of proposals for collaborative, 

4 multidisciplinary research and health care pro5 grams, including proposals to evaluate factors 

6 that may be related to the etiology of prostate 

7 cancer, that would— 

8 (i) result in innovative approaches to 

9 study emerging scientific opportunities or 

10 eliminate knowledge gaps in research to 

11 improve the prostate cancer research port12 folio of the Federal Government; 

13 (ii) outline key research questions, 

14 methodologies, and knowledge gaps; and 

15 (iii) ensure consistent action, as out16 lined by section 402(b) of the Public 

17 Health Service Act; 

18 (E) develop a coordinated message related 

19 to screening and treatment for prostate cancer 

20 to be reflected in educational and beneficiary 

21 materials for Federal health programs as such 

22 documents are updated; and 

23 (F) not later than 2 years after the date 

24 of the establishment of the Prostate Cancer 

25 Task Force, submit to the Expert Advisory 


emcdonald on DSK5VPTVN1PROD with BILLS
372 

•HR 2954 IH

1 Panel to be reviewed and returned within 30 

2 days, and then within 90 days submitted to 

3 Congress recommendations— 

4 (i) regarding any appropriate changes 

5 to research and health care programs, in6 cluding recommendations to improve the 

7 research portfolio of the Department of 

8 Veterans Affairs, Department of Defense, 

9 National Institutes of Health, and other 

10 Federal agencies to ensure that scientif11 ically based strategic planning is imple12 mented in support of research and health 

13 care program priorities; 

14 (ii) designed to ensure that the re15 search and health care programs and ac16 tivities of the Department of Veterans Af17 fairs, the Department of Defense, the De18 partment of Health and Human Services, 

19 and other Federal agencies are free of un20 necessary duplication; 

21 (iii) regarding public participation in 

22 decisions relating to prostate cancer re23 search and health care programs to in24 crease the involvement of patient advo25 cates, community organizations, and medVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
373 

•HR 2954 IH

1 ical associations representing a broad geo2 graphical area; 

3 (iv) on how to best disseminate infor4 mation on prostate cancer research and 

5 progress achieved by health care programs; 

6 (v) about how to expand partnerships 

7 between public entities, including Federal 

8 agencies, and private entities to encourage 

9 collaborative, cross-cutting research and 

10 health care delivery; 

11 (vi) assessing any cost savings and ef12 ficiencies realized through the efforts iden13 tified and supported in this section and 

14 recommending expansion of those efforts 

15 that have proved most promising while also 

16 ensuring against any conflicts in directives 

17 from other congressional or statutory man18 dates or enabling statutes; 

19 (vii) identifying key priority action 

20 items from among the recommendations; 

21 and 

22 (viii) with respect to the level of fund23 ing needed by each agency to implement 

24 the recommendations contained in the re25 port. 


emcdonald on DSK5VPTVN1PROD with BILLS
374 

•HR 2954 IH

1 (3) MEMBERS OF THE PROSTATE CANCER TASK

2 FORCE.—The Prostate Cancer Task Force described 

3 in subsection (a) shall be composed of representa4 tives from such Federal agencies, as each Secretary 

5 determines necessary, to coordinate a uniform mes6 sage relating to prostate cancer screening and treat7 ment where appropriate, including representatives of 

8 the following: 

9 (A) The Department of Veterans Affairs, 

10 including representatives of each relevant pro11 gram areas of the Department of Veterans Af12 fairs. 

13 (B) The Prostate Cancer Research Pro14 gram of the Congressionally Directed Medical 

15 Research Program of the Department of De16 fense. 

17 (C) The Department of Health and 

18 Human Services, including at a minimum rep19 resentatives of the following: 

20 (i) The National Institutes of Health. 

21 (ii) National research institutes and 

22 centers, including the National Cancer In23 stitute, the National Institute of Allergy 

24 and Infectious Diseases, and the Office of 

25 Minority Health. 


emcdonald on DSK5VPTVN1PROD with BILLS
375 

•HR 2954 IH

1 (iii) The Centers for Medicare & Med2 icaid Services. 

3 (iv) The Food and Drug Administra4 tion. 

5 (v) The Centers for Disease Control 

6 and Prevention. 

7 (vi) The Agency for Healthcare Re8 search and Quality. 

9 (vii) The Health Resources and Serv10 ices Administration. 

11 (4) APPOINTING EXPERT ADVISORY PANELS.— 

12 The Prostate Cancer Task Force shall appoint ex13 pert advisory panels, as determined appropriate, to 

14 provide input and concurrence from individuals and 

15 organizations from the medical, prostate cancer pa16 tient and advocate, research, and delivery commu17 nities with expertise in prostate cancer diagnosis, 

18 treatment, and research, including practicing urolo19 gists, primary care providers, and others and indi20 viduals with expertise in education and outreach to 

21 underserved populations affected by prostate cancer. 

22 (5) MEETINGS.—The Prostate Cancer Task 

23 Force shall convene not less than twice a year, or 

24 more frequently as the Secretary determines to be 

25 appropriate. 


emcdonald on DSK5VPTVN1PROD with BILLS
376 

•HR 2954 IH

1 (6) SUBMISSION OF RECOMMENDATIONS TO

2 CONGRESS.—The Secretary of Veterans Affairs shall 

3 submit to Congress any recommendations submitted 

4 to the Secretary under paragraph (2)(E). 

5 (7) FEDERAL ADVISORY COMMITTEE ACT.— 

6 (A) IN GENERAL.—Except as provided in 

7 subparagraph (B), the Federal Advisory Com8 mittee Act (5 U.S.C. App.) shall apply to the 

9 Prostate Cancer Task Force. 

10 (B) EXCEPTION.—Section 14(a)(2)(B) of 

11 such Act (relating to the termination of advi12 sory committees) shall not apply to the Prostate 

13 Cancer Task Force. 

14 (8) SUNSET DATE.—The Prostate Cancer Task 

15 Force shall terminate at the end of fiscal year 2016. 

16 (d) PROSTATE CANCER RESEARCH.— 

17 (1) RESEARCH COORDINATION.—The Secretary 

18 of Veterans Affairs, in coordination with the Secre19 taries of Defense and of Health and Human Serv20 ices, shall establish and carry out a program to co21 ordinate and intensify prostate cancer research as 

22 needed. Specifically, such research program shall— 

23 (A) develop advances in diagnostic and 

24 prognostic methods and tests, including bio25 markers and an improved prostate cancer 


emcdonald on DSK5VPTVN1PROD with BILLS
377 

•HR 2954 IH

1 screening blood test, including improvements or 

2 alternatives to the prostate specific antigen test 

3 and additional tests to distinguish indolent from 

4 aggressive disease; 

5 (B) better understand the etiology of the 

6 disease (including an analysis of lifestyle factors 

7 proven to be involved in higher rates of prostate 

8 cancer, such as obesity and diet, and in dif9 ferent ethnic, racial, and socioeconomic groups, 

10 such as the African-American, Latin-American, 

11 and American Indian populations and men with 

12 a family history of prostate cancer) to improve 

13 prevention efforts; 

14 (C) expand basic research into prostate 

15 cancer, including studies of fundamental molec16 ular and cellular mechanisms; 

17 (D) identify and provide clinical testing of 

18 novel agents for the prevention and treatment 

19 of prostate cancer; 

20 (E) establish clinical registries for prostate 

21 cancer; 

22 (F) use the National Institute of Bio23 medical Imaging and Bioengineering and the 

24 National Cancer Institute for assessment of ap25 propriate imaging modalities; and 


emcdonald on DSK5VPTVN1PROD with BILLS
378 

•HR 2954 IH

1 (G) address such other matters relating to 

2 prostate cancer research as may be identified by 

3 the Federal agencies participating in the pro4 gram under this section. 

5 (2) PROSTATE CANCER ADVISORY BOARD.— 

6 There is established in the Office of the Chief Sci7 entist of the Food and Drug Administration a Pros8 tate Cancer Scientific Advisory Board. Such board 

9 shall be responsible for accelerating real-time shar10 ing of the latest research data and accelerating 

11 movement of new medicines to patients. 

12 (3) UNDERSERVED MINORITY GRANT PRO13 GRAM.—In carrying out such program, the Secretary 

14 shall— 

15 (A) award grants to eligible entities to 

16 carry out components of the research outlined 

17 in paragraph (1); 

18 (B) integrate and build upon existing 

19 knowledge gained from comparative effective20 ness research; and 

21 (C) recognize and address— 

22 (i) the racial and ethnic disparities in 

23 the incidence and mortality rates of pros24 tate cancer and men with a family history 

25 of prostate cancer; 


emcdonald on DSK5VPTVN1PROD with BILLS
379 

•HR 2954 IH

1 (ii) any barriers in access to care and 

2 participation in clinical trials that are spe3 cific to racial, ethnic, and other under4 served minorities and men with a family 

5 history of prostate cancer; 

6 (iii) needed outreach and educational 

7 efforts to raise awareness in these commu8 nities; and 

9 (iv) appropriate access and utilization 

10 of imaging modalities. 

11 (e) TELEHEALTH AND RURAL ACCESS PILOT

12 PROJECT.— 

13 (1) IN GENERAL.—The Secretary of Veterans 

14 Affairs, the Secretary of Defense, and the Secretary 

15 of Health and Human Services (in this section re16 ferred to as the ‘‘Secretaries’’) shall establish 4-year 

17 telehealth pilot projects for the purpose of analyzing 

18 the clinical outcomes and cost effectiveness associ19 ated with telehealth services in a variety of geo20 graphic areas that contain high proportions of medi21 cally underserved populations, including African22 Americans, Latin-Americans, American Indians, and 

23 those in rural areas. Such projects shall promote ef24 ficient use of specialist care through better coordina25 tion of primary care and physician extender teams 


emcdonald on DSK5VPTVN1PROD with BILLS
380 

•HR 2954 IH

1 in underserved areas and more effectively employ 

2 tumor boards to better counsel patients. 

3 (2) ELIGIBLE ENTITIES.— 

4 (A) IN GENERAL.—The Secretaries shall 

5 select eligible entities to participate in the pilot 

6 projects under this section. 

7 (B) PRIORITY.—In selecting eligible enti8 ties to participate in the pilot projects under 

9 this section, the Secretaries shall give priority 

10 to such entities located in medically under11 served areas, particularly those that include Af12 rican-Americans, Latin-Americans, and facili13 ties of the Indian Health Service, and those in 

14 rural areas. 

15 (3) EVALUATION.—The Secretaries shall, 

16 through the pilot projects, evaluate— 

17 (A) the effective and economic delivery of 

18 care in diagnosing and treating prostate cancer 

19 with the use of telehealth services in medically 

20 underserved and tribal areas including collabo21 rative uses of health professionals and integra22 tion of the range of telehealth and other tech23 nologies; 

24 (B) the effectiveness of improving the ca25 pacity of nonmedical providers and nonspecialVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00380 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
381 

•HR 2954 IH

1 ized medical providers to provide health services 

2 for prostate cancer in medically underserved 

3 and tribal areas, including the exploration of in4 novative medical home models with collabora5 tion between urologists, other relevant medical 

6 specialists, including oncologists, radiologists, 

7 and primary care teams and coordination of 

8 care through the efficient use of primary care 

9 teams and physician extenders; and 

10 (C) the effectiveness of using telehealth 

11 services to provide prostate cancer treatment in 

12 medically underserved areas, including the use 

13 of tumor boards to facilitate better patient 

14 counseling. 

15 (4) REPORT.—Not later than 12 months after 

16 the completion of the pilot projects under this sub17 section, the Secretaries shall submit to Congress a 

18 report describing the outcomes of such pilot projects, 

19 including any cost savings and efficiencies realized, 

20 and providing recommendations, if any, for expand21 ing the use of telehealth services. 

22 (f) EDUCATION AND AWARENESS.— 

23 (1) IN GENERAL.—The Secretary of Veterans 

24 Affairs shall develop a national education campaign 

25 for prostate cancer. Such campaign shall involve the 


emcdonald on DSK5VPTVN1PROD with BILLS
382 

•HR 2954 IH

1 use of written educational materials and public serv2 ice announcements consistent with the findings of 

3 the Prostate Cancer Task Force under subsection 

4 (c), that are intended to encourage men to seek 

5 prostate cancer screening when appropriate. 

6 (2) RACIAL DISPARITIES AND THE POPULATION

7 OF MEN WITH A FAMILY HISTORY OF PROSTATE

8 CANCER.—In developing the national campaign 

9 under paragraph (1), the Secretary shall ensure that 

10 such educational materials and public service an11 nouncements are more readily available in commu12 nities experiencing racial disparities in the incidence 

13 and mortality rates of prostate cancer and by men 

14 of any race classification with a family history of 

15 prostate cancer. 

16 (3) GRANTS.—In carrying out the national 

17 campaign under this section, the Secretary shall 

18 award grants to nonprofit private entities to enable 

19 such entities to test alternative outreach and edu20 cation strategies. 

21 (g) AUTHORIZATION OF APPROPRIATIONS.— 

22 (1) IN GENERAL.—There is authorized to be 

23 appropriated to carry out this section for the period 

24 of fiscal years 2012 through 2016 an amount equal 

25 to the savings described in paragraph (2). 


emcdonald on DSK5VPTVN1PROD with BILLS
383 

•HR 2954 IH

1 (2) CORRESPONDING REDUCTION.—The 

2 amount authorized to be appropriated by provisions 

3 of law other than this section for the period of fiscal 

4 years 2012 through 2016 for Federal research and 

5 health care program activities related to prostate 

6 cancer is reduced by the amount of Federal savings 

7 projected to be achieved over such period by imple8 mentation of subsection (c)(2)(C) of this section. 

9 SEC. 703. IMPROVED MEDICAID COVERAGE FOR CERTAIN 

10 BREAST AND CERVICAL CANCER PATIENTS 

11 IN THE TERRITORIES. 

12 (a) ELIMINATION OF FUNDING LIMITATIONS.— 

13 (1) IN GENERAL.—Section 1108(g)(4) of the 

14 Social Security Act (42 U.S.C. 1308(g)(4)) is 

15 amended by adding at the end the following: ‘‘With 

16 respect to fiscal years beginning with fiscal year 

17 2012, payment for medical assistance for individuals 

18 who are eligible for such assistance only on the basis 

19 of section 1902(a)(10)(A)(ii)(XVIII) shall not be 

20 taken into account in applying subsection (f) (as in21 creased in accordance with paragraphs (1), (2), and 

22 (3) of this subsection) to such commonwealth or ter23 ritory for such fiscal year.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
384 

•HR 2954 IH

1 (2) TECHNICAL AMENDMENT.—Such section is 

2 further amended by striking ‘‘(3), and (4)’’ and in3 serting ‘‘and (3)’’. 

4 (b) APPLICATION OF ENHANCED FMAP FOR HIGH5 EST STATE.—Section 1905(b) of such Act (42 U.S.C. 

6 1396d(b)) is amended by adding at the end the following: 

7 ‘‘Notwithstanding the first sentence of this subsection, 

8 with respect to medical assistance described in clause (4) 

9 of such sentence that is furnished in Puerto Rico, the 

10 United States Virgin Islands, Guam, the Commonwealth 

11 of the Northern Mariana Islands, or American Samoa in 

12 a fiscal year, the Federal medical assistance percentage 

13 is equal to the highest such percentage applied under such 

14 clause for such fiscal year for any of the 50 States or the 

15 District of Columbia that provides such medical assistance 

16 for any portion of such fiscal year.’’ 

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

18 this section shall apply to payment for medical assistance 

19 for items and services furnished on or after October 1, 

20 2011. 

21 SEC. 704. CANCER PREVENTION AND TREATMENT DEM22 ONSTRATION FOR ETHNIC AND RACIAL MI23 NORITIES. 

24 (a) DEMONSTRATION.— 


emcdonald on DSK5VPTVN1PROD with BILLS
385 

•HR 2954 IH

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

2 Human Services (in this section referred to as the 

3 ‘‘Secretary’’) shall conduct demonstration projects 

4 (in this section referred to as ‘‘demonstration 

5 projects’’) for the purpose of developing models and 

6 evaluating methods that— 

7 (A) improve the quality of items and serv8 ices provided to target individuals in order to 

9 facilitate reduced disparities in early detection 

10 and treatment of cancer; 

11 (B) improve clinical outcomes, satisfaction, 

12 quality of life, and appropriate use of Medicare13 covered services and referral patterns among 

14 those target individuals with cancer; 

15 (C) eliminate disparities in the rate of pre16 ventive cancer screening measures, such as Pap 

17 smears, prostate cancer screenings, and CT 

18 scans for lung cancer among target individuals; 

19 (D) promote collaboration with community20 based organizations to ensure cultural com21 petency of health care professionals and lin22 guistic access for persons with limited-English 

23 proficiency; and 

24 (E) encourage the incorporation of commu25 nity health workers to increase the efficiency 


emcdonald on DSK5VPTVN1PROD with BILLS
386 

•HR 2954 IH

1 and appropriateness of cervical cancer pro2 grams. 

3 (2) COMMUNITY HEALTH WORKER DEFINED.— 

4 In this section, the term ‘‘community health worker’’ 

5 includes a community health advocate, a lay health 

6 worker, a community health representative, a peer 

7 health promotor, a community health outreach work8 ers, and promotores de salud, who promotes health 

9 or nutrition within the community in which the indi10 vidual resides. 

11 (3) TARGET INDIVIDUAL DEFINED.—In this 

12 section, the term ‘‘target individual’’ means an indi13 vidual of a racial and ethnic minority group, as de14 fined in section 1707(g)(1) of the Public Health 

15 Service Act (42 U.S.C. 300u–6(g)(1)), who is enti16 tled to benefits under part A, and enrolled under 

17 part B, of title XVIII of the Social Security Act. 

18 (b) PROGRAM DESIGN.— 

19 (1) INITIAL DESIGN.—Not later than 1 year 

20 after the date of the enactment of this Act, the Sec21 retary shall evaluate best practices in the private 

22 sector, community programs, and academic research 

23 of methods that reduce disparities among individuals 

24 of racial and ethnic minority groups in the prevenVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00386 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
387 

•HR 2954 IH

1 tion and treatment of cancer and shall design the 

2 demonstration projects based on such evaluation. 

3 (2) NUMBER AND PROJECT AREAS.—Not later 

4 than 2 years after the date of the enactment of this 

5 Act, the Secretary shall implement at least nine 

6 demonstration projects, including the following: 

7 (A) Two projects for each of the four fol8 lowing major racial and ethnic minority groups: 

9 (i) American Indians and Alaska Na10 tives, Eskimos and Aleuts. 

11 (ii) Asian-Americans. 

12 (iii) Blacks/African-Americans. 

13 (iv) Hispanic/Latin-Americans. 

14 (v) Native Hawaiians and other Pa15 cific Islanders. 

16 The two projects must target different ethnic 

17 subpopulations. 

18 (B) One project within the Pacific Islands 

19 or United States insular areas. 

20 (C) At least one project each in a rural 

21 area and inner-city area. 

22 (3) EXPANSION OF PROJECTS; IMPLEMENTA23 TION OF DEMONSTRATION PROJECT RESULTS.—If 

24 the initial report under subsection (c) contains an 

25 evaluation that demonstration projects— 


emcdonald on DSK5VPTVN1PROD with BILLS
388 

•HR 2954 IH

1 (A) reduce expenditures under the Medi2 care program under title XVIII of the Social 

3 Security Act; or 

4 (B) do not increase expenditures under the 

5 Medicare program and reduce racial and ethnic 

6 health disparities in the quality of health care 

7 services provided to target individuals and in8 crease satisfaction of beneficiaries and health 

9 care providers; 

10 the Secretary shall continue the existing demonstra11 tion projects and may expand the number of dem12 onstration projects. 

13 (c) REPORT TO CONGRESS.— 

14 (1) IN GENERAL.—Not later than 2 years after 

15 the date the Secretary implements the initial dem16 onstration projects, and biannually thereafter, the 

17 Secretary shall submit to Congress a report regard18 ing the demonstration projects. 

19 (2) CONTENTS OF REPORT.—Each report under 

20 paragraph (1) shall include the following: 

21 (A) A description of the demonstration 

22 projects. 

23 (B) An evaluation of— 

24 (i) the cost effectiveness of the dem25 onstration projects; 


emcdonald on DSK5VPTVN1PROD with BILLS
389 

•HR 2954 IH

1 (ii) the quality of the health care serv2 ices provided to target individuals under 

3 the demonstration projects; and 

4 (iii) beneficiary and health care pro5 vider satisfaction under the demonstration 

6 projects. 

7 (C) Any other information regarding the 

8 demonstration projects that the Secretary de9 termines to be appropriate. 

10 (d) WAIVER AUTHORITY.—The Secretary shall waive 

11 compliance with the requirements of title XVIII of the So12 cial Security Act to such extent and for such period as 

13 the Secretary determines is necessary to conduct dem14 onstration projects. 

15 SEC. 705. REDUCING CANCER DISPARITIES WITHIN MEDI16 CARE. 

17 (a) DEVELOPMENT OF MEASURES OF DISPARITIES

18 IN QUALITY OF CANCER CARE.— 

19 (1) DEVELOPMENT OF MEASURES.—The Sec20 retary of Health and Human Services (in this sec21 tion referred to as the ‘‘Secretary’’) shall enter into 

22 an agreement with the National Quality Forum 

23 under which the National Quality Forum shall de24 velop a uniform set of measures to evaluate dispari25 ties in the quality of cancer care, endorse such set 


emcdonald on DSK5VPTVN1PROD with BILLS
390 

•HR 2954 IH

1 of measures through its multistakeholder consensus 

2 development process, and annually update such set 

3 of measures. 

4 (2) MEASURES TO BE INCLUDED.—Such set of 

5 measures shall include, with respect to the treatment 

6 of cancer, measures of patient outcomes, the process 

7 for delivering medical care related to such treat8 ment, patient counseling and engagement in deci9 sionmaking, patient experience of care, resource use, 

10 and practice capabilities, such as care coordination. 

11 (b) ESTABLISHMENT OF REPORTING PROCESS.— 

12 (1) IN GENERAL.—The Secretary shall establish 

13 a reporting process that provides for a method for 

14 health care providers specified under paragraph (2) 

15 to submit to the Secretary and make public data on 

16 the performance of such providers during each re17 porting period through use of the measures devel18 oped pursuant to subsection (a). Such data shall be 

19 submitted in a form and manner and at a time spec20 ified by the Secretary. 

21 (2) SPECIFICATION OF PROVIDERS TO REPORT

22 ON MEASURES.—The Secretary shall specify the 

23 classes of Medicare providers of services and sup24 pliers, including hospitals, cancer centers, physi25 cians, primary care providers, and specialty proVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00390 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
391 

•HR 2954 IH

1 viders, that will be required under such process to 

2 publicly report on the measures specified under sub3 section (a). 

4 (3) ASSESSMENT OF CHANGES.—Within this re5 porting process, the Secretary shall also establish a 

6 format that assesses changes in both the absolute 

7 and relative disparities over time. These measures 

8 shall be presented in an easily comprehensible for9 mat, such as those presented in the final publica10 tions relating to Healthy People 2010 or the Na11 tional Healthcare Disparities Report. 

12 (4) INITIAL IMPLEMENTATION.—The Secretary 

13 shall implement the reporting process under this 

14 subsection for reporting periods beginning not later 

15 than 6 months after the date that measures are first 

16 established under subsection (a). 

17 Subtitle B—Viral Hepatitis and 

18 Liver Cancer Control and Pre19 vention 

20 SEC. 711. VIRAL HEPATITIS AND LIVER CANCER CONTROL 

21 AND PREVENTION. 

22 (a) SHORT TITLE.—This subtitle may be cited as the 

23 ‘‘Viral Hepatitis and Liver Cancer Control and Prevention 

24 Act of 2011’’. 

25 (b) FINDINGS.—Congress finds the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
392 

•HR 2954 IH

1 (1) Approximately 5,300,000 Americans are 

2 chronically infected with the hepatitis B virus (re3 ferred to in this section as ‘‘HBV’’), the hepatitis C 

4 virus (referred to in this section as ‘‘HCV’’), or 

5 both. 

6 (2) In the United States, chronic HBV and 

7 HCV are the most common cause of liver cancer, 

8 one of the most lethal and fastest growing cancers 

9 in this country. It is the most common cause of 

10 chronic liver disease, liver cirrhosis, and the most 

11 common indication for liver transplantation. It is 

12 also a leading cause of death in Americans living 

13 with HIV/AIDS, many of whom are coinfected with 

14 chronic HBV, chronic HCV, or both. At least 15,000 

15 deaths per year in the United States can be attrib16 uted to chronic HBV and HCV. 

17 (3) According to the Centers for Disease Con18 trol and Prevention (referred to in this section as 

19 the ‘‘CDC’’ ‘‘’’), approximately 2 percent of the pop20 ulation of the United States is living with chronic 

21 HBV, chronic HCV, or both. The CDC has recog22 nized HCV as the Nation’s most common chronic 

23 bloodborne virus infection and HBV as the deadliest 

24 vaccine-preventable disease. 


emcdonald on DSK5VPTVN1PROD with BILLS
393 

•HR 2954 IH

1 (4) HBV is easily transmitted and is 100 times 

2 more infectious than HIV. According to the CDC, 

3 HBV is transmitted through percutaneous (i.e., 

4 puncture through the skin) or mucosal contact with 

5 infectious blood or body fluids. HCV is transmitted 

6 by percutaneous exposures to infectious blood. 

7 (5) The CDC conservatively estimates that in 

8 2008 approximately 18,000 Americans were newly 

9 infected with HCV and more than 38,000 Americans 

10 were newly infected with HBV. 

11 (6) There were 6 outbreaks reported to CDC 

12 for investigation in 2008 related to health care ac13 quired infection of HBV and HCV, potentially ex14 posing more than 52,000 Americans to the viruses, 

15 in 2009–2010 there were 15 outbreaks in which 

16 more than 30,000 people were potentially exposed. 

17 (7) Chronic HBV and chronic HCV usually do 

18 not cause symptoms early in the course of the dis19 ease, but after many years of a clinically ‘‘silent’’ 

20 phase, more than 50 percent of infected individuals 

21 will develop cirrhosis, end-stage liver disease, or liver 

22 cancer. Since most of those with chronic HBV and 

23 HCV are unaware of their infection, they do not 

24 know to take precautions to prevent the spread of 


emcdonald on DSK5VPTVN1PROD with BILLS
394 

•HR 2954 IH

1 their infection and can unknowingly exacerbate their 

2 own disease progression. 

3 (8) HBV and HCV disproportionately affect 

4 certain populations in the United States. Although 

5 representing only 5 percent of the population, Asian6 Americans and Pacific Islanders account for over 

7 half of the 1,400,000 domestic chronic HBV cases. 

8 Baby boomers (those born between 1946 and 1964) 

9 account for more than half of domestic chronic hepa10 titis C cases. In addition, African-Americans, Latin11 Americans, and American Indian/Alaskan Natives 

12 are among the groups which have disproportionately 

13 high rates of HBV and/or HCV infections in the 

14 United States. 

15 (9) For both chronic HBV and chronic HCV, 

16 behavioral changes can slow disease progression if 

17 diagnosis is made early. Early diagnosis, which is 

18 determined through simple blood tests, can reduce 

19 the risk of transmission and disease progression 

20 through education and vaccination of household 

21 members and other susceptible persons at risk. 

22 (10) For those chronically infected with HBV 

23 or HCV, regular monitoring can lead to the early de24 tection of liver cancer at a stage where cure is still 

25 possible. Liver cancer is the third deadliest cancer in 


emcdonald on DSK5VPTVN1PROD with BILLS
395 

•HR 2954 IH

1 the United States however, liver cancer has received 

2 little funding for research, prevention, or treatment. 

3 (11) Treatment for chronic HCV can eradicate 

4 the disease in approximately 75 percent of those cur5 rently treated. The treatment of chronic HBV can 

6 effectively suppress viral replication in the over7 whelming majority (>80%) of those treated thereby 

8 reducing the risk of transmission and progression to 

9 liver scarring or liver cancer even though a complete 

10 cure is much less common than for HCV. 

11 (12) To combat the HBV and HCV epidemics 

12 in the United States, in May 2011, the Department 

13 of Health and Human Services released Combating 

14 the Silent Epidemic of Viral Hepatitis: Action Plan 

15 for the Prevention, Care & Treatment of Viral Hepa16 titis (hereafter referred to as the HHS Action Plan). 

17 The Institute of Medicine (IOM) of the National 

18 Academies 2010 reported on the Federal response to 

19 HBV and HCV titled: Hepatitis and Liver Cancer: 

20 A National Strategy for Prevention and Control of 

21 Hepatitis B and C. These recommendations and 

22 guidelines provide a framework for HBV and HCV 

23 prevention, education, control, research, and medical 

24 management programs. 


emcdonald on DSK5VPTVN1PROD with BILLS
396 

•HR 2954 IH

1 (13) The annual health care costs attributable 

2 to HBV and HCV in the United States are signifi3 cant. For HBV, it is estimated to be approximately 

4 $1,000,000,000 to 2,000,000,000 ($1,000 to $2,000 

5 per infected person). More than $1,000,000,000 is 

6 spent each year for HBV-related hospitalizations. 

7 The indirect costs of chronic HBV infection are 

8 harder to measure, but include reduced physical and 

9 emotional quality of life, reduced economic produc10 tivity, long-term disability, and premature death. 

11 For HCV, medical costs for patients are expected to 

12 increase from $30,000,000,000 in 2009 to over 

13 $85,000,000,000 in 2024. Avoiding these costs by 

14 screening and diagnosing individuals earlier—and 

15 connecting them to appropriate treatment and care 

16 will save lives and critical health care dollars. Cur17 rently, without a comprehensive screening, testing 

18 and diagnosis program, most patients are diagnosed 

19 too late when they need a liver transplant costing at 

20 least $314,000 for uncomplicated cases or when they 

21 have liver cancer or end stage liver disease which 

22 costs $30,980 to $110,576 per hospital admission. 

23 As health care costs continue to grow, it is critical 

24 that the Federal Government invests in effective 

25 mechanisms to avoid documented cost drivers. 


emcdonald on DSK5VPTVN1PROD with BILLS
397 

•HR 2954 IH

1 (14) According to the IOM report in 2010, 

2 chronic HBV and HCV infections cause substantial 

3 morbidity and mortality despite being preventable 

4 and treatable. Deficiencies in the implementation of 

5 established guidelines for the prevention, diagnosis, 

6 and medical management of chronic HBV and HCV 

7 infections perpetuate personal and economic bur8 dens. Existing grants are not sufficient for the scale 

9 of the health burden presented by HBV and HCV. 

10 (15) Screening and testing for HBV and HCV 

11 is aligned with the Healthy People 2020 goal; In12 crease immunization rates and reduce preventable 

13 infectious diseases. Awareness of disease and access 

14 to prevention and treatment remain essential compo15 nents for reducing infectious disease transmission. 

16 (16) Federal support is necessary to increase 

17 knowledge and awareness of HBV and HCV and to 

18 assist State and local prevention and control efforts 

19 in reducing the morbidity and mortality of these 

20 epidemics. 

21 (c) BIENNIAL ASSESSMENT OF HHS HEPATITIS B 

22 AND HEPATITIS C PREVENTION, EDUCATION, RESEARCH, 

23 AND MEDICAL MANAGEMENT PLAN.—Title III of the 

24 Public Health Service Act (42 U.S.C. 241 et seq.) is 

25 amended— 


emcdonald on DSK5VPTVN1PROD with BILLS
398 

•HR 2954 IH

1 (1) by striking section 317N (42 U.S.C. 247b– 

2 15); and 

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

4 ‘‘PART X—BIENNIAL ASSESSMENT OF HHS HEPA5 TITIS B AND HEPATITIS C PREVENTION, EDU6 CATION, RESEARCH, AND MEDICAL MANAGE7 MENT PLAN 

8 ‘‘SEC. 399NN. BIENNIAL UPDATE OF THE PLAN. 

9 ‘‘(a) IN GENERAL.—The Secretary shall conduct a bi10 ennial assessment of the Secretary’s plan for the preven11 tion, control, and medical management of, and education 

12 and research relating to, hepatitis B and hepatitis C, for 

13 the purposes of— 

14 ‘‘(1) incorporating into such plan new knowl15 edge or observations relating to hepatitis B and hep16 atitis C (such as knowledge and observations that 

17 may be derived from clinical, laboratory, and epide18 miological research and disease detection, preven19 tion, and surveillance outcomes); 

20 ‘‘(2) addressing gaps in the coverage or effec21 tiveness of the plan; and 

22 ‘‘(3) evaluating and, if appropriate, updating 

23 recommendations, guidelines, or educational mate24 rials of the Centers for Disease Control and Preven25 tion or the National Institutes of Health for health 


emcdonald on DSK5VPTVN1PROD with BILLS
399 

•HR 2954 IH

1 care providers or the public on viral hepatitis in 

2 order to be consistent with the plan. 

3 ‘‘(b) PUBLICATION OF NOTICE OF ASSESSMENTS.— 

4 Not later than October 1 of the first even-numbered year 

5 beginning after the date of the enactment of this part, 

6 and October 1 of each even-numbered year thereafter, the 

7 Secretary shall publish in the Federal Register a notice 

8 of the results of the assessments conducted under para9 graph (1). Such notice shall include— 

10 ‘‘(1) a description of any revisions to the plan 

11 referred to in subsection (a) as a result of the as12 sessment; 

13 ‘‘(2) an explanation of the basis for any such 

14 revisions, including the ways in which such revisions 

15 can reasonably be expected to further promote the 

16 original goals and objectives of the plan; and 

17 ‘‘(3) in the case of a determination by the Sec18 retary that the plan does not need revision, an expla19 nation of the basis for such determination. 

20 ‘‘SEC. 399NN–1. ELEMENTS OF PROGRAM. 

21 ‘‘(a) EDUCATION AND AWARENESS PROGRAMS.—The 

22 Secretary, acting through the Director of the Centers for 

23 Disease Control and Prevention, the Administrator of the 

24 Health Resources and Services Administration, and the 

25 Administrator of the Substance Abuse and Mental Health 


emcdonald on DSK5VPTVN1PROD with BILLS
400 

•HR 2954 IH

1 Services Administration, and in accordance with the plan 

2 referred to in section 399NN(a), shall implement pro3 grams to increase awareness and enhance knowledge and 

4 understanding of hepatitis B and hepatitis C. Such pro5 grams shall include— 

6 ‘‘(1) the conduct of culturally and language ap7 propriate health education in primary and secondary 

8 schools, college campuses, public awareness cam9 paigns, and community outreach activities (especially 

10 to the ethnic communities with high rates of chronic 

11 hepatitis B and chronic hepatitis C and other high12 risk groups) to promote public awareness and knowl13 edge about the value of hepatitis A and hepatitis B 

14 immunization, risk factors, the transmission and 

15 prevention of hepatitis B and hepatitis C, the value 

16 of screening for the early detection of hepatitis B 

17 and hepatitis C, and options available for the treat18 ment of chronic hepatitis B and chronic hepatitis C; 

19 ‘‘(2) the promotion of immunization programs 

20 that increase awareness and access to hepatitis A 

21 and hepatitis B vaccines for susceptible adults and 

22 children; 

23 ‘‘(3) the training of health care professionals 

24 regarding the importance of vaccinating individuals 

25 infected with hepatitis C and individuals who are at 


emcdonald on DSK5VPTVN1PROD with BILLS
401 

•HR 2954 IH

1 risk for hepatitis C infection against hepatitis A and 

2 hepatitis B; 

3 ‘‘(4) the training of health care professionals 

4 regarding the importance of vaccinating individuals 

5 chronically infected with hepatitis B and individuals 

6 who are at risk for chronic hepatitis B infection 

7 against the hepatitis A virus; 

8 ‘‘(5) the training of health care professionals 

9 and health educators to make them aware of the 

10 high rates of chronic hepatitis B and chronic hepa11 titis C in certain adult ethnic populations, and the 

12 importance of prevention, detection, and medical 

13 management of hepatitis B and hepatitis C and of 

14 liver cancer screening; 

15 ‘‘(6) the development and distribution of health 

16 education curricula (including information relating 

17 to the special needs of individuals infected with hep18 atitis B and hepatitis C, such as the importance of 

19 prevention and early intervention, regular moni20 toring, the recognition of psychosocial needs, appro21 priate treatment, and liver cancer screening) for in22 dividuals providing hepatitis B and hepatitis C coun23 seling; and 


emcdonald on DSK5VPTVN1PROD with BILLS
402 

•HR 2954 IH

1 ‘‘(7) support for the implementation curricula 

2 described in paragraph (6) by State and local public 

3 health agencies. 

4 ‘‘(b) IMMUNIZATION, PREVENTION, AND CONTROL

5 PROGRAMS.— 

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

7 through the Director of the Centers for Disease 

8 Control and Prevention, shall support the integra9 tion of activities described in paragraph (2) into ex10 isting clinical and public health programs at State, 

11 local, territorial, and tribal levels (including commu12 nity health clinics, programs for the prevention and 

13 treatment of HIV/AIDS, sexually transmitted dis14 eases, and substance abuse, and programs for indi15 viduals in correctional settings). 

16 ‘‘(2) ACTIVITIES.— 

17 ‘‘(A) VOLUNTARY TESTING PROGRAMS.— 

18 ‘‘(i) IN GENERAL.—The Secretary 

19 shall establish a mechanism by which to 

20 support and promote the development of 

21 State, local, territorial, and tribal vol22 untary hepatitis B and hepatitis C testing 

23 programs to screen the high-prevalence 

24 populations to aid in the early identifica25 tion of chronically infected individuals. 


emcdonald on DSK5VPTVN1PROD with BILLS
403 

•HR 2954 IH

1 ‘‘(ii) CONFIDENTIALITY OF THE TEST

2 RESULTS.—The Secretary shall prohibit 

3 the use of the results of a hepatitis B or 

4 hepatitis C test conducted by a testing pro5 gram developed or supported under this 

6 subparagraph for any of the following: 

7 ‘‘(I) Issues relating to health in8 surance. 

9 ‘‘(II) To screen or determine 

10 suitability for employment. 

11 ‘‘(III) To discharge a person 

12 from employment. 

13 ‘‘(B) COUNSELING REGARDING VIRAL HEP14 ATITIS.—The Secretary shall support State, 

15 local, territorial, and tribal programs in a wide 

16 variety of settings, including those providing 

17 primary and specialty health care services in 

18 nonprofit private and public sectors, to— 

19 ‘‘(i) provide individuals with ongoing 

20 risk factors for hepatitis B and hepatitis C 

21 infection with client-centered education 

22 and counseling which concentrates on— 

23 ‘‘(I) promoting testing of individ24 uals that have been exposed to their 


emcdonald on DSK5VPTVN1PROD with BILLS
404 

•HR 2954 IH

1 blood, family members, and their sex2 ual partners; and 

3 ‘‘(II) changing behaviors that 

4 place individuals at risk for infection; 

5 ‘‘(ii) provide individuals chronically in6 fected with hepatitis B or hepatitis C with 

7 education, health information, and coun8 seling to reduce their risk of— 

9 ‘‘(I) dying from end-stage liver 

10 disease and liver cancer; and 

11 ‘‘(II) transmitting viral hepatitis 

12 to others; and 

13 ‘‘(iii) provide women chronically in14 fected with hepatitis B or hepatitis C who 

15 are pregnant or of childbearing age with 

16 culturally and language appropriate health 

17 information, such as how to prevent hepa18 titis B perinatal infection, and to alleviate 

19 fears associated with pregnancy or raising 

20 a family. 

21 ‘‘(C) IMMUNIZATION.—The Secretary shall 

22 support State, local, territorial, and tribal ef23 forts to expand the current vaccination pro24 grams to protect every child in the country and 

25 all susceptible adults, particularly those infected 


emcdonald on DSK5VPTVN1PROD with BILLS
405 

•HR 2954 IH

1 with hepatitis C and high-prevalence ethnic 

2 populations and other high-risk groups, from 

3 the risks of acute and chronic hepatitis B infec4 tion by— 

5 ‘‘(i) ensuring continued funding for 

6 hepatitis B vaccination for all children 19 

7 years of age or younger through the Vac8 cines for Children Program; 

9 ‘‘(ii) ensuring that the recommenda10 tions of the Advisory Committee on Immu11 nization Practices are followed regarding 

12 the birth dose of hepatitis B vaccinations 

13 for newborns; 

14 ‘‘(iii) requiring proof of hepatitis B 

15 vaccination for entry into public or private 

16 daycare, preschool, elementary school, sec17 ondary school, and institutions of higher 

18 education; 

19 ‘‘(iv) expanding the availability of 

20 hepatitis B vaccination for all susceptible 

21 adults to protect them from becoming 

22 acutely or chronically infected, including 

23 ethnic and other populations with high 

24 prevalence rates of chronic hepatitis B in25 fection; 


emcdonald on DSK5VPTVN1PROD with BILLS
406 

•HR 2954 IH

1 ‘‘(v) expanding the availability of hep2 atitis B vaccination for all susceptible 

3 adults, particularly those in their reproduc4 tive age (women and men less than 45 

5 years of age), to protect them from the 

6 risk of hepatitis B infection; 

7 ‘‘(vi) ensuring the vaccination of indi8 viduals infected, or at risk for infection, 

9 with hepatitis C against hepatitis A, hepa10 titis B, and other infectious diseases, as 

11 appropriate, for which such individuals 

12 may be at increased risk; and 

13 ‘‘(vii) ensuring the vaccination of indi14 viduals infected, or at risk for infection, 

15 with hepatitis B against hepatitis A virus 

16 and other infectious diseases, as appro17 priate, for which such individuals may be 

18 at increased risk. 

19 ‘‘(D) MEDICAL REFERRAL.—The Secretary 

20 shall support State, local, territorial, and tribal 

21 programs that support— 

22 ‘‘(i) referral of persons chronically in23 fected with hepatitis B or hepatitis C— 

24 ‘‘(I) for medical evaluation to de25 termine the appropriateness for 


emcdonald on DSK5VPTVN1PROD with BILLS
407 

•HR 2954 IH

1 antiviral treatment to reduce the risk 

2 of progression to cirrhosis and liver 

3 cancer; and 

4 ‘‘(II) for ongoing medical man5 agement including regular monitoring 

6 of liver function and screening for 

7 liver cancer; and 

8 ‘‘(ii) referral of persons infected with 

9 acute or chronic hepatitis B infection or 

10 acute or chronic hepatitis C infection for 

11 drug and alcohol abuse treatment where 

12 appropriate. 

13 ‘‘(3) INCREASED SUPPORT FOR ADULT VIRAL

14 HEPATITIS COORDINATORS.—The Secretary, acting 

15 through the Director of the Centers for Disease 

16 Control and Prevention, shall provide increased sup17 port to Adult Viral Hepatitis Coordinators in State, 

18 local, territorial, and tribal health departments in 

19 order to enhance the additional management, net20 working, and technical expertise needed to ensure 

21 successful integration of hepatitis B and hepatitis C 

22 prevention and control activities into existing public 

23 health programs. 

24 ‘‘(c) EPIDEMIOLOGICAL SURVEILLANCE.— 


emcdonald on DSK5VPTVN1PROD with BILLS
408 

•HR 2954 IH

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

2 through the Director of the Centers for Disease 

3 Control and Prevention, shall support the establish4 ment and maintenance of a national chronic and 

5 acute hepatitis B and hepatitis C surveillance pro6 gram, in order to identify— 

7 ‘‘(A) trends in the incidence of acute and 

8 chronic hepatitis B and acute and chronic hepa9 titis C; 

10 ‘‘(B) trends in the prevalence of acute and 

11 chronic hepatitis B and acute and chronic hepa12 titis C infection among groups that may be dis13 proportionately affected; and 

14 ‘‘(C) trends in liver cancer and end-stage 

15 liver disease incidence and deaths, caused by 

16 chronic hepatitis B and chronic hepatitis C in 

17 the high-risk ethnic populations. 

18 ‘‘(2) SEROPREVALENCE AND LIVER CANCER

19 STUDIES.—The Secretary, acting through the Direc20 tor of the Centers for Disease Control and Preven21 tion, shall prepare a report outlining the population22 based seroprevalence studies currently underway, fu23 ture planned studies, the criteria involved in deter24 mining which seroprevalence studies to conduct, 

25 defer, or suspend, and the scope of those studies, the 


emcdonald on DSK5VPTVN1PROD with BILLS
409 

•HR 2954 IH

1 economic and clinical impact of hepatitis B and hep2 atitis C, and the impact of chronic hepatitis B and 

3 chronic hepatitis C infections on the quality of life. 

4 Not later than one year after the date of the enact5 ment of this part, the Secretary shall submit the re6 port to the Committee on Energy and Commerce of 

7 the House of Representatives and the Committee on 

8 Health, Education, Labor, and Pensions of the Sen9 ate. 

10 ‘‘(3) CONFIDENTIALITY.—The Secretary shall 

11 not disclose any individually identifiable information 

12 identified under paragraph (1) or derived through 

13 studies under paragraph (2). 

14 ‘‘(d) RESEARCH.—The Secretary, acting through the 

15 Director of the Centers for Disease Control and Preven16 tion, the Director of the National Cancer Institute, and 

17 the Director of the National Institutes of Health, shall— 

18 ‘‘(1) conduct epidemiologic and community19 based research to develop, implement, and evaluate 

20 best practices for hepatitis B and hepatitis C pre21 vention especially in the ethnic populations with high 

22 rates of chronic hepatitis B and chronic hepatitis C 

23 and other high-risk groups; 

24 ‘‘(2) conduct research on hepatitis B and hepa25 titis C natural history, pathophysiology, improved 


emcdonald on DSK5VPTVN1PROD with BILLS
410 

•HR 2954 IH

1 treatments and prevention (such as the hepatitis C 

2 vaccine), and noninvasive tests that help to predict 

3 the risk of progression to liver cirrhosis and liver 

4 cancer; 

5 ‘‘(3) conduct research that will lead to better 

6 noninvasive or blood tests to screen for liver cancer, 

7 and more effective treatments of liver cancer caused 

8 by chronic hepatitis B and chronic hepatitis C; and 

9 ‘‘(4) conduct research comparing the effective10 ness of screening, diagnostic, management, and 

11 treatment approaches for chronic hepatitis B, chron12 ic hepatitis C, and liver cancer in the affected com13 munities. 

14 ‘‘(e) UNDERSERVED AND DISPROPORTIONATELY AF15 FECTED POPULATIONS.—In carrying out this section, the 

16 Secretary shall provide expanded support for individuals 

17 with limited access to health education, testing, and health 

18 care services and groups that may be disproportionately 

19 affected by hepatitis B and hepatitis C. 

20 ‘‘(f) EVALUATION OF PROGRAM.—The Secretary 

21 shall develop benchmarks for evaluating the effectiveness 

22 of the programs and activities conducted under this sec23 tion and make determinations as to whether such bench24 marks have been achieved. 


emcdonald on DSK5VPTVN1PROD with BILLS
411 

•HR 2954 IH

1 ‘‘SEC. 399NN–2. GRANTS. 

2 ‘‘(a) IN GENERAL.—The Secretary may award grants 

3 to, or enter into contracts or cooperative agreements with, 

4 States, political subdivisions of States, territories, Indian 

5 tribes, or nonprofit entities that have special expertise re6 lating to hepatitis B, hepatitis C, or both, to carry out 

7 activities under this part. 

8 ‘‘(b) APPLICATION.—To be eligible for a grant, con9 tract, or cooperative agreement under subsection (a), an 

10 entity shall prepare and submit to the Secretary an appli11 cation at such time, in such manner, and containing such 

12 information as the Secretary may require. 

13 ‘‘SEC. 399NN–3. AUTHORIZATION OF APPROPRIATIONS. 

14 ‘‘There are authorized to be appropriated to carry out 

15 this part $90,000,000 for fiscal year 2012, $90,000,000 

16 for fiscal year 2013, $110,000,000 for fiscal year 2014, 

17 $130,000,000 for fiscal year 2015, and $150,000,000 for 

18 fiscal year 2016.’’. 

19 (d) ENHANCING SAMHSA’S ROLE IN HEPATITIS AC20 TIVITIES.—Paragraph (6) of section 501(d) of the Public 

21 Health Service Act (42 U.S.C. 290aa(d)) is amended by 

22 striking ‘‘HIV or tuberculosis’’ and inserting ‘‘HIV, tuber23 culosis, or hepatitis’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
412 

•HR 2954 IH

1 Subtitle C—Acquired Bone Marrow 

2 Failure Diseases 

3 SEC. 721. ACQUIRED BONE MARROW FAILURE DISEASES. 

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

5 ‘‘Bone Marrow Failure Disease Research and Treatment 

6 Act of 2011’’. 

7 (b) FINDINGS.—The Congress finds the following: 

8 (1) Between 20,000 and 30,000 Americans are 

9 diagnosed each year with myelodysplastic syndromes, 

10 aplastic anemia, paroxysmal nocturnal hemo11 globinuria, and other acquired bone marrow failure 

12 diseases. 

13 (2) Acquired bone marrow failure diseases have 

14 a debilitating and often fatal impact on those diag15 nosed with these diseases. 

16 (3) While some treatments for acquired bone 

17 marrow failure diseases can prolong and improve the 

18 quality of patients’ lives, there is no single cure for 

19 these diseases. 

20 (4) The prevalence of acquired bone marrow 

21 failure diseases in the United States will continue to 

22 grow as the general public ages. 

23 (5) Evidence exists suggesting that acquired 

24 bone marrow failure diseases occur more often in 


emcdonald on DSK5VPTVN1PROD with BILLS
413 

•HR 2954 IH

1 minority populations, particularly in Asian-American 

2 and Hispanic/Latin-American populations. 

3 (6) The National Heart, Lung, and Blood Insti4 tute and the National Cancer Institute have con5 ducted important research into the causes of and 

6 treatments for acquired bone marrow failure dis7 eases. 

8 (7) The National Marrow Donor Program Reg9 istry has made significant contributions to the fight 

10 against bone marrow failure diseases by connecting 

11 millions of potential marrow donors with individuals 

12 and families suffering from these conditions. 

13 (8) Despite these advances, a more comprehen14 sive Federal strategic effort among numerous Fed15 eral agencies is needed to discover a cure for ac16 quired bone marrow failure disorders. 

17 (9) Greater Federal surveillance of acquired 

18 bone marrow failure diseases is needed to gain a bet19 ter understanding of the causes of acquired bone 

20 marrow failure diseases. 

21 (10) The Federal Government should increase 

22 its research support for and engage with public and 

23 private organizations in developing a comprehensive 

24 approach to combat and cure acquired bone marrow 

25 failure diseases. 


emcdonald on DSK5VPTVN1PROD with BILLS
414 

•HR 2954 IH

1 (c) NATIONAL ACQUIRED BONE MARROW FAILURE

2 DISEASE REGISTRY.—Part B of the Public Health Service 

3 Act (42 U.S.C. 311 et seq.) is amended by inserting after 

4 section 317W, as added, the following: 

5 ‘‘SEC. 317X. NATIONAL ACQUIRED BONE MARROW FAILURE 

6 DISEASE REGISTRY. 

7 ‘‘(a) ESTABLISHMENT OF REGISTRY.— 

8 ‘‘(1) IN GENERAL.—Not later than 6 months 

9 after the date of the enactment of this section, the 

10 Secretary, acting through the Director of the Cen11 ters for Disease Control and Prevention, shall— 

12 ‘‘(A) develop a system to collect data on 

13 acquired bone marrow failure diseases; and 

14 ‘‘(B) establish and maintain a national and 

15 publicly available registry, to be known as the 

16 National Acquired Bone Marrow Failure Dis17 ease Registry, in accordance with paragraph 

18 (3). 

19 ‘‘(2) RECOMMENDATIONS OF ADVISORY COM20 MITTEE.—In carrying out this subsection, the Sec21 retary shall take into consideration the recommenda22 tions of the Advisory Committee on Acquired Bone 

23 Marrow Failure Diseases established under sub24 section (b). 


emcdonald on DSK5VPTVN1PROD with BILLS
415 

•HR 2954 IH

1 ‘‘(3) PURPOSES OF REGISTRY.—The National 

2 Acquired Bone Marrow Failure Disease Registry— 

3 ‘‘(A) shall identify the incidence and preva4 lence of acquired bone marrow failure diseases 

5 in the United States; 

6 ‘‘(B) shall be used to collect and store data 

7 on acquired bone marrow failure diseases, in8 cluding data concerning— 

9 ‘‘(i) the age, race or ethnicity, general 

10 geographic location, sex, and family history 

11 of individuals who are diagnosed with ac12 quired bone marrow failure diseases, and 

13 any other characteristics of such individ14 uals determined appropriate by the Sec15 retary; 

16 ‘‘(ii) the genetic and environmental 

17 factors that may be associated with devel18 oping acquired bone marrow failure dis19 eases; 

20 ‘‘(iii) treatment approaches for deal21 ing with acquired bone marrow failure dis22 eases; 

23 ‘‘(iv) outcomes for individuals treated 

24 for acquired bone marrow failure diseases, 

25 including outcomes for recipients of stem 


emcdonald on DSK5VPTVN1PROD with BILLS
416 

•HR 2954 IH

1 cell therapeutic products as contained in 

2 the database established pursuant to sec3 tion 379A; and 

4 ‘‘(v) any other factors pertaining to 

5 acquired bone marrow failure diseases de6 termined appropriate by the Secretary; and 

7 ‘‘(C) shall be made available— 

8 ‘‘(i) to the general public; and 

9 ‘‘(ii) to researchers to facilitate fur10 ther research into the causes of, and treat11 ments for, acquired bone marrow failure 

12 diseases in accordance with standard prac13 tices of the Centers for Disease Control 

14 and Preventions. 

15 ‘‘(b) ADVISORY COMMITTEE.— 

16 ‘‘(1) ESTABLISHMENT.—Not later than 6 

17 months after the date of the enactment of this sec18 tion, the Secretary, acting through the Director of 

19 the Centers for Disease Control and Prevention, 

20 shall establish an advisory committee, to be known 

21 as the Advisory Committee on Acquired Bone Mar22 row Failure Diseases. 

23 ‘‘(2) MEMBERS.—The members of the Advisory 

24 Committee on Acquired Bone Marrow Failure Dis25 eases shall be appointed by the Secretary, acting 


emcdonald on DSK5VPTVN1PROD with BILLS
417 

•HR 2954 IH

1 through the Director of the Centers for Disease 

2 Control and Prevention, and shall include at least 

3 one representative from each of the following: 

4 ‘‘(A) A national patient advocacy organiza5 tion with experience advocating on behalf of pa6 tients suffering from acquired bone marrow 

7 failure diseases. 

8 ‘‘(B) The National Institutes of Health, in9 cluding at least one representative from each 

10 of— 

11 ‘‘(i) the National Cancer Institute; 

12 ‘‘(ii) the National Heart, Lung, and 

13 Blood Institute; and 

14 ‘‘(iii) the Office of Rare Diseases. 

15 ‘‘(C) The Centers for Disease Control and 

16 Prevention. 

17 ‘‘(D) Clinicians with experience in— 

18 ‘‘(i) diagnosing or treating acquired 

19 bone marrow failure diseases; and 

20 ‘‘(ii) medical data registries. 

21 ‘‘(E) Epidemiologists who have experience 

22 with data registries. 

23 ‘‘(F) Publicly or privately funded research24 ers who have experience researching acquired 

25 bone marrow failure diseases. 


emcdonald on DSK5VPTVN1PROD with BILLS
418 

•HR 2954 IH

1 ‘‘(G) The entity operating the C.W. Bill 

2 Young Cell Transplantation Program estab3 lished pursuant to section 379 and the entity 

4 operating the C.W. Bill Young Cell Transplan5 tation Program Outcomes Database. 

6 ‘‘(3) RESPONSIBILITIES.—The Advisory Com7 mittee on Acquired Bone Marrow Failure Diseases 

8 shall provide recommendations to the Secretary on 

9 the establishment and maintenance of the National 

10 Acquired Bone Marrow Failure Disease Registry, in11 cluding recommendations on the collection, mainte12 nance, and dissemination of data. 

13 ‘‘(4) PUBLIC AVAILABILITY.—The Secretary 

14 shall make the recommendations of the Advisory 

15 Committee on Acquired Bone Marrow Failure Dis16 ease publicly available. 

17 ‘‘(c) GRANTS.—The Secretary, acting through the 

18 Director of the Centers for Disease Control and Preven19 tion, may award grants to, and enter into contracts and 

20 cooperative agreements with, public or private nonprofit 

21 entities for the management of, as well as the collection, 

22 analysis, and reporting of data to be included in, the Na23 tional Acquired Bone Marrow Failure Disease Registry. 

24 ‘‘(d) DEFINITION.—In this section, the term ‘ac25 quired bone marrow failure disease’ means— 


emcdonald on DSK5VPTVN1PROD with BILLS
419 

•HR 2954 IH

1 ‘‘(1) myelodysplastic syndromes (MDS); 

2 ‘‘(2) aplastic anemia; 

3 ‘‘(3) paroxysmal nocturnal hemoglobinuria 

4 (PNH); 

5 ‘‘(4) pure red cell aplasia; 

6 ‘‘(5) acute myeloid leukemia that has pro7 gressed from myelodysplastic syndromes; or 

8 ‘‘(6) large granular lymphocytic leukemia. 

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

10 is authorized to be appropriated to carry out this section 

11 $3,000,000 for each of fiscal years 2012 through 2016.’’. 

12 (d) PILOT STUDIES THROUGH THE AGENCY FOR

13 TOXIC SUBSTANCES AND DISEASE REGISTRY.— 

14 (1) PILOT STUDIES.—The Secretary of Health 

15 and Human Services, acting through the Adminis16 trator of the Agency for Toxic Substances and Dis17 ease Registry, shall conduct pilot studies to deter18 mine which environmental factors, including expo19 sure to toxins, may cause acquired bone marrow fail20 ure diseases. 

21 (2) COLLABORATION WITH THE RADIATION IN22 JURY TREATMENT NETWORK.—In carrying out the 

23 directives of this section, the Secretary may collabo24 rate with the Radiation Injury Treatment Network 

25 of the C.W. Bill Young Cell Transplantation ProVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00419 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
420 

•HR 2954 IH

1 gram established pursuant to section 379 of the 

2 Public Health Service Act (42 U.S.C. 274j) to— 

3 (A) augment data for the pilot studies au4 thorized by this section; 

5 (B) access technical assistance that may be 

6 provided by the Radiation Injury Treatment 

7 Network; or 

8 (C) perform joint research projects. 

9 (3) AUTHORIZATION OF APPROPRIATIONS.— 

10 There is authorized to be appropriated to carry out 

11 this section $1,000,000 for each of fiscal years 2012 

12 through 2016. 

13 (e) MINORITY-FOCUSED PROGRAMS ON ACQUIRED

14 BONE MARROW FAILURE DISEASES.—Title XVII of the 

15 Public Health Service Act (42 U.S.C. 300u et seq.) is 

16 amended by inserting after section 1707A the following: 

17 ‘‘MINORITY-FOCUSED PROGRAMS ON ACQUIRED BONE

18 MARROW FAILURE DISEASES

19 ‘‘SEC. 1707B. (a) INFORMATION AND REFERRAL

20 SERVICES.— 

21 ‘‘(1) IN GENERAL.—Not later than 6 months 

22 after the date of the enactment of this section, the 

23 Secretary, acting through the Deputy Assistant Sec24 retary for Minority Health, shall establish and co25 ordinate outreach and informational programs tarVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00420 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
421 

•HR 2954 IH

1 geted to minority populations affected by acquired 

2 bone marrow failure diseases. 

3 ‘‘(2) PROGRAM REQUIREMENTS.—Minority-fo4 cused outreach and informational programs author5 ized by this section— 

6 ‘‘(A) shall make information about treat7 ment options and clinical trials for acquired 

8 bone marrow failure diseases publicly available, 

9 and 

10 ‘‘(B) shall provide referral services for 

11 treatment options and clinical trials, 

12 at the national minority health resource center sup13 ported under section 1707(b)(8) (including by means 

14 of the center’s Web site, through appropriate loca15 tions such as the center’s knowledge center, and 

16 through appropriate programs such as the center’s 

17 resource persons network) and through minority 

18 health consultants located at each Department of 

19 Health and Human Services regional office. 

20 ‘‘(b) HISPANIC AND ASIAN-AMERICAN AND PACIFIC

21 ISLANDER OUTREACH.— 

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

23 through the Deputy Assistant Secretary for Minority 

24 Health, shall undertake a coordinated outreach ef25 fort to connect Hispanic, Asian-American, and PaVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00421 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
422 

•HR 2954 IH

1 cific Islander communities with comprehensive serv2 ices focused on treatment of, and information about, 

3 acquired bone marrow failure diseases. 

4 ‘‘(2) COLLABORATION.—In carrying out this 

5 subsection, the Secretary may collaborate with public 

6 health agencies, nonprofit organizations, community 

7 groups, and online entities to disseminate informa8 tion about treatment options and clinical trials for 

9 acquired bone marrow failure diseases. 

10 ‘‘(c) GRANTS AND COOPERATIVE AGREEMENTS.— 

11 ‘‘(1) IN GENERAL.—Not later than 6 months 

12 after the date of the enactment of this section, the 

13 Secretary, acting through the Deputy Assistant Sec14 retary for Minority Health, shall award grants to, or 

15 enter into cooperative agreements with, entities to 

16 perform research on acquired bone marrow failure 

17 diseases. 

18 ‘‘(2) REQUIREMENT.—Grants and cooperative 

19 agreements authorized by this subsection shall be 

20 awarded or entered into on a competitive, peer-re21 viewed basis. 

22 ‘‘(3) SCOPE OF RESEARCH.—Research funded 

23 under this section shall examine factors affecting the 

24 incidence of acquired bone marrow failure diseases 

25 in minority populations. 


emcdonald on DSK5VPTVN1PROD with BILLS
423 

•HR 2954 IH

1 ‘‘(d) DEFINITION.—In this section, the term ‘ac2 quired bone marrow failure disease’ has the meaning given 

3 to such term in section 317X(d). 

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

5 is authorized to be appropriated to carry out this section 

6 $2,000,000 for each of fiscal years 2012 through 2016.’’. 

7 (f) DIAGNOSIS AND QUALITY OF CARE FOR AC8 QUIRED BONE MARROW FAILURE DISEASES.— 

9 (1) GRANTS.—The Secretary of Health and 

10 Human Services, acting through the Director of the 

11 Agency for Healthcare Research and Quality, shall 

12 award grants to entities to improve diagnostic prac13 tices and quality of care with respect to patients 

14 with acquired bone marrow failure diseases. 

15 (2) AUTHORIZATION OF APPROPRIATIONS.— 

16 There is authorized to be appropriated to carry out 

17 this section $2,000,000 for each of fiscal years 2012 

18 through 2016. 

19 (g) DEFINITION.—In this section, the term ‘‘acquired 

20 bone marrow failure disease’’ means— 

21 (1) myelodysplastic syndromes (MDS); 

22 (2) aplastic anemia; 

23 (3) paroxysmal nocturnal hemoglobinuria 

24 (PNH); 

25 (4) pure red cell aplasia; 


emcdonald on DSK5VPTVN1PROD with BILLS
424 

•HR 2954 IH

1 (5) acute myeloid leukemia that progressed 

2 from myelodysplastic syndromes; or 

3 (6) large granular lymphocytic leukemia. 

4 Subtitle D—Cardiovascular Dis5 ease, Chronic Disease, and 

6 Other Disease Issues 

7 SEC. 731. GUIDELINES FOR DISEASE SCREENING FOR MI8 NORITY PATIENTS. 

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

10 Director of the Agency for Healthcare Research and Qual11 ity, shall convene a series of meetings to develop guidelines 

12 for disease screening for minority patient populations 

13 which have a higher than average risk for many chronic 

14 diseases and cancers. 

15 (b) PARTICIPANTS.—In convening meetings under 

16 subsection (a), the Secretary shall ensure that meeting 

17 participants include representatives of— 

18 (1) professional societies and associations; 

19 (2) minority health organizations; 

20 (3) health care researchers and providers, in21 cluding those with expertise in minority health; 

22 (4) Federal health agencies, including the Of23 fice of Minority Health, the National Institute on 

24 Minority Health and Health Disparities, and the 

25 National Institutes of Health; and 


emcdonald on DSK5VPTVN1PROD with BILLS
425 

•HR 2954 IH

1 (5) other experts determined appropriate by the 

2 Secretary. 

3 (c) DISEASES.—Screening guidelines for minority 

4 populations shall be developed as appropriate under sub5 section (a) for— 

6 (1) hypertension; 

7 (2) hypercholesterolemia; 

8 (3) diabetes; 

9 (4) cardiovascular disease; 

10 (5) cancers, including breast, prostate, colon, 

11 cervical, and lung cancer; 

12 (6) asthma; 

13 (7) diabetes; 

14 (8) kidney diseases; 

15 (9) eye diseases and disorders, including glau16 coma; 

17 (10) HIV/AIDS and sexually transmitted dis18 eases; 

19 (11) uterine fibroids; 

20 (12) autoimmune disease; 

21 (13) mental health conditions; 

22 (14) dental health conditions and oral diseases; 

23 (15) environmental and related health illnesses 

24 and conditions; 

25 (16) Sickle cell disease; 


emcdonald on DSK5VPTVN1PROD with BILLS
426 

•HR 2954 IH

1 (17) violence and injury prevention and control; 

2 (18) genetic and related conditions; 

3 (19) heart disease and stroke; 

4 (20) tuberculosis; 

5 (21) chronic obstructive pulmonary disease; and 

6 (22) other diseases determined appropriate by 

7 the Secretary. 

8 (d) DISSEMINATION.—Not later than 24 months 

9 after the date of enactment of this title, the Secretary 

10 shall publish and disseminate to health care provider orga11 nizations the guidelines developed under subsection (a). 

12 (e) 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 2012 through 2016. 

16 SEC. 732. COVERAGE OF THE SHINGLES VACCINE UNDER 

17 THE MEDICARE PROGRAM. 

18 (a) IN GENERAL.—Section 1861 of the Social Secu19 rity Act (42 U.S.C. 1395x) is amended— 

20 (1) in subsection (s)(10)(A), by inserting ‘‘, 

21 shingles vaccine and its administration,’’ before 

22 ‘‘and, subject to’’; and 

23 (2) in subsection (ww)(2)(A), by inserting 

24 ‘‘shingles,’’ after ‘‘Pneumococcal,’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
427 

•HR 2954 IH

1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply to shingles vaccine furnished on 

3 or after January 1 of the first calendar year beginning 

4 more than 60 days after the date of the enactment of this 

5 Act. 

6 SEC. 733. CDC WISEWOMAN SCREENING PROGRAM. 

7 Section 1509 of the Public Health Service Act (42 

8 U.S.C. 300n–4a) is amended— 

9 (1) in subsection (a)— 

10 (A) by striking the heading and inserting 

11 ‘‘IN GENERAL.—’’; and 

12 (B) in the matter preceding paragraph (1), 

13 by striking ‘‘may make grants’’ and all that fol14 lows through ‘‘purpose’’ and inserting the fol15 lowing: ‘‘may make grants to such States for 

16 the purpose’’; and 

17 (2) in subsection (d)(1), by striking ‘‘there are 

18 authorized’’ and all that follows through the period 

19 and inserting ‘‘there are authorized to be appro20 priated $23,000,000 for fiscal year 2012, 

21 $25,300,000 for fiscal year 2013, $27,800,000 for 

22 fiscal year 2014, $30,800,000 for fiscal year 2015, 

23 and $34,000,000 for fiscal year 2016.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
428 

•HR 2954 IH

1 SEC. 734. REPORT ON CARDIOVASCULAR CARE FOR WOMEN 

2 AND MINORITIES. 

3 Part P of title III of the Public Health Service Act 

4 (42 U.S.C. 280g et seq.) is amended by adding at the end 

5 the following: 

6 ‘‘SEC. 399V–5. REPORT ON CARDIOVASCULAR CARE FOR 

7 WOMEN AND MINORITIES. 

8 ‘‘Not later than September 30, 2014, and annually 

9 thereafter, the Secretary shall prepare and submit to the 

10 Congress a report on the quality of and access to care 

11 for women and minorities with heart disease, stroke, and 

12 other cardiovascular diseases. The report shall contain rec13 ommendations for eliminating disparities in, and improv14 ing the treatment of, heart disease, stroke, and other car15 diovascular diseases in women, racial and ethnic minori16 ties, those for whom English is not their primary lan17 guage, and individuals with disabilities.’’. 

18 SEC. 735. COVERAGE OF COMPREHENSIVE TOBACCO CES19 SATION SERVICES IN MEDICAID. 

20 (a) REQUIRING COVERAGE OF COUNSELING AND

21 PHARMACOTHERAPY FOR CESSATION OF TOBACCO

22 USE.—Section 1905 of the Social Security Act (42 U.S.C. 

23 1396d) is amended— 

24 (1) in subsection (a)(4)(D) is amended by strik25 ing ‘‘by pregnant women’’; and 

26 (2) in subsection (bb)— 


emcdonald on DSK5VPTVN1PROD with BILLS
429 

•HR 2954 IH

1 (A) by striking ‘‘by pregnant women’’ each 

2 place it appears; 

3 (B) in paragraph (1), in the matter before 

4 subparagraph (A), by inserting ‘‘by individuals’’ 

5 before ‘‘who use tobacco’’; and 

6 (C) in paragraph (2)(A), by striking ‘‘with 

7 respect to pregnant women’’. 

8 (b) EXCEPTION FROM OPTIONAL RESTRICTION

9 UNDER MEDICAID PRESCRIPTION DRUG COVERAGE.— 

10 Section 1927(d)(2)(F) of the Social Security Act (42 

11 U.S.C. 1396r–8(d)(2)(F)) is amended by striking ‘‘in the 

12 case of pregnant women’’. 

13 (c) REMOVAL OF COST SHARING FOR COUNSELING

14 AND PHARMACOTHERAPY FOR CESSATION OF TOBACCO

15 USE.— 

16 (1) GENERAL COST SHARING LIMITATIONS.— 

17 Section 1916 of the Social Security Act (42 U.S.C. 

18 1396o) is amended— 

19 (A) in subsections (a)(2)(B) and (b)(2)(B), 

20 by striking ‘‘and counseling and pharmacother21 apy for cessation of tobacco use by pregnant 

22 women (as defined in section 1905(bb)) and 

23 covered outpatient drugs (as defined in sub24 section (k)(2) of section 1927 and including 

25 nonprescription drugs described in subsection 


emcdonald on DSK5VPTVN1PROD with BILLS
430 

•HR 2954 IH

1 (d)(2) of such section) that are prescribed for 

2 purposes of promoting, and when used to pro3 mote, tobacco cessation by pregnant women in 

4 accordance with the Guideline referred to in 

5 section 1905(bb)(2)(A)’’ each place it appears; 

6 and 

7 (B) in each of subsections (a)(2)(D) and 

8 (b)(2)(D) by inserting ‘‘and counseling and 

9 pharmacotherapy for cessation of tobacco use 

10 (as defined in section 1905(bb)) and covered 

11 outpatient drugs (as defined in subsection 

12 (k)(2) of section 1927 and including non13 prescription drugs described in subsection 

14 (d)(2) of such section) that are prescribed for 

15 purposes of promoting, and when used to pro16 mote, tobacco cessation in accordance with the 

17 Guideline referred to in section 

18 1905(bb)(2)(A),’’ after ‘‘section 

19 1905(a)(4)(C),’’. 

20 (2) APPLICATION TO ALTERNATIVE

21 COSTSHARING.—Section 1916A(b)(3)(B) of such Act 

22 (42 U.S.C. 1396o–1(b)(3)(B)) is amended— 

23 (A) in clause (iii), by striking ‘‘, and coun24 seling and pharmacotherapy for cessation of toVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00430 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
431 

•HR 2954 IH

1 bacco use by pregnant women (as defined in 

2 section 1905(bb))’’; and 

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

4 ‘‘(xi) Counseling and 

5 pharmacotherapy for cessation of tobacco 

6 use (as defined in section 1905(bb)) and 

7 covered outpatient drugs (as defined in 

8 subsection (k)(2) of section 1927 and in9 cluding nonprescription drugs described in 

10 subsection (d)(2) of such section) that are 

11 prescribed for purposes of promoting, and 

12 when used to promote, tobacco cessation in 

13 accordance with the Guideline referred to 

14 in section 1905(bb)(2)(A).’’. 

15 (d) EFFECTIVE DATE.—The amendments made by 

16 this section shall take effect on October 1, 2012. 

17 SEC. 736. CLINICAL RESEARCH FUNDING FOR ORAL 

18 HEALTH. 

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

20 Human Services shall expand and intensify the conduct 

21 and support of the research activities of the National In22 stitutes of Health and the National Institute of Dental 

23 and Craniofacial Research to improve the oral health of 

24 the population through the prevention and management 

25 of oral diseases and conditions. 


emcdonald on DSK5VPTVN1PROD with BILLS
432 

•HR 2954 IH

1 (b) INCLUDED RESEARCH ACTIVITIES.—Research 

2 activities under subsection (a) shall include— 

3 (1) comparative effectiveness research and clin4 ical disease management research addressing early 

5 childhood caries and oral cancer; and 

6 (2) awarding of grants and contracts to support 

7 the training and development of health services re8 searchers, comparative effectiveness researchers, and 

9 clinical researchers whose research improves the oral 

10 health of the population. 

11 Subtitle E—HIV/AIDS 

12 SEC. 741. FINDINGS. 

13 The Congress finds the following: 

14 (1) Over one million people are estimated to be 

15 living with HIV in the United States according to 

16 the Centers for Disease Control and Prevention. 

17 (2) Annually there are over 17,000 deaths in 

18 people with an HIV diagnoses in 40 States and 5 

19 dependent areas of the United States. 

20 (3) The Centers for Disease Control and Pre21 vention estimates that in 2009 there were approxi22 mately 48,100 people newly infected with HIV. 

23 Though this number seems to be staying relatively 

24 stable, the number of new infections is rapidly in25 creasing among certain populations especially among 


emcdonald on DSK5VPTVN1PROD with BILLS
433 

•HR 2954 IH

1 young African-American men who have sex with men 

2 who had an overall 48 percent increase in new infec3 tions from 2006 to 2009. 

4 (4) HIV disproportionately affects certain popu5 lations in the United States. Though African-Ameri6 cans represent less than 13 percent of the popu7 lation, African-Americans account for almost half 

8 (46 percent) of all people living with HIV in the 

9 United States. Men who have sex with men (MSM) 

10 make up approximately 2 percent of the population, 

11 but account for over half (53 percent) of individuals 

12 living with HIV and are the only risk group in which 

13 HIV infections continue to increase. 

14 (5) Disparities exist among Latin-Americans; 

15 they make up 15 percent of US population and 17 

16 percent of new infections (2006). 

17 (6) Though American Indians/Alaska Natives 

18 represent less than 1 percent of the total number of 

19 HIV/AIDS cases, American Indians and Alaska Na20 tives rank third in rates of HIV/AIDS diagnosis, 

21 after African-Americans and Latin-Americans. 

22 (7) While Asian-Americans, Native Hawaiians, 

23 and Pacific Islanders HIV/AIDS cases account for 

24 approximately 1 percent of cases nationally, Asian 

25 Americans and Pacific Islanders were the only raVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00433 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
434 

•HR 2954 IH

1 cial/ethnic groups with a statistically significant in2 crease in new HIV diagnoses between 2001 and 

3 2008. 

4 (8) The limited data available on transgender 

5 individuals point to a disproportionate burden of 

6 HIV infection. 

7 (9) Stigma and discrimination contribute to 

8 these disparities. 

9 (10) For HIV, early detection and treatment 

10 can have huge effects. New research suggests that 

11 treatment of individuals not only slows disease pro12 gression, but can also greatly reduce the risk of 

13 transmission to other individuals. 

14 (11) To combat the HIV epidemic in the United 

15 States, the National HIV/AIDS Strategy (NHAS) 

16 from the White House Office of National AIDS Pol17 icy provides a framework of increasing access to 

18 care, reducing new infections, and eliminating HIV19 related health disparities. The vision of NHAS is 

20 ‘‘The United States will become a place where new 

21 HIV infections are rare and when they do occur, 

22 every person, regardless of age, gender, race/eth23 nicity, sexual orientation, gender identity, or socio24 economic circumstance, will have unfettered access 


emcdonald on DSK5VPTVN1PROD with BILLS
435 

•HR 2954 IH

1 to high quality, life extending care, free from stigma 

2 and discrimination.’’. 

3 (12) Although the cost of education, treatment 

4 and care, and research are not inconsequential, they 

5 are substantially less than the annual health care 

6 cost attributable to HIV in the United States. The 

7 lifetime cost of HIV care and treatment in 2004 was 

8 estimated to be $405,000 to $648,000 dollars annu9 ally. Preventing 40,000 new infections in the United 

10 States each year would save $12.8 billion annually. 

11 SEC. 742. ADDRESSING HIV/AIDS IN COMMUNITIES OF 

12 COLOR. 

13 (a) NATIONAL OBSERVANCE DAYS.—It is the sense 

14 of the Congress that national observance days highlighting 

15 the impact of HIV/AIDS on communities of color include 

16 the following: 

17 (1) National Black HIV/AIDS Awareness Day. 

18 (2) National Latino AIDS Awareness Day. 

19 (3) National Asian and Pacific Islander HIV/ 

20 AIDS Awareness Day. 

21 (4) National Native HIV/AIDS Awareness Day. 

22 (5) Caribbean American HIV/AIDS Awareness 

23 Day. 


emcdonald on DSK5VPTVN1PROD with BILLS
436 

•HR 2954 IH

1 (b) CALL TO ACTION.—It is the sense of the Con2 gress that the President should call on members of com3 munities of color— 

4 (1) to become involved at the local community 

5 level in HIV/AIDS testing, policy, and advocacy; 

6 (2) to become aware, engaged, and empowered 

7 on the HIV/AIDS epidemic within their commu8 nities; and 

9 (3) to urge members of their communities to re10 duce risk factors, practice safe sex and other preven11 tive measures, be tested for HIV/AIDS, and seek 

12 care when appropriate. 

13 SEC. 743. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MI14 NORITY COMMUNITIES. 

15 (a) EXPANDED FUNDING.—The Secretary, in col16 laboration with the Deputy Assistant Secretary for Minor17 ity Health, the Director of the Centers for Disease Control 

18 and Prevention, the Administrator of the Health Re19 sources and Services Administration, and the Adminis20 trator of the Substance Abuse and Mental Health Services 

21 Administration, shall provide funds and carry out activi22 ties to expand the Minority HIV/AIDS Initiative. 

23 (b) USE OF FUNDS.—The additional funds made 

24 available under this section may be used, through the Mi25 nority AIDS Initiative, to support the following activities: 


emcdonald on DSK5VPTVN1PROD with BILLS
437 

•HR 2954 IH

1 (1) Providing technical assistance and infra2 structure support to reduce HIV/AIDS in minority 

3 populations. 

4 (2) Increasing minority populations’ access to 

5 HIV/AIDS prevention and care services. 

6 (3) Building strong community programs and 

7 partnerships to address HIV prevention and the 

8 health care needs of specific racial and ethnic minor9 ity populations. 

10 (c) PRIORITY INTERVENTIONS.—Within the racial 

11 and ethnic minority populations referred to in subsection 

12 (b), priority in conducting intervention services shall be 

13 given to— 

14 (1) women; 

15 (2) youth; 

16 (3) men who have sex with men; 

17 (4) persons who engage in intravenous drug 

18 abuse; 

19 (5) homeless individuals; and 

20 (6) individuals incarcerated or in the penal sys21 tem. 

22 (d) AUTHORIZATION OF APPROPRIATIONS.—For car23 rying out this section, there are authorized to be appro24 priated $610,000,0000 for fiscal year 2012 and such sums 


emcdonald on DSK5VPTVN1PROD with BILLS
438 

•HR 2954 IH

1 as may be necessary for each of fiscal years 2013 through 

2 2016. 

3 SEC. 744. REPEALING INEFFECTIVE AND INCOMPLETE AB4 STINENCE-ONLY EDUCATION PROGRAM. 

5 (a) IN GENERAL.—Title V of the Social Security Act 

6 (42 U.S.C. 701 et seq.) is amended by striking section 

7 510. 

8 (b) RESCISSION.—Amounts appropriated for each of 

9 fiscal years 2010 and 2011 under section 510(d) of the 

10 Social Security Act (42 U.S.C. 710(d)) (as in effect on 

11 the day before the date of enactment of this Act) that are 

12 unobligated as of the date of enactment of this Act are 

13 rescinded. 

14 (c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY

15 FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION

16 PROGRAM (PREP).—Section 513(f) of the Social Security 

17 Act (42 U.S.C. 713(f)) is amended by striking ‘‘for each 

18 of fiscal years 2010 through 2014’’ and inserting ‘‘for fis19 cal year 2010, $75,000,000 increased by an amount equal 

20 to the unobligated portion of funds appropriated for each 

21 of fiscal years 2010 and 2011 under section 510(d) that 

22 are rescinded under subsection (b), and $125,000,000 for 

23 each of fiscal years 2012 through 2014’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
439 

•HR 2954 IH

1 SEC. 745. DENTAL EDUCATION LOAN REPAYMENT PRO2 GRAM. 

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

4 Human Services may enter into an agreement with any 

5 dentist under which— 

6 (1) the dentist agrees to serve as a dentist for 

7 a period of not less than 2 years at a facility with 

8 a critical shortage of dentists (as determined by the 

9 Secretary) in an area with a high incidence of HIV/ 

10 AIDS; and 

11 (2) the Secretary agrees to make payments in 

12 accordance with subsection (b) on the dental edu13 cation loans of the dentist. 

14 (b) MANNER OF PAYMENTS.—The payments de15 scribed in subsection (a) shall be made by the Secretary 

16 as follows: 

17 (1) Upon completion by the dentist for whom 

18 the payments are to be made of the first year of the 

19 service specified in the agreement entered into with 

20 the Secretary under subsection (a), the Secretary 

21 shall pay 30 percent of the principal of and the in22 terest on the dental education loans of the dentist. 

23 (2) Upon completion by the dentist of the sec24 ond year of such service, the Secretary shall pay an25 other 30 percent of the principal of and the interest 

26 on such loans. 


emcdonald on DSK5VPTVN1PROD with BILLS
440 

•HR 2954 IH

1 (3) Upon completion by that individual of a 

2 third year of such service, the Secretary shall pay 

3 another 25 percent of the principal of and the inter4 est on such loans. 

5 (c) APPLICABILITY OF CERTAIN PROVISIONS.—The 

6 provisions of subpart III of part D of title III of the Public 

7 Health Service Act (42 U.S.C. 254l et seq.) shall, except 

8 as inconsistent with this section, apply to the program car9 ried out under this section in the same manner and to 

10 the same extent as such provisions apply to the National 

11 Health Service Corps Loan Repayment Program. 

12 (d) REPORTS.—Not later than 18 months after the 

13 date of the enactment of this Act, and annually thereafter, 

14 the Secretary shall prepare and submit to the Congress 

15 a report describing the program carried out under this sec16 tion, including statements regarding the following: 

17 (1) The number of dentists enrolled in the pro18 gram. 

19 (2) The number and amount of loan repay20 ments. 

21 (3) The placement location of loan repayment 

22 recipients at facilities described in subsection (a)(1). 

23 (4) The default rate and actions required. 

24 (5) The amount of outstanding default funds. 


emcdonald on DSK5VPTVN1PROD with BILLS
441 

•HR 2954 IH

1 (6) To the extent that it can be determined, the 

2 reason for the default. 

3 (7) The demographics of individuals partici4 pating in the program. 

5 (8) An evaluation of the overall costs and bene6 fits of the program. 

7 (e) DEFINITIONS.—In this section: 

8 (1) The term ‘‘dental education loan’’— 

9 (A) means a loan that is incurred for the 

10 cost of attendance (including tuition, other rea11 sonable educational expenses, and reasonable 

12 living costs) at a school of dentistry; and 

13 (B) includes only the portion of the loan 

14 that is outstanding on the date the dentist in15 volved begins the service specified in the agree16 ment under subsection (a). 

17 (2) The term ‘‘dentist’’ means a graduate of a 

18 school of dentistry who has completed postgraduate 

19 training in general or pediatric dentistry. 

20 (3) The term ‘‘HIV/AIDS’’ means human im21 munodeficiency virus and acquired immune defi22 ciency syndrome. 

23 (4) The term ‘‘school of dentistry’’ has the 

24 meaning given to that term in section 799B of the 

25 Public Health Service Act (42 U.S.C. 295p). 


emcdonald on DSK5VPTVN1PROD with BILLS
442 

•HR 2954 IH

1 (5) The term ‘‘Secretary’’ means the Secretary 

2 of Health and Human Services. 

3 (f) AUTHORIZATION OF APPROPRIATIONS.—To carry 

4 out this section, there are authorized to be appropriated 

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

6 2012 through 2016. 

7 SEC. 746. REPORT ON THE IMPLEMENTATION OF THE NA8 TIONAL HIV/AIDS STRATEGY. 

9 (a) REPORT REQUIRED.—Not later than 6 months 

10 after the date of the enactment of this Act, the President, 

11 in consultation with the heads of all relevant agencies in12 cluding the Department of Education, the Department of 

13 Health and Human Services, the Department of Housing 

14 and Urban Development, the Department of Justice, the 

15 Department of Labor, the Department of Veterans Af16 fairs, and the Social Security Administration, shall trans17 mit to the Congress and make publicly available a report 

18 on the status of the implementation of the National HIV/ 

19 AIDS Strategy. 

20 (b) CONTENTS.—The report required by subsection 

21 (a) shall include a description, analysis, and evaluation 

22 of— 

23 (1) key steps taken by the Federal Government 

24 towards the achievement of the goals of the National 

25 HIV/AIDS Strategy, including the goals of— 


emcdonald on DSK5VPTVN1PROD with BILLS
443 

•HR 2954 IH

1 (A) reducing the number of people who be2 come infected with HIV; 

3 (B) increasing access to care and opti4 mizing health outcomes for people living with 

5 HIV; and 

6 (C) reducing HIV-related health dispari7 ties; 

8 (2) the extent to which the National HIV/AIDS 

9 Strategy has improved coordination of efforts to 

10 maximize the effective delivery of HIV/AIDS preven11 tion, care, and treatment services at the community 

12 level, including coordination— 

13 (A) within and among Federal agencies 

14 and departments; 

15 (B) between the Federal Government and 

16 State and local governments and health depart17 ments; 

18 (C) between the Federal Government and 

19 nonprofit foundations and civil society organiza20 tions, including community- and faith-based or21 ganizations focused on addressing the issue of 

22 HIV/AIDS; and 

23 (D) between the Federal Government and 

24 private businesses; 


emcdonald on DSK5VPTVN1PROD with BILLS
444 

•HR 2954 IH

1 (3) efforts by the Federal Government to edu2 cate, involve, and establish and strengthen partner3 ships with civil society organizations, including 

4 community- and faith-based organizations, in order 

5 to implement the National HIV/AIDS Strategy and 

6 achieve its goals; 

7 (4) how Federal resources are being deployed to 

8 implement the Strategy, including— 

9 (A) the amount of funding used to date, by 

10 each Federal agency and department, to imple11 ment the National HIV/AIDS Strategy; 

12 (B) a brief summary for each Federal 

13 agency and department of the number and 

14 function of all Federal employees assisting in 

15 implementing the Strategy; and 

16 (C) an estimate of the amount of funding 

17 necessary to implement the National HIV/AIDS 

18 Strategy, by each Federal agency and depart19 ment, for the next fiscal year; and 

20 (5) what additional steps, if any, are necessary 

21 to fully implement the National HIV/AIDS Strategy, 

22 including— 

23 (A) whether any existing statutory laws, 

24 policies, or regulations are impeding the imple25 mentation of the National HIV/AIDS Strategy, 


emcdonald on DSK5VPTVN1PROD with BILLS
445 

•HR 2954 IH

1 at the Federal, State, or local level, and wheth2 er any changes to such laws, policies, or regula3 tions are necessary or recommended; and 

4 (B) whether any Federal agencies or de5 partments require additional statutory authority 

6 to effectively carry out their duties as part of 

7 the National HIV/AIDS Strategy. 

8 (c) USE OF PREVIOUSLY APPROPRIATED FUNDS.— 

9 Funding for the report required under subsection (a) shall 

10 derive from discretionary funds of the departments and 

11 agencies specified in such subsection. 

12 SEC. 747. ADDRESSING HIV/AIDS IN THE AFRICAN-AMER13 ICAN COMMUNITY. 

14 (a) SENSE OF CONGRESS ON NATIONAL BLACK

15 CLERGY HIV/AIDS AWARENESS SUNDAY.—It is the 

16 sense of Congress that— 

17 (1) there should be established a National 

18 Black Clergy HIV/AIDS Awareness Sunday on 

19 which the Congress and the President call on mem20 bers of the Black clergy— 

21 (A) to become involved at the local commu22 nity level in HIV/AIDS testing, policy, and ad23 vocacy; 


emcdonald on DSK5VPTVN1PROD with BILLS
446 

•HR 2954 IH

1 (B) to discuss the HIV/AIDS epidemic 

2 with their congregations and the community at3 large; and 

4 (C) to urge members of their congregations 

5 to reduce risk factors, practice safe sex and 

6 other preventive measures, be tested for HIV/ 

7 AIDS, and seek care when appropriate; and 

8 (2) an appropriate Sunday should be selected 

9 for this occasion. 

10 (b) SENSE OF CONGRESS ON FEDERAL AGENCIES

11 WITH RESPONSIBILITY FOR PREVENTING, TESTING FOR, 

12 AND TREATING HIV/AIDS.—It is the sense of Congress 

13 that all Federal agencies with a responsibility for pre14 venting, testing for, and treating HIV/AIDS should— 

15 (1) adopt policies for prevention, testing, and 

16 treatment that are consistent with the guidelines 

17 issued in 2006 by the Centers for Disease Control 

18 and Prevention, entitled ‘‘Revised Recommendations 

19 for HIV Testing of Adults, Adolescents, and Preg20 nant Women in Health-Care Settings’’; and 

21 (2) begin a systemic, aggressive approach to im22 plementing voluntary, routine testing as part of all 

23 health exams, including in emergency rooms, clinics, 

24 and private physician offices. 


emcdonald on DSK5VPTVN1PROD with BILLS
447 

•HR 2954 IH

1 (c) SENSE OF CONGRESS ON FEDERAL BUREAU OF

2 PRISONS PROCEDURES FOR INMATES WITH HIV.—It is 

3 the sense of Congress that the Federal Bureau of Prisons 

4 should implement procedures for— 

5 (1) voluntary HIV testing as a routine compo6 nent of inmate care; and 

7 (2) referral to care as a routine component of 

8 release planning for inmates with HIV/AIDS, includ9 ing referral to community-based care and faith-based 

10 institutions. 

11 SEC. 748. NATIONAL BLACK CLERGY FOR THE ELIMI12 NATION OF HIV/AIDS. 

13 (a) SHORT TITLE.—This section may be cited as the 

14 ‘‘National Black Clergy for the Elimination of HIV/AIDS 

15 Act of 2011’’. 

16 (b) FINDINGS.—Congress finds the following: 

17 (1) It has been estimated that more than 

18 1,200,000 people in the United States are living 

19 with HIV/AIDS, and approximately 500,000 of them 

20 are Black. Blacks are 8 times more likely to have 

21 AIDS than their White counterparts. Within the 

22 Black community, the subpopulation most dispropor23 tionately impacted by HIV/AIDS is Black men who 

24 have sex with men (MSM) with prevalence rates 

25 twice those of White MSM. Black women account 


emcdonald on DSK5VPTVN1PROD with BILLS
448 

•HR 2954 IH

1 for the majority of new AIDS cases among women 

2 and are 23 times more likely to be living with AIDS 

3 than White women and 4 times more likely than 

4 Latinas. 

5 (2) On October 7–8, 2007, 186 Black clergy, 

6 consisting of Baptist, COGIC, Methodist, Protes7 tant, AME, and Pentecostal, together with, medical, 

8 policy, and AIDS leaders, were brought together by 

9 the National Black Leadership Commission on 

10 AIDS (NBLCA), the oldest and largest Black AIDS 

11 organization of its kind in America, hosted by Time 

12 Warner, Inc., with other foundation support, to par13 ticipate in the National Black Clergy Conclave On 

14 HIV/AIDS Policy. 

15 (3) The attendees included faith leaders across 

16 traditional, mega, and activist churches representing 

17 millions of congregants: the National Medical Asso18 ciation (NMA) representing 30,000 African-Amer19 ican physicians; the National Conference of Black 

20 Mayors; the National Caucus of Black State Legisla21 tors; and the Health Brain Trust of the Congres22 sional Black Caucus and key African-American HIV/ 

23 AIDS advocates from across the United States. This 

24 group developed a plan of action that has become 

25 the National Black Clergy for the Elimination of 


emcdonald on DSK5VPTVN1PROD with BILLS
449 

•HR 2954 IH

1 HIV/AIDS Act of 2011 to respond to the ‘‘on the 

2 ground’’ emergency in prevention, care, and treat3 ment for AIDS in Black America. 

4 (4) In August 2007, the NMA, the oldest and 

5 largest organization representing 30,000 African6 American physicians, released a consensus report en7 titled ‘‘Addressing The HIV/AIDS Crisis In The Af8 rican American Community: Fact, Fiction and Pol9 icy’’; and specifically called on the next President of 

10 the United States to declare HIV/AIDS in African11 American communities a public health emergency 

12 and worked with NBLCA to organize clergy to advo13 cate for the specific needs of Black physicians, their 

14 patients, and those at risk in African-American com15 munities; and have pledged to advocate and work 

16 with clergy to develop, execute, and implement these 

17 initiatives as a part of their rightful role of leader18 ship in African-American communities and culture. 

19 (5) The National Conference of Black Mayors 

20 has pledged to work with clergy, medical, and com21 munity leaders to develop and support these initia22 tives on a local level and to help them to continue 

23 to develop a policy agenda leading to the elimination 

24 of HIV/AIDS. 


emcdonald on DSK5VPTVN1PROD with BILLS
450 

•HR 2954 IH

1 (6) The National Caucus of Black State Legis2 lators pledged to take the initiatives herein to their 

3 body and develop plans of action for Black State 

4 Legislators to work with local clergy, health depart5 ments, and CBOs to adopt and implement these ini6 tiatives on a national level. 

7 (7) At their April 2008 annual meeting, the 

8 National Policy Alliance (NPA), consisting of the 

9 Joint Center For Political and Economic Studies 

10 (secretariat) and the National Black Caucus of 

11 School Board Members, National Black Caucus of 

12 Local Elected Officials; the Judicial Council of the 

13 National Bar Association; the National Association 

14 of Black County Officials; Blacks in Government 

15 and the CBC; NCBM; WCM, voted unanimously to 

16 support, endorse, and encourage the passage of the 

17 National Black Clergy for the Elimination of HIV/ 

18 AIDS Act of 2011 and to organize their respective 

19 members to endorse and support the passage of this 

20 bill. 

21 (8) The World Conference of Black Mayors has 

22 ratified its support of these initiatives and legisla23 tion, and pledged to assist the clergy to take them 

24 internationally. 


emcdonald on DSK5VPTVN1PROD with BILLS
451 

•HR 2954 IH

1 (9) The National Black Leadership Commission 

2 on AIDS, the Balm in Gilead, and the Black AIDS 

3 Institute have been recognized by the clergy for their 

4 tradition and history of service and will work with 

5 clergy to conduct community and policy develop6 ment, linkages to local departments of health and 

7 other services, infrastructure development, education 

8 media, and fund development activities. 

9 (10) Bishop T.D. Jakes of the Potters House 

10 in Dallas, Texas, and Rev. Calvin O. Butts of the 

11 Abyssinian Baptist Church in Harlem, New York, 

12 and chairman of the National Black Leadership 

13 Commission on AIDS have been recognized as the 

14 organizers of this group and will help guide and lead 

15 the development efforts of fellow clergy through this 

16 process. 

17 (11) The National Conclave on HIV/AIDS for 

18 Black Clergy calls upon the President, Congress, 

19 and corporate America to declare the HIV/AIDS cri20 sis in the African-American community a ‘‘public 

21 health emergency’’. 

22 (12) The Black clergy will aggressively seek to 

23 have every person under the sphere of their influence 

24 tested for HIV in order to know the person’s status. 


emcdonald on DSK5VPTVN1PROD with BILLS
452 

•HR 2954 IH

1 (13) The Black clergy will promote HIV/AIDS 

2 awareness to ensure that all Black clergy serving in 

3 their denominations and other congregations are 

4 equipped to address issues related to this disease in 

5 a factual and scientifically sound manner. 

6 (14) The Black clergy will use the ABC/D 

7 model as a behavioral guideline for prevention initia8 tives: 

9 (A) A–Abstain. 

10 (B) B–Be Faithful. 

11 (C) C–Use Condoms. 

12 (D) D–Don’t Engage in Risky Behaviors. 

13 (c) DEFINITIONS APPLICABLE THROUGHOUT SEC14 TION.—In this section— 

15 (1) the terms ‘‘HIV’’ and ‘‘HIV/AIDS’’ have 

16 the meanings given to such terms in section 2689 of 

17 the Public Health Service Act (42 U.S.C. 300ff–88); 

18 and 

19 (2) the term ‘‘Secretary’’ means the Secretary 

20 of Health and Human Services. 

21 (d) SERVICES TO REDUCE HIV/AIDS IN THE AFRI22 CAN-AMERICAN COMMUNITY.— 

23 (1) IN GENERAL.—For the purpose of reducing 

24 HIV/AIDS in the African-American community, the 

25 Secretary, acting through the Deputy Assistant SecVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00452 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
453 

•HR 2954 IH

1 retary for Minority Health, may make grants to 

2 public health agencies and faith-based organizations 

3 to conduct— 

4 (A) outreach activities related to HIV/ 

5 AIDS prevention and testing activities; 

6 (B) HIV/AIDS prevention activities; and 

7 (C) HIV/AIDS testing activities. 

8 (2) AUTHORIZATION OF APPROPRIATIONS.—To 

9 carry out this section, there are authorized to be ap10 propriated $50,000,000 for fiscal year 2012, and 

11 such sums as may be necessary for fiscal years 2013 

12 through 2016. 

13 (e) GRANTS FOR SUBSTANCE ABUSE AND MENTAL

14 HEALTH SERVICES TO PUBLIC HEALTH AGENCIES AND

15 FAITH-BASED ORGANIZATIONS.— 

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

17 through the Administrator of the Substance Abuse 

18 and Mental Health Services Administration, may 

19 make grants to public health agencies and faith20 based organizations to— 

21 (A) conduct HIV/AIDS and sexually trans22 mitted disease outreach, prevention, and testing 

23 activities that are targeted to the African-Amer24 ican community; and 


emcdonald on DSK5VPTVN1PROD with BILLS
454 

•HR 2954 IH

1 (B) in connection with such activities, pro2 vide substance abuse testing and mental health 

3 services to members of such community. 

4 (2) AUTHORIZATION OF APPROPRIATIONS.—To 

5 carry out this section, there are authorized to be ap6 propriated $90,000,000 for fiscal year 2012 and 

7 such sums as may be necessary for fiscal years 2013 

8 through 2016. 

9 (f) SERVICES FOR HIV/AIDS AFFECTED YOUTH

10 WHO ARE SEPARATED FROM THEIR FAMILIES.— 

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

12 through the Administrator of the Substance Abuse 

13 and Mental Health Services Administration, may 

14 make grants to faith- and community-based organi15 zations to provide family reunification services, men16 tal health counseling, HIV/AIDS and sexually trans17 mitted disease testing, and substance abuse testing 

18 and treatment to youth who— 

19 (A)(i) have run away from home; 

20 (ii) are homeless; or 

21 (iii) reside in a detention center or foster 

22 care; and 

23 (B) are HIV positive or at risk for HIV/ 

24 AIDS, including young men who have sex with 

25 men. 


emcdonald on DSK5VPTVN1PROD with BILLS
455 

•HR 2954 IH

1 (2) AUTHORIZATION OF APPROPRIATIONS.—To 

2 carry out this section, there are authorized to be ap3 propriated $5,000,000 for fiscal year 2012, and such 

4 sums as may be necessary for fiscal years 2013 

5 through 2016. 

6 (g) PUBLIC HEALTH INTERVENTION AND PREVEN7 TION ACTIVITIES.— 

8 (1) IN GENERAL.—For the purpose of reducing 

9 HIV/AIDS, sexually transmitted diseases, tuber10 culosis, and viral hepatitis in African-American com11 munities, the Secretary, acting through the Director 

12 of the Centers for Disease Control and Prevention, 

13 may make grants to faith-based organizations for 

14 public health intervention and prevention activities, 

15 including the use of rapid testing in traditional and 

16 nontraditional settings to increase the number of in17 dividuals who know their status at the point of care 

18 and are put into treatment. 

19 (2) PARTNERSHIPS.—In carrying out this sec20 tion, the Secretary shall encourage grantees to enter 

21 into partnerships with public health agencies. 

22 (3) AUTHORIZATION OF APPROPRIATIONS.—To 

23 carry out this section, there are authorized to be ap24 propriated $100,000,000 for fiscal year 2012, and 


emcdonald on DSK5VPTVN1PROD with BILLS
456 

•HR 2954 IH

1 such sums as may be necessary for fiscal years 2013 

2 through 2016. 

3 (h) HIV/AIDS PREVENTION AND EDUCATION.— 

4 (1) PREVENTION ACTIVITIES.—The Secretary, 

5 acting through the Director of the Centers for Dis6 ease Control and Prevention, shall expand and inten7 sify HIV/AIDS prevention activities in African8 American communities. Such activities— 

9 (A) shall be targeted to specific popu10 lations; 

11 (B) shall be comprehensive and accurately 

12 based on science and research; and 

13 (C) shall include information on absti14 nence, the proper use of condoms, risks associ15 ated with unprotected sex, and the value of sex16 ual delay particularly among young adolescents 

17 and teenagers. 

18 (2) EDUCATION.—The Secretary, acting 

19 through the Director of the Centers for Disease 

20 Control and Prevention, shall expand and intensify 

21 HIV/AIDS educational activities targeting Black 

22 women, youth, and men who have sex with men. 

23 (3) COORDINATION.—The Secretary shall carry 

24 out this section in coordination with public schools 

25 of all levels, Black organizations, historically Black 


emcdonald on DSK5VPTVN1PROD with BILLS
457 

•HR 2954 IH

1 colleges and universities, and faith-based organiza2 tions and institutions. 

3 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

4 carry out this section, there are authorized to be ap5 propriated $90,000,000 for fiscal year 2012, and 

6 such sums as may be necessary for fiscal years 2013 

7 through 2016. 

8 (i) BUILDING CAPACITY OF COMMUNITIES.— 

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

10 through the Director of the Centers for Disease 

11 Control and Prevention, shall expand funding to eli12 gible entities to build the capacity of African-Amer13 ican communities to respond to HIV/AIDS. 

14 (2) EMPHASIS.—In carrying out this section, 

15 the Secretary shall emphasize the provision of fund16 ing for policy development, education, technical as17 sistance, and training— 

18 (A) to national and local faith-based orga19 nizations; and 

20 (B) to organizations with a significant his21 tory of working within the African-American 

22 community on HIV/AIDS issues, an inter23 denominational center of seminaries specializing 

24 in the training of African-American clergy, and 

25 historically Black colleges and universities. 


emcdonald on DSK5VPTVN1PROD with BILLS
458 

•HR 2954 IH

1 (3) DEFINITION.—In this section, the term ‘‘el2 igible entity’’ means a national or community-based 

3 organization with a history and tradition of service 

4 to African-American communities. 

5 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

6 carry out this section, there are authorized to be ap7 propriated $25,000,000 for fiscal year 2012, and 

8 such sums as may be necessary for fiscal years 2013 

9 through 2016. 

10 (j) NATIONAL MEDIA OUTREACH CAMPAIGN.— 

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

12 through the Director of the Centers for Disease 

13 Control and Prevention, shall implement a national 

14 media outreach campaign that urges all sexually ac15 tive individuals to be tested for and know their HIV/ 

16 AIDS status. 

17 (2) REQUIREMENTS.—The national media out18 reach campaign under this subsection shall— 

19 (A) be science-driven and targeted to Afri20 can-American men, women, and youth; and 

21 (B) give special emphasis to Black women 

22 and men who have sex with men. 

23 (3) COORDINATION; CONSULTATION.—The Sec24 retary shall carry out this subsection— 


emcdonald on DSK5VPTVN1PROD with BILLS
459 

•HR 2954 IH

1 (A) in coordination with Black media out2 lets for print, electronic, and Web-based media 

3 and Black media associations, including the Na4 tional Association of Black Owned Broadcasters 

5 and the National Newspaper Publishers Asso6 ciation; and 

7 (B) in consultation with an advisory board 

8 including representatives of the National Med9 ical Association, faith leaders, elected and ap10 pointed officials, social marketing experts, and 

11 business and community stakeholders. 

12 (4) AUTHORIZATION OF APPROPRIATIONS.—To 

13 carry out this subsection, there are authorized to be 

14 appropriated $10,000,000 for fiscal year 2012, and 

15 such sums as may be necessary for fiscal years 2013 

16 through 2016. 

17 (k) RESEARCH TO DEVELOP BEHAVIORAL STRATE18 GIES TO REDUCE TRANSMISSION OF HIV/AIDS.— 

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

20 through the Director of the National Institutes of 

21 Health, may conduct or support culturally competent 

22 research to develop evidence-based behavioral strate23 gies to reduce the transmission of HIV/AIDS within 

24 the African-American community. 


emcdonald on DSK5VPTVN1PROD with BILLS
460 

•HR 2954 IH

1 (2) PRIORITY.—In carrying out this section, the 

2 Secretary shall prioritize research that focuses on 

3 populations within the African-American community 

4 that are at increased risk for HIV/AIDS, includ5 ing— 

6 (A) men who have sex with men; and 

7 (B) women. 

8 (3) AUTHORIZATION OF APPROPRIATIONS.—To 

9 carry out this section, there are authorized to be ap10 propriated $10,000,000 for fiscal year 2012, and 

11 such sums as may be necessary for fiscal years 2013 

12 through 2016. 

13 (l) STUDY OF BIOLOGICAL AND BEHAVIORAL FAC14 TORS.— 

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

16 through the Director of the National Institute on 

17 Minority Health and Health Disparities, may make 

18 grants for— 

19 (A) the study of biological and behavioral 

20 factors that lead to increased HIV/AIDS preva21 lence in the African-American community, to be 

22 conducted by researchers with a history and 

23 tradition of service to Black communities; and 

24 (B) behavioral and structural network re25 search and interventions, in collaboration with 


emcdonald on DSK5VPTVN1PROD with BILLS
461 

•HR 2954 IH

1 other institutes and centers of the National In2 stitutes of Health, indigenous faith and national 

3 and community-based organizations with a his4 tory and tradition of conducting such research 

5 for Black communities, with a special emphasis 

6 on Black women and Black men who have sex 

7 with men. 

8 (2) AUTHORIZATION OF APPROPRIATIONS.—To 

9 carry out this subsection, there are authorized to be 

10 appropriated $100,000,000 for fiscal year 2012, and 

11 such sums as may be necessary for fiscal years 2013 

12 through 2016. 

13 (m) HEALTH CARE PROFESSIONALS TREATING INDI14 VIDUALS WITH HIV/AIDS.—Part E of title VII of the 

15 Public Health Service Act (42 U.S.C. 294n et seq.) is 

16 amended by adding at the end the following: 

17 ‘‘Subpart 4—Health Care Professionals Treating 

18 Individuals With HIV/AIDS 

19 ‘‘SEC. 781. BETTER CARE FOR INDIVIDUALS WITH HIV/AIDS. 

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

21 the Administrator of the Health Resources and Services 

22 Administration and in consultation with the African23 American church community, may award grants for any 

24 of the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
462 

•HR 2954 IH

1 ‘‘(1) Development of curricula for training pri2 mary care providers in HIV/AIDS prevention and 

3 care. 

4 ‘‘(2) Training health care professionals with ex5 pertise in HIV/AIDS to provide care to individuals 

6 with HIV/AIDS. 

7 ‘‘(3) Development by grant recipients under 

8 title XXVI and other persons of policies for pro9 viding culturally relevant and sensitive treatment to 

10 individuals with HIV/AIDS, with particular empha11 sis on treatment to African-Americans and children 

12 with HIV/AIDS. 

13 ‘‘(4) Development and implementation of pro14 grams to increase the use of telemedicine to respond 

15 to HIV/AIDS-specific health care needs in rural and 

16 minority communities, with particular emphasis 

17 given to medically underserved communities and the 

18 southern States. 

19 ‘‘(5) Creation of faith- and community-based 

20 certification programs for providers in HIV/AIDS 

21 care and support services. 

22 ‘‘(6) Establishment of comfort care centers that 

23 provide mental, emotional, and psychosocial coun24 seling for people with HIV/AIDS and implement ad25 ditional protocols to be carried out in the centers 


emcdonald on DSK5VPTVN1PROD with BILLS
463 

•HR 2954 IH

1 that address the needs of children and young adults 

2 who are infected with the disease and are 

3 transitioning from childhood to adulthood. 

4 ‘‘(7) Incentive payments to health care pro5 viders supported by the Health Resources and Serv6 ices Administration to implement HIV/AIDS testing 

7 consistent with the guidelines issued in 2006 by the 

8 Centers for Disease Control and Prevention entitled 

9 ‘Revised Recommendations for HIV Testing of 

10 Adults, Adolescents, and Pregnant Women in 

11 Health-Care Settings’. 

12 ‘‘(b) DEFINITION.—In this section, the term ‘HIV/ 

13 AIDS’ has the meaning given to such term in section 

14 2689. 

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

16 carry out this section, there are authorized to be appro17 priated $100,000,000 for fiscal year 2012, and such sums 

18 as may be necessary for fiscal years 2013 through 2016.’’. 

19 (n) REPORT ON IMPACT OF HIV/AIDS IN THE AFRI20 CAN-AMERICAN COMMUNITY.— 

21 (1) IN GENERAL.—The Secretary shall submit 

22 to Congress and the President an annual report on 

23 the impact of HIV/AIDS in the African-American 

24 community. 


emcdonald on DSK5VPTVN1PROD with BILLS
464 

•HR 2954 IH

1 (2) CONTENTS.—The report under subsection 

2 (a) shall include information on the— 

3 (A) progress that has been made in reduc4 ing the impact of HIV/AIDS in such commu5 nity; 

6 (B) opportunities that exist to make addi7 tional progress in reducing the impact of HIV/ 

8 AIDS in such community; 

9 (C) challenges that may impede such addi10 tional progress; and 

11 (D) Federal funding necessary to achieve 

12 substantial reductions in HIV/AIDS in the Afri13 can-American community. 

14 SEC. 749. REDUCING THE SPREAD OF SEXUALLY TRANS15 MITTED INFECTIONS IN CORRECTIONAL FA16 CILITIES. 

17 (a) SHORT TITLE.—This section may be cited as the 

18 ‘‘Justice for the Unprotected Against Sexually Trans19 mitted Infections among the Confined and Exposed Act’’ 

20 or the ‘‘JUSTICE Act’’. 

21 (b) FINDINGS.—The Congress makes the following 

22 findings: 

23 (1) According to the Bureau of Justice Statis24 tics (BJS), 2,292,133 persons were incarcerated in 

25 the United States as of the end of 2009. Between 


emcdonald on DSK5VPTVN1PROD with BILLS
465 

•HR 2954 IH

1 1998 and 2008, the number of persons incarcerated 

2 in Federal or State correctional facilities increased 

3 by an average of 2.4 percent per year. One in every 

4 32 United States residents was on probation, in jail 

5 or prison, or on parole at the end of 2009. 

6 (2) As of 2009, 66.8 percent of incarcerated 

7 persons were racial or ethnic minorities. Based on 

8 current incarceration rates, BJS estimates that Afri9 can-American males are 6 times more likely to be 

10 held in custody than White males, while Hispanic 

11 males are a little more than 2 times more likely to 

12 be held in custody. Across all age categories, Afri13 can-American males were incarcerated at higher 

14 rates than Hispanic or White males. 

15 (3) There is a disproportionately high rate of 

16 HIV/AIDS among incarcerated persons, especially 

17 among minorities. Approximately 25 percent of the 

18 HIV-positive population of the United States passes 

19 through correctional facilities each year. BJS has 

20 determined that the rate of confirmed AIDS cases is 

21 2.4 times higher among incarcerated persons than in 

22 the general population. Minorities account for the 

23 majority of AIDS-related deaths among incarcerated 

24 persons, with African-American incarcerated persons 

25 2.8 times more likely than White incarcerated perVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00465 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
466 

•HR 2954 IH

1 sons and 1.4 times more likely than Hispanic incar2 cerated persons to die from AIDS-related causes. 

3 Nearly two-thirds of AIDS-related deaths are among 

4 Black, non-Hispanic males. 

5 (4) Studies suggest that other sexually trans6 mitted infections (STIs), such as gonorrhea, 

7 chlamydia, syphilis, genital herpes, viral hepatitis, 

8 and human papillomavirus, also exist at a higher 

9 rate among incarcerated persons than in the general 

10 population. For instance, researchers have estimated 

11 that the rate of hepatitis C (HCV) infection among 

12 incarcerated persons is somewhere between 8 and 20 

13 times higher than that of the general population. 

14 (5) Correctional facilities lack a uniform system 

15 of STI testing and reporting. Establishing a uniform 

16 data collection system would assist in developing and 

17 targeting counseling and treatment programs for in18 carcerated persons. Better developed and targeted 

19 programs may reduce the spread of STIs. 

20 (6) Although Congress has acted to reduce the 

21 spread of sexual violence in correctional facilities by 

22 enacting the National Prison Rape Elimination Act 

23 (PREA) of 2003, BJS reported that approximately 

24 4.4 percent of incarcerated persons in prisons and 

25 3.1 percent of persons in jail reported experiencing 


emcdonald on DSK5VPTVN1PROD with BILLS
467 

•HR 2954 IH

1 one or more incidents of sexual victimization by an2 other incarcerated person or correctional facility 

3 staff in the previous year. 

4 (7) Approximately 95 percent of all incarcer5 ated persons eventually return to society. According 

6 to one study, every year approximately 100,000 per7 sons infected with both HIV and HCV are released 

8 from correctional facilities. These individuals com9 prise approximately 50 percent of all persons with 

10 both infections in the United States. 

11 (8) According to the Centers for Disease Con12 trol and Prevention (CDC), latex condoms, when 

13 used consistently and correctly, are highly effective 

14 in preventing the transmission of HIV. Latex 

15 condoms also reduce the risk of other STIs. Despite 

16 the effectiveness of condoms in reducing the spread 

17 of STIs, the Bureau of Prisons does not recommend 

18 their use in correctional facilities. 

19 (9) The distribution of condoms in correctional 

20 facilities is currently legal in certain parts of the 

21 United States and the world. The States of Vermont 

22 and Mississippi and the District of Columbia allow 

23 condom distribution programs in their correctional 

24 facilities. The cities of New York, San Francisco, 

25 Los Angeles, Washington DC, and Philadelphia also 


emcdonald on DSK5VPTVN1PROD with BILLS
468 

•HR 2954 IH

1 allow condom distribution in their correctional facili2 ties. However, these States and cities operate fewer 

3 than 1 percent of all correctional facilities. 

4 (10) A 2007 report by the Massachusetts Gen5 eral Hospital Division of Infectious Diseases and the 

6 University of California, San Francisco, found that 

7 the proportion of European prison systems allowing 

8 condoms rose from 53 percent in 1989 to 81 percent 

9 in 1997. The same report also found that no prison 

10 system allowing the distribution of condoms had re11 versed their decision, and no prison system reported 

12 an increase in sexual activity among incarcerated 

13 persons as a result of a decision to allow condom 

14 distribution. 

15 (11) In 2000 and 2001, researchers surveyed 

16 300 incarcerated persons and 100 correctional offi17 cers at the Central Detention Facility, a correctional 

18 facility operated by the District of Columbia at 

19 which condoms are available. Researchers found that 

20 both incarcerated persons and correctional officers 

21 generally supported the condom distribution pro22 gram and considered it to be important. Further23 more, the researchers determined that the program 

24 had not caused any major security infractions. In 

25 Canada, the Expert Committee on AIDS and PrisVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00468 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
469 

•HR 2954 IH

1 ons surveyed more than 400 correctional officers in 

2 the Federal prison system of Canada in 1995 and 

3 reported that 82 percent of those responding indi4 cated that the availability of condoms had created no 

5 problems at their facility. 

6 (12) The American Public Health Association, 

7 the United Nations Joint Program on HIV/AIDS, 

8 and the World Health Organization have endorsed 

9 the effectiveness of condom distribution programs in 

10 correctional facilities. 

11 (13) Many correctional facilities in the United 

12 States do not provide comprehensive testing and 

13 treatment programs to reduce the spread of STIs. 

14 According to BJS surveys from 2005, only 996 of 

15 the 1,821 Federal and State correctional facilities 

16 (i.e. 54.7 percent) provided HIV/AIDS counseling 

17 programs. 

18 (14) Individuals who are enrolled in Medicaid 

19 prior to incarceration face a suspension of their ben20 efits upon incarceration, and in some States a termi21 nation of their Medicaid eligibility. The Federal Gov22 ernment encourages States to automatically re-enroll 

23 incarcerated persons on Medicaid upon their release 

24 from a correctional facility, unless the State reaches 


emcdonald on DSK5VPTVN1PROD with BILLS
470 

•HR 2954 IH

1 a determination that the individual is no longer eligi2 ble for reasons other than their prior incarceration. 

3 (15) Formerly incarcerated individuals who are 

4 newly released from correctional facilities often face 

5 delays in the resumption of their Medicaid benefits 

6 which may exacerbate any health issues which they 

7 face. 

8 (16) Incarcerated individuals living with HIV/ 

9 AIDS who are eligible for Medicaid would benefit 

10 from prompt and automatic enrollment upon their 

11 release in order to ensure their continued ability to 

12 access health services, including antiretroviral treat13 ment. 

14 (c) AUTHORITY TO ALLOW COMMUNITY ORGANIZA15 TIONS TO PROVIDE STI COUNSELING, STI PREVENTION

16 EDUCATION, AND SEXUAL BARRIER PROTECTION DE17 VICES IN FEDERAL CORRECTIONAL FACILITIES.— 

18 (1) DIRECTIVE TO ATTORNEY GENERAL.—Not 

19 later than 30 days after the date of enactment of 

20 this Act, the Attorney General shall direct the Bu21 reau of Prisons to allow community organizations to 

22 distribute sexual barrier protection devices and to 

23 engage in STI counseling and STI prevention edu24 cation in Federal correctional facilities. These activi25 ties shall be subject to all relevant Federal laws and 


emcdonald on DSK5VPTVN1PROD with BILLS
471 

•HR 2954 IH

1 regulations which govern visitation in correctional 

2 facilities. 

3 (2) INFORMATION REQUIREMENT.—Any com4 munity organization permitted to distribute sexual 

5 barrier protection devices under paragraph (1) must 

6 ensure that the persons to whom the devices are dis7 tributed are informed about the proper use and dis8 posal of sexual barrier protection devices in accord9 ance with established public health practices. Any 

10 community organization conducting STI counseling 

11 or STI prevention education under paragraph (1) 

12 must offer comprehensive sexuality education. 

13 (3) POSSESSION OF DEVICE PROTECTED.—No 

14 Federal correctional facility may, because of the pos15 session or use of a sexual barrier protection device— 

16 (A) take adverse action against an incar17 cerated person; or 

18 (B) consider possession or use as evidence 

19 of prohibited activity for the purpose of any 

20 Federal correctional facility administrative pro21 ceeding. 

22 (4) IMPLEMENTATION.—The Attorney General 

23 and Bureau of Prisons shall implement this section 

24 according to established public health practices in a 

25 manner that protects the health, safety, and privacy 


emcdonald on DSK5VPTVN1PROD with BILLS
472 

•HR 2954 IH

1 of incarcerated persons and of correctional facility 

2 staff. 

3 (d) SENSE OF CONGRESS REGARDING DISTRIBUTION

4 OF SEXUAL BARRIER PROTECTION DEVICES IN STATE

5 PRISON SYSTEMS.—It is the sense of Congress that States 

6 should allow for the legal distribution of sexual barrier 

7 protection devices in State correctional facilities to reduce 

8 the prevalence and spread of STIs in those facilities. 

9 (e) AUTOMATIC REINSTATEMENT OF MEDICAID BEN10 EFITS.— 

11 (1) IN GENERAL.—Section 1902(e) of the So12 cial Security Act (42 U.S.C. 1396a(e)) is amended 

13 by adding at the end the following: 

14 ‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 

15 ‘‘(A) AUTOMATIC ENROLLMENT OR REIN16 STATEMENT.— 

17 ‘‘(i) IN GENERAL.—The State plan 

18 shall provide for the automatic enrollment 

19 or reinstatement of enrollment of an eligi20 ble individual if— 

21 ‘‘(I) such individual is scheduled 

22 to be released from a public institu23 tion due to the completion of sen24 tence, not less than 30 days prior to 

25 the scheduled date of the release; and 


emcdonald on DSK5VPTVN1PROD with BILLS
473 

•HR 2954 IH

1 ‘‘(II) such individual is to be re2 leased from a public institution on pa3 role or on probation, as soon as pos4 sible after the date on which the de5 termination to release such individual 

6 was made, and before the date such 

7 individual is released. 

8 ‘‘(ii) EXCEPTION.—If a State makes a 

9 determination that an individual is not eli10 gible to be enrolled under the State plan— 

11 ‘‘(I) on or before the date by 

12 which the individual would be enrolled 

13 under clause (i), such clause shall not 

14 apply to such individual; or 

15 ‘‘(II) after such date, the State 

16 may terminate the enrollment of such 

17 individual. 

18 ‘‘(B) RELATIONSHIP OF ENROLLMENT TO

19 PAYMENT FOR SERVICES.— 

20 ‘‘(i) IN GENERAL.—Subject to sub21 paragraph (A)(ii), an eligible individual 

22 who is enrolled, or whose enrollment is re23 instated under subparagraph (A), shall be 

24 eligible for medical assistance that is pro25 vided after the date that the eligible indiVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00473 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
474 

•HR 2954 IH

1 vidual is released from the public institu2 tion 

3 ‘‘(ii) RELATIONSHIP TO PAYMENT

4 PROHIBITION FOR INMATES.—No provision 

5 of this paragraph may be construed to per6 mit payment for care or services for which 

7 payment is excluded under the subpara8 graph (A), following paragraph (29), of 

9 section 1905(a). 

10 ‘‘(C) TREATMENT OF CONTINUOUS ELIGI11 BILITY.— 

12 ‘‘(i) SUSPENSION FOR INMATES.—Any 

13 period of continuous eligibility under this 

14 title shall be suspended on the date an in15 dividual enrolled under this title becomes 

16 an inmate of a public institution (except as 

17 a patient of a medical institution). 

18 ‘‘(ii) DETERMINATION OF REMAINING

19 PERIOD.—Notwithstanding any changes to 

20 State law related to continuous eligibility 

21 during the time that an individual is an in22 mate of a public institution (except as a 

23 patient of a medical institution), subject to 

24 clause (iii), with respect to an eligible indi25 vidual who was subject to a suspension 


emcdonald on DSK5VPTVN1PROD with BILLS
475 

•HR 2954 IH

1 under subclause (I), on the date that such 

2 individual is released from a public institu3 tion the suspension of continuous eligibility 

4 under such subclause shall be lifted for a 

5 period that is equal to the time remaining 

6 in the period of continuous eligibility for 

7 such individual on the date that such pe8 riod was suspended under such subclause. 

9 ‘‘(iii) EXCEPTION.—If a State makes 

10 a determination that an individual is not 

11 eligible to be enrolled under the State 

12 plan— 

13 ‘‘(I) on or before the date that 

14 the suspension of continuous eligibility 

15 is lifted under clause (ii), such clause 

16 shall not apply to such individual; or 

17 ‘‘(II) after such date, the State 

18 may terminate the enrollment of such 

19 individual. 

20 ‘‘(D) AUTOMATIC ENROLLMENT OR REIN21 STATEMENT OF ENROLLMENT DEFINED.—For 

22 purposes of this paragraph, the term ‘automatic 

23 enrollment or reinstatement of enrollment’ 

24 means that the State determines eligibility for 

25 medical assistance under the State plan without 


emcdonald on DSK5VPTVN1PROD with BILLS
476 

•HR 2954 IH

1 a program application from, or on behalf of, the 

2 eligible individual, but an individual can only be 

3 automatically enrolled in the State Medicaid 

4 plan if the individual affirmatively consents to 

5 being enrolled through affirmation in writing, 

6 by telephone, orally, through electronic signa7 ture, or through any other means specified by 

8 the Secretary. 

9 ‘‘(E) ELIGIBLE INDIVIDUAL DEFINED.— 

10 For purposes of this paragraph, the term ‘eligi11 ble individual’ means an individual who is an 

12 inmate of a public institution (except as a pa13 tient in a medical institution)— 

14 ‘‘(i) who was enrolled under the State 

15 plan for medical assistance immediately be16 fore becoming an inmate of such an insti17 tution; or 

18 ‘‘(ii) is diagnosed with human im19 munodeficiency virus.’’. 

20 (2) SUPPLEMENTAL FUNDING FOR STATE IM21 PLEMENTATION OF AUTOMATIC REINSTATEMENT OF

22 MEDICAID BENEFITS.— 

23 (A) IN GENERAL.—Subject to paragraph 

24 (6), for each State for which the Secretary of 

25 Health and Human Services has approved an 


emcdonald on DSK5VPTVN1PROD with BILLS
477 

•HR 2954 IH

1 application under paragraph (3), the Federal 

2 matching payments (including payments based 

3 on the Federal medical assistance percentage) 

4 made to such State under section 1903 of the 

5 Social Security Act (42 U.S.C. 1396b) shall be 

6 increased by 5.0 percentage points for pay7 ments to the State for the activities permitted 

8 under paragraph (2) for a period of one year. 

9 (B) USE OF FUNDS.—A State may only 

10 use increased matching payments authorized 

11 under paragraph (1)— 

12 (i) to strengthen the State’s enroll13 ment and administrative resources for the 

14 purpose of improving processes for enroll15 ing (or reinstating the enrollment of) eligi16 ble individuals (as such term is defined in 

17 section 1902(e)(15)(E) of the Social Secu18 rity Act); and 

19 (ii) for medical assistance (as such 

20 term is defined in section 1905(a) of the 

21 Social Security Act) provided to such eligi22 ble individuals. 

23 (C) APPLICATION AND AGREEMENT.—The 

24 Secretary may only make payments to a State 

25 in the increased amount if— 


emcdonald on DSK5VPTVN1PROD with BILLS
478 

•HR 2954 IH

1 (i) the State has amended the State 

2 plan under section 1902 of the Social Se3 curity Act to incorporate the requirements 

4 of subsection (e)(15) of such section; 

5 (ii) the State has submitted an appli6 cation to the Secretary that includes a plan 

7 for implementing the requirements of sec8 tion 1902(e)(15) of the Social Security Act 

9 under the State’s amended State plan be10 fore the end of the 90-day period begin11 ning on the date that the State receives in12 creased matching payments under para13 graph (1); 

14 (iii) the State’s application meets the 

15 satisfaction of the Secretary; and 

16 (iv) the State enters an agreement 

17 with the Secretary that states that— 

18 (I) the State will only use the in19 creased matching funds for the uses 

20 permitted under paragraph (2); and 

21 (II) at the end of the period 

22 under paragraph (1), the State will 

23 submit to the Secretary, and make 

24 publicly available, a report that conVerDate Mar 15 2010 03:50 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00478 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
479 

•HR 2954 IH

1 tains the information required under 

2 paragraph (4). 

3 (D) REQUIRED REPORT INFORMATION.— 

4 The information that is required in the report 

5 under paragraph (3)(D)(ii) includes— 

6 (i) the results of an evaluation of the 

7 impact of the implementation of the re8 quirements of section 1902(e)(15) of the 

9 Social Security Act on improving the 

10 State’s processes for enrolling of individ11 uals who are released for public institu12 tions into the Medicaid program; 

13 (ii) the number of individuals who 

14 were automatically enrolled (or whose en15 rollment is reinstated) under such section 

16 1902(e)(15) during the period under para17 graph (1); and 

18 (iii) any other information that is re19 quired by the Secretary. 

20 (E) INCREASE IN CAP ON MEDICAID PAY21 MENTS TO TERRITORIES.—Subject to para22 graph (6), the amounts otherwise determined 

23 for Puerto Rico, the United States Virgin Is24 lands, Guam, the Commonwealth of the North25 ern Mariana Islands, and American Samoa 


emcdonald on DSK5VPTVN1PROD with BILLS
480 

•HR 2954 IH

1 under subsections (f) and (g) of section 1108 of 

2 the Social Security Act (42 U.S.C. 1308) shall 

3 each be increased by the necessary amount to 

4 allow for the increase in the Federal matching 

5 payments under paragraph (1), but only for the 

6 period under such paragraph for such State. In 

7 the case of such an increase for a territory, sub8 section (a)(1) of such section 1108 shall be ap9 plied without regard to any increase in payment 

10 made to the territory under part E of title IV 

11 of such Act that is attributable to the increase 

12 in Federal medical assistance percentage ef13 fected under paragraph (1) for the territory. 

14 (F) LIMITATIONS.— 

15 (i) TIMING.—With respect to a State, 

16 at the end of the period under paragraph 

17 (1), no increased matching payments may 

18 be made to such State under this sub19 section. 

20 (ii) MAINTENANCE OF ELIGIBILITY.— 

21 (I) IN GENERAL.—Subject to 

22 clause (ii), a State is not eligible for 

23 an increase in its Federal matching 

24 payments under paragraph (1), or an 

25 increase in a cap amount under paraVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00480 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
481 

•HR 2954 IH

1 graph (5), if eligibility standards, 

2 methodologies, or procedures under its 

3 State plan under title XIX of the So4 cial Security Act (including any waiv5 er under such title or under section 

6 1115 of such Act (42 U.S.C. 1315)) 

7 are more restrictive than the eligibility 

8 standards, methodologies, or proce9 dures, respectively, under such plan 

10 (or waiver) as in effect on the date of 

11 enactment of this Act. 

12 (II) STATE REINSTATEMENT OF

13 ELIGIBILITY PERMITTED.—A State 

14 that has restricted eligibility stand15 ards, methodologies, or procedures 

16 under its State plan under title XIX 

17 of the Social Security Act (including 

18 any waiver under such title or under 

19 section 1115 of such Act (42 U.S.C. 

20 1315)) after the date of enactment of 

21 this Act, is no longer ineligible under 

22 clause (i) beginning with the first cal23 endar quarter in which the State has 

24 reinstated eligibility standards, meth25 odologies, or procedures that are no 


emcdonald on DSK5VPTVN1PROD with BILLS
482 

•HR 2954 IH

1 more restrictive than the eligibility 

2 standards, methodologies, or proce3 dures, respectively, under such plan 

4 (or waiver) as in effect on such date. 

5 (iii) NO WAIVER AUTHORITY.—The 

6 Secretary may not waive the application of 

7 this subsection under section 1115 of the 

8 Social Security Act or otherwise. 

9 (iv) LIMITATION OF MATCHING PAY10 MENTS TO 100 PERCENT.—In no case shall 

11 an increase in Federal matching payments 

12 under this subsection result in Federal 

13 matching payments that exceed 100 per14 cent. 

15 (3) EFFECTIVE DATE.— 

16 (A) IN GENERAL.—Except as provided in 

17 paragraph (2), the amendments made by sub18 section (a) shall take effect 180 days after the 

19 date of the enactment of this Act and shall 

20 apply to services furnished on or after such 

21 date. 

22 (B) RULE FOR CHANGES REQUIRING

23 STATE LEGISLATION.—In the case of a State 

24 plan for medical assistance under title XIX of 

25 the Social Security Act which the Secretary of 


emcdonald on DSK5VPTVN1PROD with BILLS
483 

•HR 2954 IH

1 Health and Human Services determines re2 quires State legislation (other than legislation 

3 appropriating funds) in order for the plan to 

4 meet the additional requirement imposed by the 

5 amendments made by this subsection, the State 

6 plan shall not be regarded as failing to comply 

7 with the requirements of such title solely on the 

8 basis of its failure to meet this additional re9 quirement before the first day of the first cal10 endar quarter beginning after the close of the 

11 first regular session of the State legislature that 

12 begins after the date of the enactment of this 

13 Act. For purposes of the previous sentence, in 

14 the case of a State that has a 2-year legislative 

15 session, each year of such session shall be 

16 deemed to be a separate regular session of the 

17 State legislature. 

18 (f) SURVEY OF AND REPORT ON CORRECTIONAL FA19 CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF

20 STIS.— 

21 (1) SURVEY.—The Attorney General, after con22 sulting with the Secretary of Health and Human 

23 Services, State officials, and community organiza24 tions, shall, to the maximum extent practicable, con25 duct a survey of all Federal and State correctional 


emcdonald on DSK5VPTVN1PROD with BILLS
484 

•HR 2954 IH

1 facilities, no later than 180 days after the date of 

2 enactment of this Act and annually thereafter for 5 

3 years, to determine the following: 

4 (A) PREVENTION EDUCATION OFFERED.— 

5 The type of prevention education, information, 

6 or training offered to incarcerated persons and 

7 correctional facility staff regarding sexual vio8 lence and the spread of STIs, including whether 

9 such education, information, or training— 

10 (i) constitutes comprehensive sexuality 

11 education; 

12 (ii) is compulsory for new incarcerated 

13 persons and for new staff; and 

14 (iii) is offered on an ongoing basis. 

15 (B) ACCESS TO SEXUAL BARRIER PROTEC16 TION DEVICES.—Whether incarcerated persons 

17 can— 

18 (i) possess sexual barrier protection 

19 devices; 

20 (ii) purchase sexual barrier protection 

21 devices; 

22 (iii) purchase sexual barrier protection 

23 devices at a reduced cost; and 

24 (iv) obtain sexual barrier protection 

25 devices without cost. 


emcdonald on DSK5VPTVN1PROD with BILLS
485 

•HR 2954 IH

1 (C) INCIDENCE OF SEXUAL VIOLENCE.— 

2 The incidence of sexual violence and assault 

3 committed by incarcerated persons and by cor4 rectional facility staff. 

5 (D) COUNSELING, TREATMENT, AND SUP6 PORTIVE SERVICES.—Whether the correctional 

7 facility requires incarcerated persons to partici8 pate in counseling, treatment, and supportive 

9 services related to STIs, or whether it offers 

10 such programs to incarcerated persons. 

11 (E) STI TESTING.—Whether the correc12 tional facility tests incarcerated persons for 

13 STIs or gives them the option to undergo such 

14 testing— 

15 (i) at intake; 

16 (ii) on a regular basis; and 

17 (iii) prior to release. 

18 (F) STI TEST RESULTS.—The number of 

19 incarcerated persons who are tested for STIs 

20 and the outcome of such tests at each correc21 tional facility, disaggregated to include results 

22 for— 

23 (i) the type of sexually transmitted in24 fection tested for; 


emcdonald on DSK5VPTVN1PROD with BILLS
486 

•HR 2954 IH

1 (ii) the race and/or ethnicity of indi2 viduals tested; 

3 (iii) the age of individuals tested; and 

4 (iv) the gender of individuals tested. 

5 (G) PRE-RELEASE REFERRAL POLICY.— 

6 Whether incarcerated persons are informed 

7 prior to release about STI-related services or 

8 other health services in their communities, in9 cluding free and low-cost counseling and treat10 ment options. 

11 (H) PRE-RELEASE REFERRALS MADE.— 

12 The number of referrals to community-based 

13 organizations or public health facilities offering 

14 STI-related or other health services provided to 

15 incarcerated persons prior to release, and the 

16 type of counseling or treatment for which the 

17 referral was made. 

18 (I) REINSTATEMENT OF MEDICAID BENE19 FITS.—Whether the correctional facility assists 

20 incarcerated persons that were enrolled in the 

21 State Medicaid program prior to their incarcer22 ation, in reinstating their enrollment upon re23 lease and whether such individuals receive refer24 rals as provided by paragraph (8) to entities 


emcdonald on DSK5VPTVN1PROD with BILLS
487 

•HR 2954 IH

1 that accept the State Medicaid program, includ2 ing if applicable— 

3 (i) the number of such individuals, in4 cluding those diagnosed with the human 

5 immunodeficiency virus, that have been re6 instated; 

7 (ii) a list of obstacles to reinstating 

8 enrollment or to making determinations of 

9 eligibility for reinstatement, if any; and 

10 (iii) the number of individuals denied 

11 enrollment. 

12 (J) OTHER ACTIONS TAKEN.—Whether the 

13 correctional facility has taken any other action, 

14 in conjunction with community organizations or 

15 otherwise, to reduce the prevalence and spread 

16 of STIs in that facility. 

17 (2) PRIVACY.—In conducting the survey, the 

18 Attorney General shall not request or retain the 

19 identity of any person who has sought or been of20 fered counseling, treatment, testing, or prevention 

21 education information regarding an STI (including 

22 information about sexual barrier protection devices), 

23 or who has tested positive for an STI. 

24 (3) REPORT.—The Attorney General shall 

25 transmit to Congress and make publicly available 


emcdonald on DSK5VPTVN1PROD with BILLS
488 

•HR 2954 IH

1 the results of the survey required under paragraph 

2 (1), both for the Nation as a whole and 

3 disaggregated as to each State and each correctional 

4 facility. To the maximum extent possible, the Attor5 ney General shall issue the first report no later than 

6 1 year after the date of enactment of this Act and 

7 shall issue reports annually thereafter for 5 years. 

8 (g) STRATEGY.— 

9 (1) DIRECTIVE TO ATTORNEY GENERAL.—The 

10 Attorney General, in consultation with the Secretary 

11 of Health and Human Services, State officials, and 

12 community organizations, shall develop and imple13 ment a 5-year strategy to reduce the prevalence and 

14 spread of STIs in Federal and State correctional fa15 cilities. To the maximum extent possible, the strat16 egy shall be developed, transmitted to Congress, and 

17 made publicly available no later than 180 days after 

18 the transmission of the first report required under 

19 subsection (h)(3). 

20 (2) CONTENTS OF STRATEGY.—The strategy 

21 shall include the following: 

22 (A) PREVENTION EDUCATION.—A plan for 

23 improving prevention education, information, 

24 and training offered to incarcerated persons 

25 and correctional facility staff, including inforVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00488 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
489 

•HR 2954 IH

1 mation and training on sexual violence and the 

2 spread of STIs, and comprehensive sexuality 

3 education. 

4 (B) SEXUAL BARRIER PROTECTION DEVICE

5 ACCESS.—A plan for expanding access to sexual 

6 barrier protection devices in correctional facili7 ties. 

8 (C) SEXUAL VIOLENCE REDUCTION.—A 

9 plan for reducing the incidence of sexual vio10 lence among incarcerated persons and correc11 tional facility staff, developed in consultation 

12 with the National Prison Rape Elimination 

13 Commission. 

14 (D) COUNSELING AND SUPPORTIVE SERV15 ICES.—A plan for expanding access to coun16 seling and supportive services related to STIs in 

17 correctional facilities. 

18 (E) TESTING.—A plan for testing incarcer19 ated persons for STIs during intake, during 

20 regular health exams, and prior to release, and 

21 that— 

22 (i) is conducted in accordance with 

23 guidelines established by the Centers for 

24 Disease Control and Prevention; 

25 (ii) includes pre-test counseling; 


emcdonald on DSK5VPTVN1PROD with BILLS
490 

•HR 2954 IH

1 (iii) requires that incarcerated persons 

2 are notified of their option to decline test3 ing at any time; 

4 (iv) requires that incarcerated persons 

5 are confidentially notified of their test re6 sults in a timely manner; and 

7 (v) ensures that incarcerated persons 

8 testing positive for STIs receive post-test 

9 counseling, care, treatment, and supportive 

10 services. 

11 (F) TREATMENT.—A plan for ensuring 

12 that correctional facilities have the necessary 

13 medicine and equipment to treat and monitor 

14 STIs and for ensuring that incarcerated per15 sons living with or testing positive for STIs re16 ceive and have access to care and treatment 

17 services. 

18 (G) STRATEGIES FOR DEMOGRAPHIC

19 GROUPS.—A plan for developing and imple20 menting culturally appropriate, sensitive, and 

21 specific strategies to reduce the spread of STIs 

22 among demographic groups heavily impacted by 

23 STIs. 

24 (H) LINKAGES WITH COMMUNITIES AND

25 FACILITIES.—A plan for establishing and 


emcdonald on DSK5VPTVN1PROD with BILLS
491 

•HR 2954 IH

1 strengthening linkages to local communities and 

2 health facilities that— 

3 (i) provide counseling, testing, care, 

4 and treatment services; 

5 (ii) may receive persons recently re6 leased from incarceration who are living 

7 with STIs; and 

8 (iii) accept payment through the State 

9 Medicaid program. 

10 (I) ENROLLMENT IN STATE MEDICAID

11 PROGRAMS.—Plans to ensure that incarcerated 

12 persons who were— 

13 (i) enrolled in their State Medicaid 

14 program prior to incarceration in a correc15 tional facility are automatically re-enrolled 

16 in such program upon their release; and 

17 (ii) not enrolled in their State Med18 icaid program prior to incarceration, but 

19 who are diagnosed with the human im20 munodeficiency virus while incarcerated in 

21 a correctional facility, are automatically 

22 enrolled in such program upon their re23 lease. 

24 (J) OTHER PLANS.—Any other plans de25 veloped by the Attorney General for reducing 


emcdonald on DSK5VPTVN1PROD with BILLS
492 

•HR 2954 IH

1 the spread of STIs or improving the quality of 

2 health care in correctional facilities. 

3 (K) MONITORING SYSTEM.—A monitoring 

4 system that establishes performance goals re5 lated to reducing the prevalence and spread of 

6 STIs in correctional facilities and which, where 

7 feasible, expresses such goals in quantifiable 

8 form. 

9 (L) MONITORING SYSTEM PERFORMANCE

10 INDICATORS.—Performance indicators that 

11 measure or assess the achievement of the per12 formance goals described in subparagraph (I). 

13 (M) COST ESTIMATE.—A detailed estimate 

14 of the funding necessary to implement the 

15 strategy at the Federal and State levels for all 

16 5 years, including the amount of funds required 

17 by community organizations to implement the 

18 parts of the strategy in which they take part. 

19 (3) REPORT.—The Attorney General shall 

20 transmit to Congress and make publicly available an 

21 annual progress report regarding the implementation 

22 and effectiveness of the strategy described in sub23 section (a). The progress report shall include an 

24 evaluation of the implementation of the strategy 

25 using the monitoring system and performance indiVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00492 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
493 

•HR 2954 IH

1 cators provided for in subparagraphs (I) and (J) of 

2 paragraph (2). 

3 (h) APPROPRIATIONS.— 

4 (1) IN GENERAL.—There are authorized to be 

5 appropriated such sums as may be necessary to 

6 carry out this section for each of the fiscal years 

7 2012 through 2018. 

8 (2) AVAILABILITY OF FUNDS.—Amounts made 

9 available under subsection (a) are authorized to re10 main available until expended. 

11 (i) DEFINITIONS.—For the purposes of this section: 

12 (1) COMMUNITY ORGANIZATION.—The term 

13 ‘‘community organization’’ means a public health 

14 care facility or a nonprofit organization which pro15 vides health- or STI-related services according to es16 tablished public health standards. 

17 (2) COMPREHENSIVE SEXUALITY EDUCATION.— 

18 The term ‘‘comprehensive sexuality education’’ 

19 means sexuality education that includes information 

20 about abstinence and about the proper use and dis21 posal of sexual barrier protection devices and which 

22 is— 

23 (A) evidence-based; 

24 (B) medically accurate; 

25 (C) age and developmentally appropriate; 


emcdonald on DSK5VPTVN1PROD with BILLS
494 

•HR 2954 IH

1 (D) gender and identity sensitive; 

2 (E) culturally and linguistically appro3 priate; and 

4 (F) structured to promote critical thinking, 

5 self-esteem, respect for others, and the develop6 ment of healthy attitudes and relationships. 

7 (3) CORRECTIONAL FACILITY.—The term ‘‘cor8 rectional facility’’ means any prison, penitentiary, 

9 adult detention facility, juvenile detention facility, 

10 jail, or other facility to which persons may be sent 

11 after conviction of a crime or act of juvenile delin12 quency within the United States. 

13 (4) INCARCERATED PERSON.—The term ‘‘incar14 cerated person’’ means any person who is serving a 

15 sentence in a correctional facility after conviction of 

16 a crime. 

17 (5) SEXUALLY TRANSMITTED INFECTION.—The 

18 term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 

19 means any disease or infection that is commonly 

20 transmitted through sexual activity, including HIV/ 

21 AIDS, gonorrhea, chlamydia, syphilis, genital her22 pes, viral hepatitis, and human papillomavirus. 

23 (6) SEXUAL BARRIER PROTECTION DEVICE.— 

24 The term ‘‘sexual barrier protection device’’ means 

25 any FDA-approved physical device which has not 


emcdonald on DSK5VPTVN1PROD with BILLS
495 

•HR 2954 IH

1 been tampered with and which reduces the prob2 ability of STI transmission or infection between sex3 ual partners, including female condoms, male 

4 condoms, and dental dams. 

5 (7) STATE.—The term ‘‘State’’ includes the 

6 District of Columbia, American Samoa, the Com7 monwealth of the Northern Mariana Islands, Guam, 

8 Puerto Rico, and the United States Virgin Islands. 

9 SEC. 750. STOP AIDS IN PRISON. 

10 (a) SHORT TITLE.—This section may be cited as the 

11 ‘‘Stop AIDS in Prison Act of 2011’’. 

12 (b) COMPREHENSIVE HIV/AIDS POLICY.— 

13 (1) IN GENERAL.—The Bureau of Prisons 

14 (hereinafter in this section referred to as the ‘‘Bu15 reau’’) shall develop a comprehensive policy to pro16 vide HIV testing, treatment, and prevention for in17 mates within the correctional setting and upon re18 entry. 

19 (2) PURPOSE.—The purposes of such policy are 

20 the following: 

21 (A) To stop the spread of HIV/AIDS 

22 among inmates. 

23 (B) To protect prison guards and other 

24 personnel from HIV/AIDS infection. 


emcdonald on DSK5VPTVN1PROD with BILLS
496 

•HR 2954 IH

1 (C) To provide comprehensive medical 

2 treatment to inmates who are living with HIV/ 

3 AIDS. 

4 (D) To promote HIV/AIDS awareness and 

5 prevention among inmates. 

6 (E) To encourage inmates to take personal 

7 responsibility for their health. 

8 (F) To reduce the risk that inmates will 

9 transmit HIV/AIDS to other persons in the 

10 community following their release from prison. 

11 (3) CONSULTATION.—The Bureau shall consult 

12 with appropriate officials of the Department of 

13 Health and Human Services, the Office of National 

14 Drug Control Policy, the Office of National AIDS 

15 Policy, and the Centers for Disease Control regard16 ing the development of such policy. 

17 (4) TIME LIMIT.—The Bureau shall draft ap18 propriate regulations to implement such policy not 

19 later than 1 year after the date of the enactment of 

20 this Act. 

21 (c) REQUIREMENTS FOR POLICY.—The policy cre22 ated under subsection (b) shall provide for the following: 

23 (1) TESTING AND COUNSELING UPON IN24 TAKE.— 


emcdonald on DSK5VPTVN1PROD with BILLS
497 

•HR 2954 IH

1 (A)(i) Subject to clause (ii), health care 

2 personnel shall provide routine HIV testing to 

3 all inmates as a part of a comprehensive med4 ical examination immediately following admis5 sion to a facility. 

6 (ii) Health care personnel shall not be re7 quired to provide routine HIV testing to an in8 mate who is transferred to a facility from an9 other facility if the inmate’s medical records are 

10 transferred with the inmate and indicate that 

11 the inmate has been tested previously. 

12 (B) To all inmates admitted to a facility 

13 prior to the effective date of this policy, health 

14 care personnel shall provide routine HIV testing 

15 within no more than 6 months. HIV testing for 

16 these inmates may be performed in conjunction 

17 with other health services provided to these in18 mates by health care personnel. 

19 (C) All HIV tests under this paragraph 

20 shall comply with paragraph (9). 

21 (2) PRE-TEST AND POST-TEST COUNSELING.— 

22 Health care personnel shall provide confidential pre23 test and post-test counseling to all inmates who are 

24 tested for HIV. Counseling may be included with 


emcdonald on DSK5VPTVN1PROD with BILLS
498 

•HR 2954 IH

1 other general health counseling provided to inmates 

2 by health care personnel. 

3 (3) HIV/AIDS PREVENTION EDUCATION.— 

4 (A) Health care personnel shall improve 

5 HIV/AIDS awareness through frequent edu6 cational programs for all inmates. HIV/AIDS 

7 educational programs may be provided by com8 munity based organizations, local health depart9 ments, and inmate peer educators. Such HIV/ 

10 AIDS educational programs shall include infor11 mation on modes of transmission, including 

12 transmission through tattooing, sexual contact, 

13 and intravenous drug use; prevention methods; 

14 treatment; and disease progression. HIV/AIDS 

15 educational programs shall be culturally sen16 sitive, conducted in a variety of languages, and 

17 present scientifically accurate information in a 

18 clear and understandable manner. 

19 (B) HIV/AIDS educational materials shall 

20 be made available to all inmates at orientation, 

21 at health care clinics, at regular educational 

22 programs, and prior to release. Both written 

23 and audio-visual materials shall be made avail24 able to all inmates. These materials shall be 


emcdonald on DSK5VPTVN1PROD with BILLS
499 

•HR 2954 IH

1 culturally sensitive, written for low literacy lev2 els, and available in a variety of languages. 

3 (4) HIV TESTING UPON REQUEST.— 

4 (A) Health care personnel shall allow in5 mates to obtain HIV tests upon request once 

6 per year or whenever an inmate has a reason to 

7 believe the inmate may have been exposed to 

8 HIV. Health care personnel shall, both orally 

9 and in writing, inform inmates, during orienta10 tion and periodically throughout incarceration, 

11 of their right to obtain HIV tests. 

12 (B) Health care personnel shall encourage 

13 inmates to request HIV tests if the inmate is 

14 sexually active, has been raped, uses intra15 venous drugs, receives a tattoo, or if the inmate 

16 is concerned that the inmate may have been ex17 posed to HIV/AIDS. 

18 (C) An inmate’s request for an HIV test 

19 shall not be considered an indication that the 

20 inmate has put himself or herself at risk of in21 fection or committed a violation of prison rules. 

22 (5) HIV TESTING OF PREGNANT WOMAN.— 

23 (A) Health care personnel shall provide 

24 routine HIV testing to all inmates who become 

25 pregnant. 


emcdonald on DSK5VPTVN1PROD with BILLS
500 

•HR 2954 IH

1 (B) All HIV tests under this paragraph 

2 shall comply with paragraph (9). 

3 (6) COMPREHENSIVE TREATMENT.— 

4 (A) Health care personnel shall provide all 

5 inmates who test positive for HIV— 

6 (i) timely, comprehensive medical 

7 treatment; 

8 (ii) confidential counseling on man9 aging their medical condition and pre10 venting its transmission to other persons; 

11 and 

12 (iii) voluntary partner notification 

13 services. 

14 (B) Medical care provided under this para15 graph shall be consistent with current Depart16 ment of Health and Human Services guidelines 

17 and standard medical practice. Health care per18 sonnel shall discuss treatment options, the im19 portance of adherence to antiretroviral therapy, 

20 and the side effects of medications with inmates 

21 receiving treatment. 

22 (C) Health care personnel and pharmacy 

23 personnel shall ensure that the facility for24 mulary contains all Food and Drug Administra25 tion-approved medications necessary to provide 


emcdonald on DSK5VPTVN1PROD with BILLS
501 

•HR 2954 IH

1 comprehensive treatment for inmates living with 

2 HIV/AIDS, and that the facility maintains ade3 quate supplies of such medications to meet in4 mates’ medical needs. Health care personnel 

5 and pharmacy personnel shall also develop and 

6 implement automatic renewal systems for these 

7 medications to prevent interruptions in care. 

8 (D) Correctional staff, health care per9 sonnel, and pharmacy personnel shall develop 

10 and implement distribution procedures to en11 sure timely and confidential access to medica12 tions. 

13 (7) PROTECTION OF CONFIDENTIALITY.— 

14 (A) Health care personnel shall develop 

15 and implement procedures to ensure the con16 fidentiality of inmate tests, diagnoses, and 

17 treatment. Health care personnel and correc18 tional staff shall receive regular training on the 

19 implementation of these procedures. Penalties 

20 for violations of inmate confidentiality by health 

21 care personnel or correctional staff shall be 

22 specified and strictly enforced. 

23 (B) HIV testing, counseling, and treat24 ment shall be provided in a confidential setting 

25 where other routine health services are provided 


emcdonald on DSK5VPTVN1PROD with BILLS
502 

•HR 2954 IH

1 and in a manner that allows the inmate to re2 quest and obtain these services as routine med3 ical services. 

4 (8) TESTING, COUNSELING, AND REFERRAL

5 PRIOR TO REENTRY.— 

6 (A)(i) Subject to clauses (ii) and (iii), 

7 health care personnel shall provide routine HIV 

8 testing to all inmates no more than 3 months 

9 prior to their release and reentry into the com10 munity. 

11 (ii) Inmates who are already known to be 

12 infected shall not be required to be tested 

13 again. 

14 (iii) The requirement under clause (i) may 

15 be waived if an inmate’s release occurs without 

16 sufficient notice to the Bureau to allow health 

17 care personnel to perform a routine HIV test 

18 and notify the inmate of the results. 

19 (B) All HIV tests under this paragraph 

20 shall comply with paragraph (9). 

21 (C) To all inmates who test positive for 

22 HIV and all inmates who already are known to 

23 have HIV/AIDS, health care personnel shall 

24 provide— 


emcdonald on DSK5VPTVN1PROD with BILLS
503 

•HR 2954 IH

1 (i) confidential prerelease counseling 

2 on managing their medical condition in the 

3 community, accessing appropriate treat4 ment and services in the community, and 

5 preventing the transmission of their condi6 tion to family members and other persons 

7 in the community; 

8 (ii) referrals to appropriate health 

9 care providers and social service agencies 

10 in the community that meet the inmate’s 

11 individual needs, including voluntary part12 ner notification services and prevention 

13 counseling services for people living with 

14 HIV/AIDS; and 

15 (iii) a 30-day supply of any medically 

16 necessary medications the inmate is cur17 rently receiving. 

18 (9) OPT-OUT PROVISION.—Inmates shall have 

19 the right to refuse routine HIV testing. Inmates 

20 shall be informed both orally and in writing of this 

21 right. Oral and written disclosure of this right may 

22 be included with other general health information 

23 and counseling provided to inmates by health care 

24 personnel. If an inmate refuses a routine test for 

25 HIV, health care personnel shall make a note of the 


emcdonald on DSK5VPTVN1PROD with BILLS
504 

•HR 2954 IH

1 inmate’s refusal in the inmate’s confidential medical 

2 records. However, the inmate’s refusal shall not be 

3 considered a violation of prison rules or result in dis4 ciplinary action. 

5 (10) EXCLUSION OF TESTS PERFORMED UNDER

6 SECTION 4014(b) FROM THE DEFINITION OF ROU7 TINE HIV TESTING.—HIV testing of an inmate 

8 under section 4014(b) of title 18, United States 

9 Code, is not routine HIV testing for the purposes of 

10 paragraph (9). Health care personnel shall document 

11 the reason for testing under section 4014(b) of title 

12 18, United States Code, in the inmate’s confidential 

13 medical records. 

14 (11) TIMELY NOTIFICATION OF TEST RE15 SULTS.—Health care personnel shall provide timely 

16 notification to inmates of the results of HIV tests. 

17 (d) CHANGES IN EXISTING LAW.— 

18 (1) SCREENING IN GENERAL.—Section 4014(a) 

19 of title 18, United States Code, is amended— 

20 (A) by striking ‘‘for a period of 6 months 

21 or more’’; 

22 (B) by striking ‘‘, as appropriate,’’; and 

23 (C) by striking ‘‘if such individual is deter24 mined to be at risk for infection with such virus 

25 in accordance with the guidelines issued by the 


emcdonald on DSK5VPTVN1PROD with BILLS
505 

•HR 2954 IH

1 Bureau of Prisons relating to infectious disease 

2 management’’ and inserting ‘‘unless the indi3 vidual declines. The Attorney General shall also 

4 cause such individual to be so tested before re5 lease unless the individual declines.’’. 

6 (2) INADMISSIBILITY OF HIV TEST RESULTS IN

7 CIVIL AND CRIMINAL PROCEEDINGS.—Section 

8 4014(d) of title 18, United States Code, is amended 

9 by inserting ‘‘or under the Stop AIDS in Prison Act 

10 of 2011’’ after ‘‘under this section’’. 

11 (3) SCREENING AS PART OF ROUTINE SCREEN12 ING.—Section 4014(e) of title 18, United States 

13 Code, is amended by adding at the end the fol14 lowing: ‘‘Such rules shall also provide that the initial 

15 test under this section be performed as part of the 

16 routine health screening conducted at intake.’’. 

17 (e) REPORTING REQUIREMENTS.— 

18 (1) REPORT ON HEPATITIS AND OTHER DIS19 EASES.—Not later than 1 year after the date of the 

20 enactment of this Act, the Bureau shall provide a re21 port to the Congress on Bureau policies and proce22 dures to provide testing, treatment, and prevention 

23 education programs for hepatitis and other diseases 

24 transmitted through sexual activity and intravenous 

25 drug use. The Bureau shall consult with appropriate 


emcdonald on DSK5VPTVN1PROD with BILLS
506 

•HR 2954 IH

1 officials of the Department of Health and Human 

2 Services, the Office of National Drug Control Policy, 

3 the Office of National AIDS Policy, and the Centers 

4 for Disease Control and Prevention regarding the 

5 development of this report. 

6 (2) ANNUAL REPORTS.— 

7 (A) GENERALLY.—Not later than 2 years 

8 after the date of the enactment of this Act, and 

9 then annually thereafter, the Bureau shall re10 port to Congress on the incidence among in11 mates of diseases transmitted through sexual 

12 activity and intravenous drug use. 

13 (B) MATTERS PERTAINING TO VARIOUS

14 DISEASES.—Reports under subparagraph (A) 

15 shall discuss— 

16 (i) the incidence among inmates of 

17 HIV/AIDS, hepatitis, and other diseases 

18 transmitted through sexual activity and in19 travenous drug use; and 

20 (ii) updates on Bureau testing, treat21 ment, and prevention education programs 

22 for these diseases. 

23 (C) MATTERS PERTAINING TO HIV/AIDS

24 ONLY.—Reports under subparagraph (A) shall 

25 also include— 


emcdonald on DSK5VPTVN1PROD with BILLS
507 

•HR 2954 IH

1 (i) the number of inmates who tested 

2 positive for HIV upon intake; 

3 (ii) the number of inmates who tested 

4 positive prior to reentry; 

5 (iii) the number of inmates who were 

6 not tested prior to reentry because they 

7 were released without sufficient notice; 

8 (iv) the number of inmates who opted9 out of taking the test; 

10 (v) the number of inmates who were 

11 tested under section 4014(b) of title 18, 

12 United States Code; and 

13 (vi) the number of inmates under 

14 treatment for HIV/AIDS. 

15 (D) CONSULTATION.—The Bureau shall 

16 consult with appropriate officials of the Depart17 ment of Health and Human Services, the Office 

18 of National Drug Control Policy, the Office of 

19 National AIDS Policy, and the Centers for Dis20 ease Control and Prevention regarding the de21 velopment of reports under subparagraph (A). 

22 SEC. 751. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 

23 ETHNIC MINORITY COMMUNITIES. 

24 (a) IN GENERAL.—For the purpose of reducing HIV/ 

25 AIDS in racial and ethnic minority communities, the SecVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00507 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
508 

•HR 2954 IH

1 retary, acting through the Deputy Assistant Secretary for 

2 Minority Health, may make grants to public health agen3 cies and faith-based organizations to conduct— 

4 (1) outreach activities related to HIV/AIDS 

5 prevention and testing activities; 

6 (2) HIV/AIDS prevention activities; and 

7 (3) HIV/AIDS testing activities. 

8 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 

9 out this section, there are authorized to be appropriated 

10 $50,000,000 for fiscal year 2012, and such sums as may 

11 be necessary for fiscal years 2013 through 2016. 

12 SEC. 752. HEALTH CARE PROFESSIONALS TREATING INDI13 VIDUALS WITH HIV/AIDS. 

14 Part E of title VII of the Public Health Service Act 

15 (42 U.S.C. 294n et seq.) is amended by adding at the end 

16 the following: 

17 ‘‘Subpart 5—Health Care Professionals Treating 

18 Individuals With HIV/AIDS 

19 ‘‘SEC. 785. HEALTH CARE PROFESSIONALS TREATING INDI20 VIDUALS WITH HIV/AIDS. 

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

22 the Administrator of the Health Resources and Services 

23 Administration and in consultation with racial and ethnic 

24 minority community organizations, may award grants for 

25 any of the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
509 

•HR 2954 IH

1 ‘‘(1) Development of curricula for training pri2 mary care providers in HIV/AIDS prevention and 

3 care. 

4 ‘‘(2) Training health care professionals with ex5 pertise in HIV/AIDS to provide care to individuals 

6 with HIV/AIDS. 

7 ‘‘(3) Development by grant recipients under 

8 title XXVI and other persons of policies for pro9 viding culturally relevant and sensitive treatment to 

10 individuals with HIV/AIDS, with particular empha11 sis on treatment to racial and ethnic minorities, men 

12 who have sex with men, and women and children 

13 with HIV/AIDS. 

14 ‘‘(4) Development and implementation of pro15 grams to increase the use of telemedicine to respond 

16 to HIV/AIDS-specific health care needs in rural and 

17 minority communities, with particular emphasis 

18 given to medically underserved communities and in19 sular areas. 

20 ‘‘(5) Creation of faith- and community-based 

21 certification programs for providers in HIV/AIDS 

22 care and support services. 

23 ‘‘(6) Establishment of comfort care centers that 

24 provide mental, emotional, and psychosocial coun25 seling for people with HIV/AIDS and implement adVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00509 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
510 

•HR 2954 IH

1 ditional protocols to be carried out in the centers 

2 that address the needs of children and young adults 

3 who are infected with the disease and are 

4 transitioning from childhood to adulthood. 

5 ‘‘(7) Incentive payments to health care pro6 viders supported by the Health Resources and Serv7 ices Administration to implement HIV/AIDS testing 

8 consistent with the guidelines issued in 2006 by the 

9 Centers for Disease Control and Prevention entitled 

10 ‘Revised Recommendations for HIV Testing of 

11 Adults, Adolescents, and Pregnant Women in 

12 Health-Care Settings’. 

13 ‘‘(b) DEFINITION.—In this section, the term ‘HIV/ 

14 AIDS’ has the meaning given to such term in section 

15 2689. 

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

17 carry out this section, there are authorized to be appro18 priated $100,000,000 for fiscal year 2012, and such sums 

19 as may be necessary for fiscal years 2013 through 2016.’’. 

20 SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN RACIAL AND 

21 ETHNIC MINORITY COMMUNITIES. 

22 (a) IN GENERAL.—The Secretary shall submit to the 

23 Congress and the President an annual report on the im24 pact of HIV/AIDS in racial and ethnic minority commu25 nities. 


emcdonald on DSK5VPTVN1PROD with BILLS
511 

•HR 2954 IH

1 (b) CONTENTS.—The report under subsection (a) 

2 shall include information on the— 

3 (1) progress that has been made in reducing 

4 the impact of HIV/AIDS in such communities; 

5 (2) opportunities that exist to make additional 

6 progress in reducing the impact of HIV/AIDS in 

7 such communities; 

8 (3) challenges that may impede such additional 

9 progress; and 

10 (4) Federal funding necessary to achieve sub11 stantial reductions in HIV/AIDS in racial and ethnic 

12 minority communities. 

13 SEC. 754. STUDY ON STATUS OF HIV/AIDS EPIDEMIC AMONG 

14 AFRICAN-AMERICANS. 

15 (a) IN GENERAL.—The Secretary shall— 

16 (1) seek to enter into an agreement with the In17 stitute of Medicine to document, in collaboration 

18 with an academic organization which specializes in 

19 the identification and reduction of health disparities 

20 within the African-American community, all aspects 

21 of the HIV/AIDS epidemic among African-Ameri22 cans, including the role that historical racial or eth23 nic barriers play in sustaining the epidemic among 

24 African-Americans; 


emcdonald on DSK5VPTVN1PROD with BILLS
512 

•HR 2954 IH

1 (2) submit a report to the President, the Direc2 tor of the Office of National AIDS Policy Coordina3 tion, the Director of the White House Domestic Pol4 icy Council, the Director of White House Office of 

5 Faith-Based and Neighborhood Partnerships, key 

6 Federal agencies, and the relevant committees of the 

7 Congress on the status of the HIV/AIDS epidemic 

8 among African-Americans in the United States; and 

9 (3) include in such report— 

10 (A) specific recommendations on the imple11 mentation of Federal policies to reduce the bur12 den of HIV/AIDS in the African-American com13 munity; and 

14 (B) a special focus on the Black clergy and 

15 the church as a unique resource in the African16 American community. 

17 (b) AUTHORIZATION OF APPROPRIATIONS.— 

18 (1) IN GENERAL.—To carry out this section, 

19 there is authorized to be appropriated $2,000,000 

20 for each of fiscal years 2012 and 2013. 

21 (2) SPECIAL RULE.—Of the amount of funds 

22 appropriated to carry out this section for a fiscal 

23 year— 


emcdonald on DSK5VPTVN1PROD with BILLS
513 

•HR 2954 IH

1 (A) 45 percent shall be allocated to the In2 stitutes of Medicine pursuant to the agreement 

3 entered into under subsection (a)(1); 

4 (B) 45 percent shall be allocated to an 

5 academic organization which specializes in the 

6 identification and reduction of health disparities 

7 within the African-American community pursu8 ant to such agreement; and 

9 (C) 10 percent shall be allocated for ad10 ministrative costs and other activities under 

11 this subsection. 

12 Subtitle F—Diabetes 

13 SEC. 755. TREATMENT OF DIABETES IN MINORITY COMMU14 NITIES. 

15 (a) SHORT TITLE.—This subtitle may be cited as the 

16 ‘‘Minority Diabetes Initiative Act’’. 

17 (b) GRANTS REGARDING TREATMENT OF DIABETES

18 IN MINORITY COMMUNITIES.—Part D of title III of the 

19 Public Health Service Act (42 U.S.C. 254b et seq.) is 

20 amended by inserting after section 330L the following: 

21 ‘‘SEC. 330M. GRANTS REGARDING TREATMENT OF DIABE22 TES IN MINORITY COMMUNITIES. 

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

24 to public and nonprofit private health care providers for 


emcdonald on DSK5VPTVN1PROD with BILLS
514 

•HR 2954 IH

1 the purpose of providing treatment for diabetes in minor2 ity communities. 

3 ‘‘(b) RECIPIENTS OF GRANTS.—The public and non4 profit private health care providers to whom grants may 

5 be made under subsection (a) include physicians, podia6 trists, community-based organizations, health care organi7 zations, community health centers, and State, local, and 

8 tribal health departments. 

9 ‘‘(c) SCOPE OF TREATMENT ACTIVITIES.—The Sec10 retary shall ensure that grants under subsection (a) cover 

11 a variety of diabetes-related health care services, including 

12 routine care for diabetic patients, public education on dia13 betes prevention and control, eye care, foot care, and 

14 treatment for kidney disease and other complications of 

15 diabetes. 

16 ‘‘(d) APPROPRIATE CULTURAL CONTEXT.—A condi17 tion for the receipt of a grant under subsection (a) is that 

18 the applicant involved agrees that, in the program carried 

19 out with the grant, services will be provided in the lan20 guages most appropriate for, and with consideration for 

21 the cultural backgrounds of, the individuals for whom the 

22 services are provided. 

23 ‘‘(e) OUTREACH SERVICES.—A condition for the re24 ceipt of a grant under subsection (a) is that the applicant 

25 involved agrees to provide outreach activities to inform the 


emcdonald on DSK5VPTVN1PROD with BILLS
515 

•HR 2954 IH

1 public of the services of the program, and to provide offsite 

2 information on diabetes. 

3 ‘‘(f) APPLICATION FOR GRANT.—A grant may be 

4 made under subsection (a) only if an application for the 

5 grant is submitted to the Secretary and the application 

6 is in such form, is made in such manner, and contains 

7 such agreements, assurances, and information as the Sec8 retary determines to be necessary to carry out this section. 

9 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For the 

10 purpose of carrying out this section, there are authorized 

11 to be appropriated such sums as may be necessary for 

12 each of the fiscal years 2012 through 2017.’’. 

13 SEC. 756. ELIMINATING DISPARITIES IN DIABETES PREVEN14 TION ACCESS AND CARE. 

15 (a) RESEARCH, TREATMENT, AND EDUCATION.— 

16 (1) IN GENERAL.—Subpart 3 of part C of title 

17 IV of the Public Health Service Act (42 U.S.C. 285c 

18 et seq.) is amended by adding at the end the fol19 lowing new section: 

20 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

21 ‘‘(a) IN GENERAL.—The Director of the National In22 stitutes of Health shall expand, intensify, and support on23 going research and other activities with respect to pre-dia24 betes and diabetes, particularly type 2, in minority popu25 lations, including research to identify clinical, socioVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00515 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
516 

•HR 2954 IH

1 economic, geographical, cultural, and organizational fac2 tors that contribute to type 2 diabetes in such populations. 

3 ‘‘(b) CERTAIN ACTIVITIES.—Activities under sub4 section (a) regarding type 2 diabetes in minority popu5 lations shall include the following: 

6 ‘‘(1) Continuing research on behavior and obe7 sity, including through the obesity research center 

8 that is sponsored by the National Institutes of 

9 Health. 

10 ‘‘(2) Research on environmental factors that 

11 may contribute to the increase in type 2 diabetes. 

12 ‘‘(3) Support for new methods to identify envi13 ronmental triggers and genetic interactions that lead 

14 to the development of type 2 diabetes in minority 

15 newborns. Such research should follow the newborns 

16 through puberty, an increasingly high-risk period for 

17 developing type 2 diabetes. 

18 ‘‘(4) Research to identify genes that predispose 

19 individuals to the onset of developing type 1 and 

20 type 2 diabetes and to the development of complica21 tions. 

22 ‘‘(5) Research to prevent complications in indi23 viduals who have already developed diabetes, such as 

24 research that attempts to identify the genes that 


emcdonald on DSK5VPTVN1PROD with BILLS
517 

•HR 2954 IH

1 predispose individuals with diabetes to the develop2 ment of complications. 

3 ‘‘(6) Research methods and alternative thera4 pies to control blood glucose. 

5 ‘‘(7) Support of ongoing research efforts exam6 ining the level of glycemia at which adverse out7 comes develop during pregnancy and to address the 

8 many clinical issues associated with minority moth9 ers and fetuses during diabetic and gestational dia10 betic pregnancies. 

11 ‘‘(c) EDUCATION.—The Director of the National In12 stitutes of Health shall— 

13 ‘‘(1) through the National Institute on Minority 

14 Health and Health Disparities and the National Di15 abetes Education Program— 

16 ‘‘(A) make grants to programs funded 

17 under section 485F (relating to centers of ex18 cellence) for the purpose of establishing a men19 toring program for health care professionals to 

20 be more involved in weight counseling, obesity 

21 research, and nutrition; and 

22 ‘‘(B) provide for the participation of mi23 nority health professionals in diabetes-focused 

24 research programs; and 


emcdonald on DSK5VPTVN1PROD with BILLS
518 

•HR 2954 IH

1 ‘‘(2) make grants for programs to establish a 

2 pipeline from high school to professional school that 

3 will increase minority representation in diabetes-fo4 cused health fields by expanding Minority Access to 

5 Research Careers (MARC) program internships and 

6 mentoring opportunities for recruitment. 

7 ‘‘(d) DEFINITION.—For purposes of this section, the 

8 term ‘minority population’ means a racial and ethnic mi9 nority group, as defined in section 1707(g). 

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

11 purpose of carrying out this section, there are authorized 

12 to be appropriated such sums as are necessary for fiscal 

13 year 2012 and each subsequent fiscal year.’’. 

14 (2) DIABETES MELLITUS INTERAGENCY CO15 ORDINATING COMMITTEE.—Section 429 of the Pub16 lic Health Service Act (42 U.S.C. 285c–3) is amend17 ed by adding at the end the following new sub18 section: 

19 ‘‘(c)(1) The Diabetes Mellitus Interagency Coordi20 nating Committee shall submit to the Secretary a biennial 

21 report that shall include an assessment of the Federal ac22 tivities and programs related to diabetes in minority popu23 lations. Such assessment shall— 

24 ‘‘(A) compile the current activities of all current 

25 Federal health programs to allow for the assessment 


emcdonald on DSK5VPTVN1PROD with BILLS
519 

•HR 2954 IH

1 of their adequacy as a systemic method of address2 ing the impact of diabetes mellitus on minority pop3 ulations; 

4 ‘‘(B) develop strategic planning activities to de5 velop an effective and comprehensive Federal plan to 

6 address diabetes mellitus within minority popu7 lations which will involve all appropriate Federal 

8 health programs and shall— 

9 ‘‘(i) include steps to address issues includ10 ing type 1 and type 2 diabetes in children and 

11 the disproportionate impact of diabetes mellitus 

12 on minority populations; and 

13 ‘‘(ii) remain consistent with the programs 

14 and activities identified in section 399O, as well 

15 as remaining consistent with the intent of the 

16 Eliminating Disparities in Diabetes Prevention 

17 Access and Care Act of 2010; and 

18 ‘‘(C) assess the implementation of such a plan 

19 throughout Federal health programs. 

20 ‘‘(2) For the purposes of this subsection, the term 

21 ‘minority population’ means a racial and ethnic minority 

22 group, as defined in section 1707(g). 

23 ‘‘(3) For the purpose of carrying out this subsection, 

24 there are authorized to be appropriated such sums as are 


emcdonald on DSK5VPTVN1PROD with BILLS
520 

•HR 2954 IH

1 necessary for fiscal year 2012 and each subsequent fiscal 

2 year.’’. 

3 (b) RESEARCH, EDUCATION, AND OTHER ACTIVI4 TIES.—Part B of title III of the Public Health Service 

5 Act (42 U.S.C. 243 et seq.) is amended by inserting after 

6 section 317T the following section: 

7 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 

8 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

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

10 through the Director of the Centers for Disease 

11 Control and Prevention, shall conduct and support 

12 research and other activities with respect to diabetes 

13 in minority populations. 

14 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

15 paragraph (1) regarding diabetes in minority popu16 lations shall include the following: 

17 ‘‘(A) Expanding the National Diabetes 

18 Laboratory capacity for translational research 

19 and the identification of genetic and 

20 immunological risk factors associated with dia21 betes. 

22 ‘‘(B) Improving the understanding of dia23 betes prevalence among Asian-American, Native 

24 Hawaiian and other Pacific Islanders by en25 hancing data in the National Health and NutriVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00520 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
521 

•HR 2954 IH

1 tion Examination Survey by oversampling these 

2 populations in appropriate geographic areas, or 

3 by another method determined appropriate to 

4 collect this data. 

5 ‘‘(C) Within the Division of Diabetes 

6 Translation, providing for prevention research 

7 to better understand how to influence health 

8 care systems changes to improve quality of care 

9 being delivered to such populations, and within 

10 the Division of Diabetes Translation, carrying 

11 out model demonstration projects to design, im12 plement, and evaluate effective diabetes preven13 tion and control intervention for such popu14 lations. 

15 ‘‘(D) Through the Division of Diabetes 

16 Translation, carrying out culturally appropriate 

17 community-based interventions designed to ad18 dress issues and problems experienced by such 

19 populations. 

20 ‘‘(E) Conducting applied research within 

21 the Division of Diabetes Translation to reduce 

22 health disparities within such populations with 

23 diabetes. 

24 ‘‘(F) Conducting applied research on pri25 mary prevention within the Division of Diabetes 


emcdonald on DSK5VPTVN1PROD with BILLS
522 

•HR 2954 IH

1 Translation to specifically focus on such popu2 lations with pre-diabetes. 

3 ‘‘(b) EDUCATION.— 

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

5 through the Director of the Centers for Disease 

6 Control and Prevention, shall direct the Division of 

7 Diabetes Translation to conduct and support pro8 grams to educate the public on the causes and ef9 fects of diabetes in minority populations. 

10 ‘‘(2) CERTAIN ACTIVITIES.—Programs under 

11 paragraph (1) regarding education on diabetes in 

12 minority populations shall include carrying out pub13 lic awareness campaigns directed toward such popu14 lations to aggressively emphasize the importance and 

15 impact of physical activity and diet in regard to dia16 betes and diabetes-related complications through the 

17 National Diabetes Education Program. 

18 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

19 ACTIVITIES, AND ACCESS.— 

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

21 through the Director of the Centers for Disease 

22 Control and Prevention, shall carry out culturally 

23 appropriate diabetes health promotion and preven24 tion programs for minority populations. 


emcdonald on DSK5VPTVN1PROD with BILLS
523 

•HR 2954 IH

1 ‘‘(2) CERTAIN ACTIVITIES.—Activities regard2 ing culturally appropriate diabetes health promotion 

3 and prevention programs for minority populations 

4 shall include the following: 

5 ‘‘(A) Expanding the Diabetes Prevention 

6 and Control Program (currently existing in all 

7 the States and territories) and providing funds 

8 for education and community outreach on dia9 betes. 

10 ‘‘(B) Providing funds for an expansion of 

11 the Diabetes Prevention Program Initiative that 

12 focuses on physical inactivity and diet and its 

13 relation to type 2 diabetes within such popu14 lations. 

15 ‘‘(C) Providing funds to strengthen exist16 ing surveillance systems to improve the quality, 

17 accuracy, and timeliness of morbidity and mor18 tality diabetes data for such populations. 

19 ‘‘(d) DEFINITION.—For purposes of this section, the 

20 term ‘minority population’ means a racial and ethnic mi21 nority group, as defined in section 1707(g). 

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

23 purpose of carrying out this section, there are authorized 

24 to be appropriated such sums as are necessary for fiscal 

25 year 2012 and each subsequent fiscal year.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
524 

•HR 2954 IH

1 (c) RESEARCH, EDUCATION, AND OTHER ACTIVI2 TIES.—Part P of title III of the Public Health Service 

3 Act is amended— 

4 (1) by redesignating the section 399R inserted 

5 by section 2 of Public Law 110–373 as section 

6 399S; 

7 (2) by redesignating the section 399R inserted 

8 by section 3 of Public Law 110–374 as section 

9 399T; and 

10 (3) by adding at the end the following new sec11 tion: 

12 ‘‘SEC. 399V–6. PROGRAMS TO EDUCATE HEALTH PRO13 VIDERS ON THE CAUSES AND EFFECTS OF DI14 ABETES IN MINORITY POPULATIONS. 

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

16 the Director of the Health Resources and Services Admin17 istration, shall conduct and support programs described 

18 in subsection (b) to educate health professionals on the 

19 causes and effects of diabetes in minority populations. 

20 ‘‘(b) PROGRAMS.—Programs described in this sub21 section, with respect to education on diabetes in minority 

22 populations, shall include the following: 

23 ‘‘(1) Making grants for diabetes-focused edu24 cation classes or training programs on cultural senVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00524 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
525 

•HR 2954 IH

1 sitivity and patient care within such populations for 

2 health care providers. 

3 ‘‘(2) Providing funds to community health cen4 ters for programs that provide diabetes services and 

5 screenings. 

6 ‘‘(3) Providing additional funds for the Health 

7 Careers Opportunity Program, Centers for Excel8 lence, and the Minority Faculty Fellowship Program 

9 to partner with the Office of Minority Health under 

10 section 1707 and the National Institutes of Health 

11 to strengthen programs for career opportunities 

12 within minority populations focused on diabetes 

13 treatment and care. 

14 ‘‘(4) Developing a diabetes focus within, and 

15 providing additional funds for, the National Health 

16 Service Corps Scholarship program to place individ17 uals in areas that are disproportionately affected by 

18 diabetes and to provide health care services to such 

19 areas. 

20 ‘‘(5) Establishing a diabetes ambassador pro21 gram for recruitment efforts to increase the number 

22 of underrepresented minorities currently serving in 

23 student, faculty, or administrative positions in insti24 tutions of higher learning, hospitals, and community 

25 health centers. 


emcdonald on DSK5VPTVN1PROD with BILLS
526 

•HR 2954 IH

1 ‘‘(6) Establishing a loan repayment program 

2 that focuses on diabetes care and prevention in mi3 nority populations.’’. 

4 (d) RESEARCH, EDUCATION, AND OTHER ACTIVI5 TIES.—Part P of title III of the Public Health Service 

6 Act (42 U.S.C. 280g et seq.), as amended by subsection 

7 (c), is further amended by adding at the end the following 

8 section: 

9 ‘‘SEC. 399V–7. RESEARCH, EDUCATION, AND OTHER ACTIVI10 TIES REGARDING DIABETES IN MINORITY 

11 POPULATIONS. 

12 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

13 ‘‘(1) IN GENERAL.—In addition to activities 

14 under sections 317U and 434B, the Secretary shall 

15 conduct and support research and other activities 

16 with respect to diabetes within minority populations. 

17 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

18 paragraph (1) regarding diabetes in minority popu19 lations shall include the following: 

20 ‘‘(A) Through the National Center on Mi21 nority Health and Health Disparities, the Office 

22 of Minority Health under section 1707, the 

23 Health Resources and Services Administration, 

24 the Centers for Disease Control and Prevention, 

25 and the Indian Health Service, establishing 


emcdonald on DSK5VPTVN1PROD with BILLS
527 

•HR 2954 IH

1 partnerships within minority populations to 

2 conduct studies on cultural, familial, and social 

3 factors that may influence health promotion, di4 abetes management, and prevention. 

5 ‘‘(B) Through the Indian Health Service, 

6 in collaboration with other appropriate Federal 

7 agencies, coordinating the collection of data on 

8 ethnic and culturally appropriate diabetes treat9 ment, care, prevention, and services by health 

10 care professionals to the American Indian popu11 lation. 

12 ‘‘(3) PROGRAMS RELATING TO CLINICAL RE13 SEARCH.— 

14 ‘‘(A) EDUCATION REGARDING CLINICAL

15 TRIALS.—The Secretary shall carry out edu16 cation and awareness programs designed to in17 crease participation of minority populations in 

18 clinical trials. 

19 ‘‘(B) MINORITY RESEARCHERS.—The Sec20 retary shall carry out mentorship programs for 

21 minority researchers who are conducting or in22 tend to conduct research on diabetes in minor23 ity populations. 

24 ‘‘(C) SUPPLEMENTING CLINICAL RE25 SEARCH REGARDING CHILDREN.—The SecVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00527 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
528 

•HR 2954 IH

1 retary shall make grants to supplement clinical 

2 research programs to assist such programs in 

3 obtaining the services of health professionals 

4 and other resources to provide specialized care 

5 for children with type 1 and type 2 diabetes. 

6 ‘‘(4) ADDITIONAL PROGRAMS.—Activities under 

7 paragraph (1) regarding education on diabetes shall 

8 include providing funds for new and existing diabe9 tes-focused education grants and programs for 

10 present and future students and clinicians in the 

11 medical field from minority populations, including 

12 for the following: 

13 ‘‘(A) For Federal and State loan repay14 ment programs for health profession students 

15 within communities of color. 

16 ‘‘(B) For the Office of Minority Health 

17 under section 1707 for training health profes18 sion students to focus on diabetes within such 

19 populations. 

20 ‘‘(b) DEFINITION.—For purposes of this section, the 

21 term ‘minority population’ means a racial and ethnic mi22 nority group as defined in section 1707(g). 

23 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

24 purpose of carrying out this section, there are authorized 


emcdonald on DSK5VPTVN1PROD with BILLS
529 

•HR 2954 IH

1 to be appropriated such sums as are necessary for fiscal 

2 year 2012 and each subsequent fiscal year.’’. 

3 (e) SENSE OF THE CONGRESS.—It is the sense of the 

4 Congress that States and localities are encourage to recog5 nize established times of diabetes awareness, such as 

6 American Diabetes Month (November), American Diabe7 tes Alert Day (annually on the 4th Tuesday of March), 

8 and World Diabetes Day (November 14th). 

9 Subtitle G—Lung Disease 

10 SEC. 761. EXPANSION OF THE NATIONAL ASTHMA EDU11 CATION AND PREVENTION PROGRAM. 

12 (a) IN GENERAL.—Not later than 2 years after the 

13 date of the enactment of this Act, the Secretary of Health 

14 and Human Services shall convene a working group com15 prised of patient groups, nonprofit organizations, medical 

16 societies, and other relevant governmental and nongovern17 mental entities, including those that participate in the Na18 tional Asthma Education and Prevention Program, to de19 velop a report to Congress that— 

20 (1) catalogs, with respect to asthma prevention, 

21 management, and surveillance— 

22 (A) the activities of the Federal Govern23 ment, including identifying all Federal pro24 grams that carry out asthma-related activities, 

25 as well as assessment of the progress of the 


emcdonald on DSK5VPTVN1PROD with BILLS
530 

•HR 2954 IH

1 Federal Government and States, with respect to 

2 achieving the goals of the Healthy People 2020 

3 initiative; and 

4 (B) the activities of other entities that par5 ticipate in the program, including nonprofit or6 ganizations, patient advocacy groups, and med7 ical societies; and 

8 (2) makes recommendations for the future di9 rection of asthma activities, in consultation with re10 searchers from the National Institutes of Health and 

11 other member bodies of the National Asthma Edu12 cation and Prevention Program who are qualified to 

13 review and analyze data and evaluate interventions, 

14 including— 

15 (A) description of how the Federal Govern16 ment may better coordinate and improve its re17 sponse to asthma including identifying any bar18 riers that may exist; 

19 (B) description of how the Federal Govern20 ment may continue, expand, and improve its 

21 private-public partnerships with respect to asth22 ma including identifying any barriers that may 

23 exist; 

24 (C) identification of steps that may be 

25 taken to reduce the— 


emcdonald on DSK5VPTVN1PROD with BILLS
531 

•HR 2954 IH

1 (i) morbidity, mortality, and overall 

2 prevalence of asthma; 

3 (ii) financial burden of asthma on so4 ciety; 

5 (iii) burden of asthma on dispropor6 tionately affected areas, particularly those 

7 in medically underserved populations (as 

8 defined in section 330(b)(3) of the Public 

9 Health Service Act (42 U.S.C. 

10 254b(b)(3)); and 

11 (iv) burden of asthma as a chronic 

12 disease; 

13 (D) identification of programs and policies 

14 that have achieved the steps described in sub15 paragraph (C), and steps that may be taken to 

16 expand such programs and policies to benefit 

17 larger populations; and 

18 (E) recommendations for future research 

19 and interventions. 

20 (b) REPORT TO CONGRESS.—At the end of the 5-year 

21 period following the submission of the report under sub22 section (a), the National Asthma Education and Preven23 tion Program shall evaluate the analyses and rec24 ommendations under such report and determine whether 


emcdonald on DSK5VPTVN1PROD with BILLS
532 

•HR 2954 IH

1 a new report to the Congress is necessary, and make ap2 propriate recommendations to the Congress. 

3 SEC. 762. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

4 FOR DISEASE CONTROL AND PREVENTION. 

5 Section 317I of the Public Health Service Act (42 

6 U.S.C. 247b–10) is amended to read as follows: 

7 ‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 

8 FOR DISEASE CONTROL AND PREVENTION. 

9 ‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND

10 EDUCATION TO THE PUBLIC.—The Secretary, acting 

11 through the Director of the Centers for Disease Control 

12 and Prevention, shall collaborate with State and local 

13 health departments to conduct activities, including the 

14 provision of information and education to the public re15 garding asthma including— 

16 ‘‘(1) deterring the harmful consequences of un17 controlled asthma; and 

18 ‘‘(2) disseminating health education and infor19 mation regarding prevention of asthma episodes and 

20 strategies for managing asthma. 

21 ‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 

22 The Secretary, acting through the Director of the Centers 

23 for Disease Control and Prevention, shall collaborate with 

24 State and local health departments to develop State plans 

25 incorporating public health responses to reduce the burden 


emcdonald on DSK5VPTVN1PROD with BILLS
533 

•HR 2954 IH

1 of asthma, particularly regarding disproportionately af2 fected populations. 

3 ‘‘(c) COMPILATION OF DATA.—The Secretary, acting 

4 through the Director of the Centers for Disease Control 

5 and Prevention, shall, in cooperation with State and local 

6 public health officials— 

7 ‘‘(1) conduct asthma surveillance activities to 

8 collect data on the prevalence and severity of asth9 ma, the effectiveness of public health asthma inter10 ventions, and the quality of asthma management, in11 cluding— 

12 ‘‘(A) collection of household data on the 

13 local burden of asthma; 

14 ‘‘(B) surveillance of health care facilities; 

15 and 

16 ‘‘(C) collection of data not containing indi17 vidually identifiable information from electronic 

18 health records or other electronic communica19 tions; 

20 ‘‘(2) compile and annually publish data regard21 ing the prevalence and incidence of childhood asth22 ma, the child mortality rate, and the number of hos23 pital admissions and emergency department visits by 

24 children associated with asthma nationally and in 

25 each State and at the county level by age, sex, race, 


emcdonald on DSK5VPTVN1PROD with BILLS
534 

•HR 2954 IH

1 and ethnicity, as well as lifetime and current preva2 lence; and 

3 ‘‘(3) compile and annually publish data regard4 ing the prevalence and incidence of adult asthma, 

5 the adult mortality rate, and the number of hospital 

6 admissions and emergency department visits by 

7 adults associated with asthma nationally and in each 

8 State and at the county level by age, sex, race, eth9 nicity, industry, and occupation, as well as lifetime 

10 and current prevalence. 

11 ‘‘(d) COORDINATION OF DATA COLLECTION.—The 

12 Director of the Centers for Disease Control and Preven13 tion, in conjunction with State and local health depart14 ments, shall coordinate data collection activities under 

15 subsection (c)(2) so as to maximize comparability of re16 sults. 

17 ‘‘(e) COLLABORATION.—The Centers for Disease 

18 Control and Prevention are encouraged to collaborate with 

19 national, State, and local nonprofit organizations to pro20 vide information and education about asthma, and to 

21 strengthen such collaborations when possible. 

22 ‘‘(f) ADDITIONAL FUNDING.—In addition to any 

23 other authorization of appropriations that is available to 

24 the Centers for Disease Control and Prevention for the 

25 purpose of carrying out this section, there are authorized 


emcdonald on DSK5VPTVN1PROD with BILLS
535 

•HR 2954 IH

1 to be appropriated to such Centers such sums as may be 

2 necessary for each of fiscal years 2012 through 2016 for 

3 the purpose of carrying out this section.’’. 

4 SEC. 763. INFLUENZA AND PNEUMONIA VACCINATION CAM5 PAIGN. 

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

7 Human Services shall— 

8 (1) enhance the annual campaign by the De9 partment of Health and Human Services to increase 

10 the number of people vaccinated each year for influ11 enza and pneumonia; and 

12 (2) include in such campaign the use of written 

13 educational materials, public service announcements, 

14 physician education, and any other means which the 

15 Secretary deems effective. 

16 (b) MATERIALS AND ANNOUNCEMENTS.—In carrying 

17 out the annual campaign described in subsection (a), the 

18 Secretary of Health and Human Services shall ensure 

19 that— 

20 (1) educational materials and public service an21 nouncements are readily and widely available in 

22 communities experiencing disparities in the incidence 

23 and mortality rates of influenza and pneumonia; and 


emcdonald on DSK5VPTVN1PROD with BILLS
536 

•HR 2954 IH

1 (2) the campaign uses targeted, culturally ap2 propriate messages and messengers to reach under3 served communities. 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

5 are authorized to be appropriated to carry out this section 

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

7 2012 through 2016. 

8 SEC. 764. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 

9 ACTION PLAN. 

10 (a) IN GENERAL.—The Director of the Centers for 

11 Disease Control and Prevention shall conduct, support, 

12 and expand public health strategies, prevention, diagnosis, 

13 surveillance, and public and professional awareness activi14 ties regarding chronic obstructive pulmonary disease. 

15 (b) NATIONAL ACTION PLAN.— 

16 (1) DEVELOPMENT.—Not later than 2 years 

17 after the date of the enactment of this Act, the Di18 rector of the National Heart, Lung, and Blood Insti19 tute, in consultation with the Director of the Centers 

20 for Disease Control and Prevention, shall develop a 

21 national action plan to address chronic obstructive 

22 pulmonary disease in the United States with partici23 pation from patients, caregivers, health profes24 sionals, patient advocacy organizations, researchers, 


emcdonald on DSK5VPTVN1PROD with BILLS
537 

•HR 2954 IH

1 providers, public health professionals, and other 

2 stakeholders. 

3 (2) CONTENTS.—At a minimum, such plan 

4 shall include recommendations for— 

5 (A) public health interventions for the pur6 pose of implementation of the national plan; 

7 (B) biomedical, health services, and public 

8 health research on chronic obstructive pul9 monary disease; and 

10 (C) inclusion of chronic obstructive pul11 monary disease in the health data collections of 

12 all Federal agencies. 

13 (3) CONSIDERATION.—In developing such plan, 

14 the Director of the National Heart, Lung, and Blood 

15 Institute shall consider the recommendations and 

16 findings of the Institute of Medicine in the report 

17 entitled ‘‘A Nationwide Framework for Surveillance 

18 of Cardiovascular and Chronic Lung Diseases’’ (July 

19 22, 2011). 

20 (c) CHRONIC DISEASE PREVENTION PROGRAMS.— 

21 The Director of the National Heart, Lung, and Blood In22 stitute shall carry out the following: 

23 (1) Conduct public education and awareness ac24 tivities with patient and professional organizations 

25 to stimulate earlier diagnosis and improve patient 


emcdonald on DSK5VPTVN1PROD with BILLS
538 

•HR 2954 IH

1 outcomes from treatment of chronic obstructive pul2 monary disease. To the extent known and relevant, 

3 such public education and awareness activities shall 

4 reflect differences in chronic obstructive pulmonary 

5 disease by cause (tobacco, environmental, occupa6 tional, biological, and genetic) and include a focus 

7 on outreach to undiagnosed and, as appropriate, mi8 nority populations. 

9 (2) Supplement and expand upon the activities 

10 of the National Heart, Lung, and Blood Institute by 

11 making grants to nonprofit organizations, State and 

12 local jurisdictions, and Indian tribes for the purpose 

13 of reducing the burden of chronic obstructive pul14 monary disease, especially in disproportionately im15 pacted communities, through public health interven16 tions and related activities. 

17 (3) Coordinate with the Centers for Disease 

18 Control and Prevention, the Indian Health Service, 

19 the Health Resources and Services Administration, 

20 and the Department of Veterans Affairs to develop 

21 pilot programs to demonstrate best practices for the 

22 diagnosis and management of chronic obstructive 

23 pulmonary disease. 

24 (4) Develop improved techniques and identify 

25 best practices, in coordination with the Secretary of 


emcdonald on DSK5VPTVN1PROD with BILLS
539 

•HR 2954 IH

1 Veterans Affairs, for assisting chronic obstructive 

2 pulmonary disease patients to successfully stop 

3 smoking, including identification of subpopulations 

4 with different needs. Initiatives under this para5 graph may include research to determine whether 

6 successful smoking cessation strategies are different 

7 for chronic obstructive pulmonary disease patients 

8 compared to such strategies for patients with other 

9 chronic diseases. 

10 (d) ENVIRONMENTAL AND OCCUPATIONAL HEALTH

11 PROGRAMS.—The Director of the Centers for Disease 

12 Control and Prevention shall— 

13 (1) support research into the environmental and 

14 occupational causes and biological mechanisms that 

15 contribute to chronic obstructive pulmonary disease; 

16 and 

17 (2) develop and disseminate public health inter18 ventions that will lessen the impact of environmental 

19 and occupational causes of chronic obstructive pul20 monary disease. 

21 (e) DATA COLLECTION.—Not later than 180 days 

22 after the enactment of this Act, the Director of the Na23 tional Heart, Lung, and Blood Institute and the Director 

24 of the Centers for Disease Control and Prevention, acting 

25 jointly, shall assess the depth and quality of information 


emcdonald on DSK5VPTVN1PROD with BILLS
540 

•HR 2954 IH

1 on chronic obstructive pulmonary disease that is collected 

2 in surveys and population studies conducted by the Cen3 ters for Disease Control and Prevention, including wheth4 er there are additional opportunities for information to be 

5 collected in the National Health and Nutrition Examina6 tion Survey, the National Health Interview Survey, and 

7 the Behavioral Risk Factors Surveillance System surveys. 

8 The Director of the National Heart, Lung, and Blood In9 stitute shall include the results of such assessment in the 

10 national action plan under subsection (b). 

11 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

12 are authorized to be appropriated to carry out this section 

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

14 2012 through 2016. 

15 TITLE VIII—HEALTH 

16 INFORMATION TECHNOLOGY 

17 Subtitle A—Reducing Health 

18 Disparities Through Health IT 

19 SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 

20 PROMOTION OF HEALTH IT. 

21 The Secretary of Health and Human Services, acting 

22 through the Administrator of the Health Resources and 

23 Services Administration, shall expand and intensify the 

24 programs and activities of the Administration (directly or 

25 through grants or contracts) to provide technical assistVerDate Mar 15 2010 20:28 Sep 21, 2011 Jkt 099200 PO 00000 Frm 00540 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
541 

•HR 2954 IH

1 ance and resources to health centers (as defined in section 

2 330(a) of the Public Health Service Act (42 U.S.C. 

3 254b(a)) to adopt and meaningfully use certified EHR 

4 technology (as defined in section 3000(1) of such Act (42 

5 U.S.C. 300jj(1)) for the management of chronic diseases 

6 and health conditions. 

7 SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA8 CIAL AND ETHNIC MINORITY COMMUNITIES; 

9 OUTREACH AND ADOPTION OF HEALTH IT IN 

10 SUCH COMMUNITIES. 

11 Section 3001(c)(6)(C) of the Public Health Service 

12 Act (42 U.S.C. 300jj–11(c)(6)(C)) is amended— 

13 (1) in the heading by inserting ‘‘, RACIAL AND

14 ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH

15 DISPARITIES’’; 

16 (2) by inserting ‘‘, in communities with a high 

17 proportion of individuals from racial and ethnic mi18 nority groups (as defined in section 1707(g)),’’ after 

19 ‘‘communities with health disparities’’; and 

20 (3) by adding at the end the following new sen21 tence: ‘‘In any publication under the previous sen22 tence, the National Coordinator shall include best 

23 practices for encouraging partnerships between the 

24 Federal Government and private entities to expand 

25 outreach for and the adoption of such technology in 


emcdonald on DSK5VPTVN1PROD with BILLS
542 

•HR 2954 IH

1 communities with a high proportion of individuals 

2 from racial and ethnic minority groups (as so de3 fined), while also maintaining the accessibility re4 quirements of section 508 of the Rehabilitation Act 

5 to encourage patient involvement in their own health 

6 care. The National Coordinator shall— 

7 ‘‘(i) not later than 6 months after the 

8 submission to the Congress of the reports 

9 required by sections 832 and 833 of the 

10 Health Equity and Accountability Act of 

11 2011, establish criteria for evaluating the 

12 impact of health information technology on 

13 communities with a high proportion of in14 dividuals from racial and ethnic minority 

15 groups (as so defined) taking into account 

16 the findings in such reports; and 

17 ‘‘(ii) not later than 12 months after 

18 the submission to the Congress of such re19 ports, conduct and publish the results of 

20 an evaluation of such impact.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
543 

•HR 2954 IH

1 Subtitle B—Modifications to 

2 Achieve Parity in Existing Pro3 grams 

4 SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 

5 HEALTH IT INFRASTRUCTURE IN RACIAL 

6 AND ETHNIC MINORITY COMMUNITIES. 

7 Section 3011 of the Public Health Service Act (42 

8 U.S.C. 300jj–31) is amended— 

9 (1) in subsection (a), by adding at the end the 

10 following new paragraph: 

11 ‘‘(8) Activities described in the previous para12 graphs of this subsection with respect to commu13 nities with a high proportion of individuals from ra14 cial and ethnic minority groups (as defined in sec15 tion 1707(g)).’’; and 

16 (2) by adding at the end the following new sub17 section: 

18 ‘‘(e) ANNUAL REPORT ON EXPENDITURES.—The 

19 National Coordinator shall report annually to the Con20 gress on activities and expenditures under this section.’’. 

21 SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS22 SISTANCE TO RACIAL AND ETHNIC MINORITY 

23 GROUPS. 

24 (a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub25 lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 


emcdonald on DSK5VPTVN1PROD with BILLS
544 

•HR 2954 IH

1 amended by inserting ‘‘or individuals from racial and eth2 nic minority groups (as defined in section 1707(g))’’ after 

3 ‘‘medically underserved individuals’’. 

4 (b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 

5 such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 

6 (1) by inserting: ‘‘Each evaluation panel shall 

7 include at least one consumer advocate from a racial 

8 and ethnic minority community served by the center 

9 involved and at least one representative of a minor10 ity-serving institution.’’ after ‘‘ ‘and of Federal offi11 cials.’’; and 

12 (2) by inserting ‘‘and shall determine the de13 gree to which such center provides outreach and as14 sistance to providers predominantly serving racial 

15 and ethnic minority groups (as defined in section 

16 1707(g))’’ after ‘‘specified in paragraph (3)’’. 

17 SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE18 VELOPMENT OF LOAN PROGRAMS TO FACILI19 TATE ADOPTION OF CERTIFIED EHR TECH20 NOLOGY BY PROVIDERS SERVING RACIAL 

21 AND ETHNIC MINORITY GROUPS. 

22 Section 3014(e) of the Public Health Service Act (42 

23 U.S.C. 300jj–34(e)) is amended— 

24 (1) in paragraph (3), by striking at the end 

25 ‘‘or’’; 


emcdonald on DSK5VPTVN1PROD with BILLS
545 

•HR 2954 IH

1 (2) in paragraph (4), by striking the period at 

2 the end and inserting ‘‘; or’’; and 

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

4 paragraph: 

5 ‘‘(5) carry out any of the activities described in 

6 a previous paragraph of this subsection with respect 

7 to communities with a high proportion of individuals 

8 from racial and ethnic minority groups (as defined 

9 in section 1707(g)).’’. 

10 Subtitle C—Additional Research 

11 and Studies 

12 SEC. 831. DATA COLLECTION AND ASSESSMENTS CON13 DUCTED IN COORDINATION WITH MINORITY14 SERVING INSTITUTIONS. 

15 Section 3001(c)(6) of the Public Health Service Act 

16 (42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 

17 end the following new subparagraph: 

18 ‘‘(F) DATA COLLECTION AND ASSESS19 MENTS CONDUCTED IN COORDINATION WITH

20 MINORITY-SERVING INSTITUTIONS.— 

21 ‘‘(i) IN GENERAL.—In carrying out 

22 subparagraph (C) with respect to commu23 nities with a high proportion of individuals 

24 from racial and ethnic minority groups (as 

25 defined in section 1707(g)), the National 


emcdonald on DSK5VPTVN1PROD with BILLS
546 

•HR 2954 IH

1 Coordinator shall, to the greatest extent 

2 possible, coordinate with an entity de3 scribed in clause (ii). 

4 ‘‘(ii) MINORITY-SERVING INSTITU5 TIONS.—For purposes of clause (i), an en6 tity described in this clause is a historically 

7 Black college or university, an Hispanic8 serving institution, a tribal college or uni9 versity, or an Asian-American-, Native 

10 American-, and Pacific Islander-serving in11 stitution with an accredited public health, 

12 health policy, or health services research 

13 program.’’. 

14 SEC. 832. IOM STUDY AND REPORT ON PRIVACY CONCERNS 

15 OF CERTAIN MINORITY POPULATIONS. 

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

17 Human Services shall seek to enter into an agreement 

18 with the Institute of Medicine of the National Academies 

19 to— 

20 (1) complete a study— 

21 (A) on the privacy concerns, relating to the 

22 exchange of health information, of individuals 

23 described in subsection (b); 

24 (B) on how such concerns may create bar25 riers for such individuals to access health care 


emcdonald on DSK5VPTVN1PROD with BILLS
547 

•HR 2954 IH

1 or participate in the exchange of health infor2 mation; and 

3 (C) including recommendations for over4 coming such barriers for such individuals; and 

5 (2) not later than 24 months after the date of 

6 the enactment of this Act, submit to Congress a re7 port on the results of such study. 

8 If such Institute declines to conduct the study and submit 

9 the report, the Secretary shall enter into an agreement 

10 with another appropriate public or nonprofit private entity 

11 to conduct the study and submit the report. 

12 (b) INDIVIDUALS DESCRIBED.—For purposes of sub13 section (a), the individuals described in this subsection are 

14 individuals from racial and ethnic minority groups (as de15 fined in section 1707(g)), including such individuals 

16 who— 

17 (1) are immigrants, as well as citizens living 

18 within immigrant households (‘‘mixed-status’’ house19 holds) in the United States; 

20 (2) are lesbian, gay, bisexual, or transgender; or 

21 (3) have a mental health disability or a record 

22 of a mental health disability or treatment for a men23 tal health disability. 


emcdonald on DSK5VPTVN1PROD with BILLS
548 

•HR 2954 IH

1 SEC. 833. STUDY OF HEALTH INFORMATION TECHNOLOGY 

2 IN MEDICALLY UNDERSERVED COMMU3 NITIES. 

4 (a) STUDY.—The Secretary of Health and Human 

5 Services shall seek to enter into an agreement with the 

6 Institute of Medicine of the National Academies to con7 duct a study on the development and implementation of 

8 health information technology in communities with a high 

9 proportion of individuals from racial and ethnic minority 

10 groups (as defined in section 1707(g)) and submit the re11 port under subsection (b). The study shall— 

12 (1) identify barriers to successful implementa13 tion of health information technology in these com14 munities; 

15 (2) examine the impact of health information 

16 technology on providing quality care and reducing 

17 the cost of care to these communities; 

18 (3) examine urban and rural community health 

19 systems and determine the impact that health infor20 mation technology may have on the capacity of pri21 mary health providers; 

22 (4) identify specific best practices for using 

23 health information technology to foster the con24 sistent provision of physical accessibility and reason25 able policy accommodations in health care to individ26 uals with disabilities in these communities; and 


emcdonald on DSK5VPTVN1PROD with BILLS
549 

•HR 2954 IH

1 (5) assess the feasibility and the costs of associ2 ated with the use of health information technology 

3 in these communities. 

4 If such Institute declines to conduct the study, the Sec5 retary shall enter into an agreement with another appro6 priate public or nonprofit private entity to conduct the 

7 study. 

8 (b) REPORT.—The Secretary shall ensure that, not 

9 later than 24 months after the date of the enactment of 

10 this Act, the study required under subsection (a) is com11 pleted and a report on the study is submitted to Congress, 

12 including any recommendations for legislation or adminis13 trative action. 

14 Subtitle D—Closing Gaps in 

15 Funding To Adopt Certified EHRs 

16 SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS 

17 TO HOSPITALS IN PUERTO RICO. 

18 (a) IN GENERAL.—Subsection (n)(6)(B) of section 

19 1886 of the Social Security Act (42 U.S.C. 1395ww) is 

20 amended by striking ‘‘subsection (d) hospital’’ and insert21 ing ‘‘hospital that is a subsection (d) hospital or a sub22 section (d) Puerto Rico hospital’’. 

23 (b) OFFSETTING REDUCTION.—Subsection (n)(2) of 

24 such section is amended by adding at the end the following 

25 new subparagraph: 


emcdonald on DSK5VPTVN1PROD with BILLS
550 

•HR 2954 IH

1 ‘‘(H) BUDGET NEUTRALITY ADJUST2 MENT.—The Secretary shall reduce the applica3 ble amounts that would otherwise be deter4 mined under this subsection with respect to— 

5 ‘‘(i) the first fiscal year to which this 

6 subparagraph applies by an amount that 

7 the Secretary estimates would ensure that 

8 estimated aggregate payments under this 

9 subsection for such fiscal year are not in10 creased as a result of the amendments 

11 made by subsection (a) of section 841 of 

12 the Health Equity and Accountability Act 

13 of 2011; or 

14 ‘‘(ii) a succeeding fiscal year by an 

15 amount that the Secretary estimates would 

16 ensure that estimated aggregate payments 

17 under this subsection for such fiscal year 

18 are not increased as a result of the amend19 ments made by subsections (a) and (c) of 

20 such section.’’. 

21 (c) CONFORMING AMENDMENTS.—(1) Subsection 

22 (b)(3)(B)(ix) of such section is amended— 

23 (A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 

24 and inserting ‘‘(n)(6)(B)’’; and 


emcdonald on DSK5VPTVN1PROD with BILLS
551 

•HR 2954 IH

1 (B) in subclause (II), by striking ‘‘subsection 

2 (d) hospital’’ and inserting ‘‘an eligible hospital’’. 

3 (2) Paragraphs (2) and (4)(A) of section 1853(m) of 

4 the Social Security Act (42 U.S.C. 1395w–23(m)) are 

5 each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 

6 ‘‘1886(n)(6)(B)’’. 

7 (d) IMPLEMENTATION.—Notwithstanding any other 

8 provision of law, the Secretary of Health and Human 

9 Services may implement the amendments made by sub10 sections (a), (b) and (c) by program instruction or other11 wise. 

12 (e) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply to payments for payment years for 

14 fiscal years beginning after the date of the enactment of 

15 this Act. 

16 SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAY17 MENTS TO LONG-TERM CARE FACILITIES AND 

18 HOME HEALTH AGENCIES. 

19 Section 1903(t)(2)(B) of the Social Security Act (42 

20 U.S.C. 1396b(t)(2)(B)) is amended— 

21 (1) in clause (i), by striking ‘‘, or’’ and insert22 ing a semicolon; 

23 (2) in clause (ii), by striking the period at the 

24 end and inserting a semicolon; and 


emcdonald on DSK5VPTVN1PROD with BILLS
552 

•HR 2954 IH

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

2 clauses: 

3 ‘‘(iii) a long-term care facility; or 

4 ‘‘(iv) a home health agency (as defined in 

5 section 1861(o)).’’. 

6 SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 

7 FOR MEDICAID ELECTRONIC HEALTH 

8 RECORD INCENTIVE PAYMENTS. 

9 (a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 

10 Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 

11 amended by striking ‘‘insofar as the assistant is prac12 ticing’’ and all that follows through ‘‘so led’’. 

13 (b) EFFECTIVE DATE.—The amendment made by 

14 subsection (a) shall apply with respect to amounts ex15 pended under 1903(a)(3)(F) of the Social Security Act 

16 (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters begin17 ning on or after the date of the enactment of this Act. 


emcdonald on DSK5VPTVN1PROD with BILLS
553 

•HR 2954 IH

1 TITLE IX—ACCOUNTABILITY 

2 AND EVALUATION 

3 SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 

4 ASSISTED HEALTH CARE SERVICES AND RE5 SEARCH PROGRAMS ON THE BASIS OF SEX, 

6 RACE, COLOR, NATIONAL ORIGIN, SEXUAL 

7 ORIENTATION, GENDER IDENTITY, OR DIS8 ABILITY STATUS. 

9 No person in the United States shall, on the basis 

10 of sex, race, color, national origin, sexual orientation, gen11 der identity, or disability status, be excluded from partici12 pation in, be denied the benefits of, or be subjected to dis13 crimination under any health care service or research pro14 gram or activity receiving Federal financial assistance. 

15 SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 

16 TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 

17 A payment to a provider of services, physician, or 

18 other supplier under part B, C, or D of title XVIII of 

19 the Social Security Act shall be deemed a grant, and not 

20 a contract of insurance or guaranty, for the purposes of 

21 title VI of the Civil Rights Act of 1964. 


emcdonald on DSK5VPTVN1PROD with BILLS
554 

•HR 2954 IH

1 SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 

2 THE DEPARTMENT OF HEALTH AND HUMAN 

3 SERVICES. 

4 Title XXXIV of the Public Health Service Act, as 

5 amended by titles I, II, and III of this Act, is further 

6 amended by inserting after subtitle B the following: 

7 ‘‘Subtitle C—Strengthening 

8 Accountability 

9 ‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

10 ‘‘(a) IN GENERAL.—The Secretary shall establish 

11 within the Office for Civil Rights an Office of Health Dis12 parities, which shall be headed by a director to be ap13 pointed by the Secretary. 

14 ‘‘(b) PURPOSE.—The Office of Health Disparities 

15 shall ensure that the health programs, activities, and oper16 ations of health entities which receive Federal financial as17 sistance are in compliance with title VI of the Civil Rights 

18 Act, which prohibits discrimination on the basis of race, 

19 color, or national origin. The activities of the Office shall 

20 include the following: 

21 ‘‘(1) The development and implementation of 

22 an action plan to address racial and ethnic health 

23 care disparities, which shall address concerns relat24 ing to the Office for Civil Rights as released by the 

25 United States Commission on Civil Rights in the re26 port entitled ‘Health Care Challenge: Acknowledging 


emcdonald on DSK5VPTVN1PROD with BILLS
555 

•HR 2954 IH

1 Disparity, Confronting Discrimination, and Ensur2 ing Equity’ (September 1999) in conjunction with 

3 the reports by the Institute of Medicine entitled ‘Un4 equal Treatment: Confronting Racial and Ethnic 

5 Disparities in Health Care’, ‘Crossing the Quality 

6 Chasm: A New Health System for the 21st Cen7 tury’, and ‘In the Nation’s Compelling Interest: En8 suring Diversity in the Health Care Workforce’, and 

9 ‘The National Partnership for Action to End Health 

10 Disparities’, and other related reports by the Insti11 tute of Medicine. This plan shall be publicly dis12 closed for review and comment and the final plan 

13 shall address any comments or concerns that are re14 ceived by the Office. 

15 ‘‘(2) Investigative and enforcement actions 

16 against intentional discrimination and policies and 

17 practices that have a disparate impact on minorities. 

18 ‘‘(3) The review of racial, ethnic, and primary 

19 language health data collected by Federal health 

20 agencies to assess health care disparities related to 

21 intentional discrimination and policies and practices 

22 that have a disparate impact on minorities. 

23 ‘‘(4) Outreach and education activities relating 

24 to compliance with title VI of the Civil Rights Act. 


emcdonald on DSK5VPTVN1PROD with BILLS
556 

•HR 2954 IH

1 ‘‘(5) The provision of technical assistance for 

2 health entities to facilitate compliance with title VI 

3 of the Civil Rights Act. 

4 ‘‘(6) Coordination and oversight of activities of 

5 the civil rights compliance offices established under 

6 section 3442. 

7 ‘‘(7) Ensuring compliance with the 1997 Office 

8 of Management and Budget Standards for Maintain9 ing, Collecting, and Presenting Federal Data on 

10 Race, Ethnicity and the available language stand11 ards. 

12 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en13 sure the effectiveness of the Office of Health Disparities 

14 by ensuring that the Office is provided with— 

15 ‘‘(1) adequate funding to enable the Office to 

16 carry out its duties under this section; and 

17 ‘‘(2) staff with expertise in— 

18 ‘‘(A) epidemiology; 

19 ‘‘(B) statistics; 

20 ‘‘(C) health quality assurance; 

21 ‘‘(D) minority health and health dispari22 ties; 

23 ‘‘(E) cultural and linguistic competency; 

24 and 

25 ‘‘(F) civil rights. 


emcdonald on DSK5VPTVN1PROD with BILLS
557 

•HR 2954 IH

1 ‘‘(d) REPORT.—Not later than December 31, 2012, 

2 and annually thereafter, the Secretary, in collaboration 

3 with the Director of the Office for Civil Rights and the 

4 Deputy Assistant Secretary for Minority Health, shall 

5 submit a report to the Committee on Health, Education, 

6 Labor, and Pensions of the Senate and the Committee on 

7 Energy and Commerce of the House of Representatives 

8 that includes— 

9 ‘‘(1) the number of cases filed, broken down by 

10 category; 

11 ‘‘(2) the number of cases investigated and 

12 closed by the office; 

13 ‘‘(3) the outcomes of cases investigated; 

14 ‘‘(4) the staffing levels of the office including 

15 staff credentials; 

16 ‘‘(5) the number of other lingering and emerg17 ing cases in which civil rights inequities can be dem18 onstrated; and 

19 ‘‘(6) the number of cases remaining open and 

20 an explanation for their open status. 

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

22 are authorized to be appropriated to carry out this section, 

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

24 2012 through 2017. 


emcdonald on DSK5VPTVN1PROD with BILLS
558 

•HR 2954 IH

1 ‘‘SEC. 3442. 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, disability, sexual orienta16 tion, and gender identity; and 

17 ‘‘(2) promotes the reduction and elimination of 

18 disparities in health and health care based on race, 

19 national origin, language, ethnicity, sex, age, dis20 ability, sexual orientation, and gender identity. 

21 ‘‘(c) POWERS AND DUTIES.—The offices established 

22 in subsection (a) shall have the following powers and du23 ties: 

24 ‘‘(1) The establishment of compliance and pro25 gram participation standards for recipients of Fed26 eral financial assistance under each program adminVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00558 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
559 

•HR 2954 IH

1 istered by an agency within the Department of 

2 Health and Human Services including the establish3 ment of disparity reduction standards to encompass 

4 disparities in health and health care related to race, 

5 national origin, language, ethnicity, sex, age, dis6 ability, sexual orientation, and gender identity. 

7 ‘‘(2) The development and implementation of 

8 program-specific guidelines that interpret and apply 

9 Department of Health and Human Services guid10 ance under title VI of the Civil Rights Act of 1964 

11 and section 1557 of the Patient Protection and Af12 fordable Care Act to each Federal health program 

13 administered by the agency. 

14 ‘‘(3) The development of a disparity-reduction 

15 impact analysis methodology that shall be applied to 

16 every rule issued by the agency and published as 

17 part of the formal rulemaking process under sections 

18 555, 556, and 557 of title 5, United States Code. 

19 ‘‘(4) Oversight of data collection, analysis, and 

20 publication requirements for all recipients of Federal 

21 financial assistance under each Federal health pro22 gram administered by the agency, and compliance 

23 with the 1997 Office of Management and Budget 

24 Standards for Maintaining, Collecting, and PreVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00559 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
560 

•HR 2954 IH

1 senting Federal Data on Race and Ethnicity and the 

2 available language standards. 

3 ‘‘(5) The conduct of publicly available studies 

4 regarding discrimination within Federal health pro5 grams administered by the agency as well as dis6 parity reduction initiatives by recipients of Federal 

7 financial assistance under Federal health programs. 

8 ‘‘(6) Annual reports to the Committee on 

9 Health, Education, Labor, and Pensions and the 

10 Committee on Finance of the Senate and the Com11 mittee on Energy and Commerce and the Committee 

12 on Ways and Means of the House of Representatives 

13 on the progress in reducing disparities in health and 

14 health care through the Federal programs adminis15 tered by the agency. 

16 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

17 IN THE DEPARTMENT OF JUSTICE.— 

18 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

19 SERVICES.—The Office for Civil Rights in the De20 partment of Health and Human Services shall pro21 vide standard-setting and compliance review inves22 tigation support services to the Civil Rights Compli23 ance Office for each agency. 

24 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

25 for Civil Rights in the Department of Justice shall 


emcdonald on DSK5VPTVN1PROD with BILLS
561 

•HR 2954 IH

1 continue to maintain the power to institute formal 

2 proceedings when an agency Office for Civil Rights 

3 determines that a recipient of Federal financial as4 sistance is not in compliance with the disparity re5 duction standards of the agency. 

6 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

7 health programs’ mean programs— 

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

9 301 et seq.) that pay for health care and services; 

10 and 

11 ‘‘(2) under this Act that provide Federal finan12 cial assistance for health care, biomedical research, 

13 health services research, and programs designed to 

14 improve the public’s health.’’. 

15 SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

16 (a) COORDINATION WITHIN DEPARTMENT OF JUS17 TICE OF ACTIVITIES REGARDING HEALTH DISPARI18 TIES.—Section 3 of the Civil Rights Commission Act of 

19 1983 (42 U.S.C. 1975a) is amended— 

20 (1) in paragraph (1), by striking ‘‘and’’ at the 

21 end; 

22 (2) in paragraph (2), by striking the period at 

23 the end and inserting ‘‘; and’’; and 

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


emcdonald on DSK5VPTVN1PROD with BILLS
562 

•HR 2954 IH

1 ‘‘(3) shall, with respect to activities carried out 

2 in health care and correctional facilities toward the 

3 goal of eliminating health disparities between the 

4 general population and members of racial or ethnic 

5 minority groups, coordinate such activities of— 

6 ‘‘(A) the Office for Civil Rights within the 

7 Department of Justice; 

8 ‘‘(B) the Office of Justice Programs within 

9 the Department of Justice; 

10 ‘‘(C) the Office for Civil Rights within the 

11 Department of Health and Human Services; 

12 and 

13 ‘‘(D) the Office of Minority Health within 

14 the Department of Health and Human Services 

15 (headed by the Deputy Assistant Secretary for 

16 Minority Health).’’. 

17 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

18 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

19 1975c) is amended by striking the first sentence and in20 serting the following: ‘‘For the purpose of carrying out 

21 this Act, there are authorized to be appropriated 

22 $30,000,000 for fiscal year 2012, and such sums as may 

23 be necessary for each of the fiscal years 2013 through 

24 2017.’’. 


emcdonald on DSK5VPTVN1PROD with BILLS
563 

•HR 2954 IH

1 SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND2 ING OF ACTIVITIES TO ELIMINATE RACIAL 

3 AND ETHNIC HEALTH DISPARITIES. 

4 (a) FINDINGS.—Congress makes the following find5 ings: 

6 (1) The health status of the American populace 

7 is declining and the United States currently ranks 

8 below most industrialized nations in health status 

9 measured by longevity, sickness, and mortality. 

10 (2) Racial and ethnic minority populations tend 

11 have the poorest health status and face substantial 

12 cultural, social, and economic barriers to obtaining 

13 quality health care. 

14 (3) Efforts to improve minority health have 

15 been limited by inadequate resources (funding, staff16 ing, and stewardship) and accountability. 

17 (b) SENSE OF CONGRESS.—It is the sense of Con18 gress that— 

19 (1) funding should be doubled by fiscal year 

20 2013 for the National Institute for Minority Health 

21 Disparities, the Office of Civil Rights in the Depart22 ment of Health and Human Services, the National 

23 Institute of Nursing Research, and the Office of Mi24 nority Health; 

25 (2) adequate funding by fiscal year 2013, and 

26 subsequent funding increases, should be provided for 


emcdonald on DSK5VPTVN1PROD with BILLS
564 

•HR 2954 IH

1 health professions training programs, the Racial and 

2 Ethnic Approaches to Community Health (REACH) 

3 at the Centers for Disease Control and Prevention, 

4 the Minority HIV/AIDS Initiative, and the Excel5 lence Centers to Eliminate Ethnic/Racial Disparities 

6 (EXCEED) Program at the Agency for Healthcare 

7 Research and Quality; 

8 (3) funding should be restored to the Racial 

9 and Ethnic Approaches to Community Health 

10 (REACH) program at the Centers for Disease Con11 trol and Prevention, which has been a successful 

12 program at the community health level; 

13 (4) current and newly created health disparity 

14 elimination incentives, programs, agencies, and de15 partments under this Act (and the amendments 

16 made by this Act) should receive adequate staffing 

17 and funding by fiscal year 2013; and 

18 (5) stewardship and accountability should be 

19 provided to the Congress and the President for 

20 measurable and sustainable progress toward health 

21 disparity elimination. 

22 SEC. 906. GAO AND NIH REPORTS. 

23 (a) GAO REPORT ON NIH GRANT RACIAL AND ETH24 NIC DIVERSITY.— 


emcdonald on DSK5VPTVN1PROD with BILLS
565 

•HR 2954 IH

1 (1) IN GENERAL.—The Comptroller General of 

2 the United States shall conduct a study on the racial 

3 and ethnic diversity among the following groups: 

4 (A) All applicants for grants, contracts, 

5 and cooperative agreements awarded by the Na6 tional Institutes of Health during the period be7 ginning January 1, 1990, and ending December 

8 31, 2011. 

9 (B) All recipients of such grants, con10 tracts, and cooperative agreements. 

11 (C) All members of the peer review panels 

12 of such applicants and recipients, respectively. 

13 (2) REPORT.—Not later than six months after 

14 the date of the enactment of this Act, the Comp15 troller General shall complete the study under para16 graph (1) and submit to Congress a report con17 taining the results of such study. 

18 (b) NIH REPORT ON CERTAIN AUTHORITY OF NA19 TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH

20 DISPARITIES.—Not later than six months after the date 

21 of the enactment of this Act, and biennially thereafter, the 

22 Director of the National Institutes of Health, in collabora23 tion with the Director of the National Institute on Minor24 ity Health and Health Disparities, shall submit to Con25 gress a report that details and evaluates— 


emcdonald on DSK5VPTVN1PROD with BILLS
566 

•HR 2954 IH

1 (1) the steps taken during the applicable report 

2 period by the Director of the National Institutes of 

3 Health to enforce the expanded planning, coordina4 tion, review, and evaluation authority provided the 

5 National Institute on Minority Health and Health 

6 Disparities under section 464z–3(h) of the Public 

7 Health Service Act (42 U.S.C. 285(h)), as added by 

8 section 10334(c) of the Patient Protection and Af9 fordable Care Act, over all minority health and 

10 health disparity research that is conducted or sup11 ported by the Institutes and Centers at the National 

12 Institutes of Health; and 

13 (2) the outcomes of such steps. 

14 (c) GAO REPORT RELATED TO RECIPIENTS OF

15 PPACA FUNDING.—Not later than one year after the 

16 date of the enactment of this Act and biennially thereafter 

17 until 2020, the Comptroller General of the United States 

18 shall submit to Congress a report that identifies, with re19 spect to minority community-based organizations that ap20 plied during the applicable report period for Federal fund21 ing provided pursuant to the provisions of (and amend22 ments made by) the Patient Protection and Affordable 

23 Care Act for purposes of achieving health equity and elimi24 nating health disparities, the percentage of such organiza25 tions that were awarded such funding. 


emcdonald on DSK5VPTVN1PROD with BILLS
567 

•HR 2954 IH

1 (d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL

2 INSTITUTE ON MINORITY HEALTH AND HEALTH DIS3 PARITIES.—The Director of the National Institute on Mi4 nority Health and Health Disparities shall prepare an an5 nual report on the activities carried out or to be carried 

6 out by the Institute, and shall submit each such report 

7 to the Committee on Health, Education, Labor, and Pen8 sions of the Senate, the Committee on Energy and Com9 merce of the House of Representatives, the Secretary of 

10 Health and Human Services, and the Director of the Na11 tional Institutes of Health. With respect to the fiscal year 

12 involved, the report shall— 

13 (1) describe and evaluate the progress made in 

14 health disparities research conducted or supported 

15 by institutes and centers of the National Institutes 

16 of Health; 

17 (2) summarize and analyze expenditures made 

18 for activities with respect to health disparities re19 search conducted or supported by the National Insti20 tutes of Health; 

21 (3) include a separate statement applying the 

22 requirements of paragraphs (1) and (2) specifically 

23 to minority health disparities research; and 

24 (4) contain such recommendations as the Direc25 tor of the Institute considers appropriate. 


emcdonald on DSK5VPTVN1PROD with BILLS
568 

•HR 2954 IH

1 TITLE X—ADDRESSING SOCIAL 

2 DETERMINANTS AND IM3 PROVING ENVIRONMENTAL 

4 JUSTICE 

5 SEC. 1001. CODIFICATION OF EXECUTIVE ORDER 12898. 

6 (a) IN GENERAL.—The President of the United 

7 States is authorized and directed to execute, administer, 

8 and enforce as a matter of Federal law the provisions of 

9 Executive Order 12898, dated February 11, 1994 (‘‘Fed10 eral Actions To Address Environmental Justice In Minor11 ity Populations and Low-Income Populations’’), with such 

12 modifications as are provided in this section. 

13 (b) DEFINITION OF ENVIRONMENTAL JUSTICE.—For 

14 purposes of carrying out the provisions of Executive Order 

15 12898, the following definitions shall apply: 

16 (1) The term ‘‘environmental justice’’ means 

17 the fair treatment and meaningful involvement of all 

18 people regardless of race, color, national origin, edu19 cational level, or income with respect to the develop20 ment, implementation, and enforcement of environ21 mental laws and regulations in order to ensure 

22 that— 

23 (A) minority and low-income communities 

24 have access to public information relating to 


emcdonald on DSK5VPTVN1PROD with BILLS
569 

•HR 2954 IH

1 human health and environmental planning, reg2 ulations, and enforcement; and 

3 (B) no minority or low-income population 

4 is forced to shoulder a disproportionate burden 

5 of the negative human health and environ6 mental impacts of pollution or other environ7 mental hazard. 

8 (2) The term ‘‘fair treatment’’ means policies 

9 and practices that ensure that no group of people, 

10 including racial, ethnic, or socioeconomic groups 

11 bear disproportionately high and adverse human 

12 health or environmental effects resulting from Fed13 eral agency programs, policies, and activities. 

14 (c) JUDICIAL REVIEW AND RIGHTS OF ACTION.— 

15 The provisions of section 6–609 of Executive Order 12898 

16 shall not apply for purposes of this Act. 

17 SEC. 1002. IMPLEMENTATION OF RECOMMENDATIONS BY 

18 ENVIRONMENTAL PROTECTION AGENCY. 

19 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 

20 Administrator of the Environmental Protection Agency 

21 shall, as promptly as practicable, carry out each of the 

22 following recommendations of the Inspector General of the 

23 agency as set forth in Report No. 2006–P–00034 entitled 

24 ‘‘EPA needs to conduct environmental justice reviews of 

25 its programs, policies and activities’’: 


emcdonald on DSK5VPTVN1PROD with BILLS
570 

•HR 2954 IH

1 (1) The recommendation that the Agency’s pro2 gram and regional offices identify which programs, 

3 policies, and activities need environmental justice re4 views and require these offices to establish a plan to 

5 complete the necessary reviews. 

6 (2) The recommendation that the Administrator 

7 of the Agency ensure that these reviews determine 

8 whether the programs, policies, and activities may 

9 have a disproportionately high and adverse health or 

10 environmental impact on minority and low-income 

11 populations. 

12 (3) The recommendation that each program 

13 and regional office develop specific environmental 

14 justice review guidance for conducting environmental 

15 justice reviews. 

16 (4) The recommendation that the Administrator 

17 designate a responsible office to compile results of 

18 environmental justice reviews and recommend appro19 priate actions. 

20 (b) GAO RECOMMENDATIONS.—In developing rules 

21 under laws administered by the Environmental Protection 

22 Agency, the Administrator of the Agency shall, as prompt23 ly as practicable, carry out each of the following rec24 ommendations of the Comptroller General of the United 

25 States as set forth in GAO Report numbered GAO–05– 


emcdonald on DSK5VPTVN1PROD with BILLS
571 

•HR 2954 IH

1 289 entitled ‘‘EPA Should Devote More Attention to En2 vironmental Justice when Developing Clean Air Rules’’: 

3 (1) The recommendation that the Administrator 

4 ensure that workgroups involved in developing a rule 

5 devote attention to environmental justice while draft6 ing and finalizing the rule. 

7 (2) The recommendation that the Administrator 

8 enhance the ability of such workgroups to identify 

9 potential environmental justice issues through such 

10 steps as providing workgroup members with guid11 ance and training to helping them identify potential 

12 environmental justice problems and involving envi13 ronmental justice coordinators in the workgroups 

14 when appropriate. 

15 (3) The recommendation that the Administrator 

16 improve assessments of potential environmental jus17 tice impacts in economic reviews by identifying the 

18 data and developing the modeling techniques needed 

19 to assess such impacts. 

20 (4) The recommendation that the Administrator 

21 direct appropriate Agency officers and employees to 

22 respond fully when feasible to public comments on 

23 environmental justice, including improving the Agen24 cy’s explanation of the basis for its conclusions, to25 gether with supporting data. 


emcdonald on DSK5VPTVN1PROD with BILLS
572 

•HR 2954 IH

1 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad2 ministrator of the Environmental Protection Agency shall, 

3 as promptly as practicable, carry out each of the following 

4 recommendations of the Inspector General of the Agency 

5 as set forth in the report entitled ‘‘EPA Needs to Consist6 ently Implement the Intent of the Executive Order on En7 vironmental Justice’’ (Report No. 2004–P–00007): 

8 (1) The recommendation that the Agency clear9 ly define the mission of the Office of Environmental 

10 Justice (OEJ) and provide Agency staff with an un11 derstanding of the roles and responsibilities of the 

12 Office. 

13 (2) The recommendation that the Agency estab14 lish (through issuing guidance or a policy statement 

15 from the Administrator) specific time frames for the 

16 development of definitions, goals, and measurements 

17 regarding environmental justice and provide the re18 gions and program offices a standard and consistent 

19 definition for a minority and low-income community, 

20 with instructions on how the Agency will implement 

21 and operationalize environmental justice into the 

22 Agency’s daily activities. 

23 (3) The recommendation that the Agency en24 sure the comprehensive training program currently 

25 under development includes standard and consistent 


emcdonald on DSK5VPTVN1PROD with BILLS
573 

•HR 2954 IH

1 definitions of the key environmental justice concepts 

2 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor3 tionately impacted’’) and instructions for implemen4 tation of those concepts. 

5 The Administrator shall submit an initial report to Con6 gress within 6 months after the enactment of this Act re7 garding the Administrator’s strategy for implementing the 

8 recommendations referred to in paragraphs (1), (2), and 

9 (3). Thereafter, the Administrator shall provide semi10 annual reports to Congress regarding the Administrator’s 

11 progress in implementing such recommendations and 

12 modifying the Administrator’s emergency management 

13 procedures to incorporate environmental justice in the 

14 Agency’s Incident Command Structure (in accordance 

15 with the December 18, 2006, letter from the Deputy Ad16 ministrator to the Acting Inspector General of the Agen17 cy). 

18 (d) FEDERAL ACTION PLAN FOR SAVING LIVES, 

19 PROTECTING PEOPLE AND THEIR FAMILIES FROM

20 RADON.— 

21 (1) IN GENERAL.—Because radon is a naturally 

22 occurring radioactive gas that is recognized as the 

23 leading cause of lung cancer among nonsmokers and 

24 is a particular environmental threat for low-income 

25 and minority individuals because of the lack of inforVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00573 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
574 

•HR 2954 IH

1 mation about radon levels in their own homes, the 

2 Administrator of the Environmental Protection 

3 Agency shall within 6 months after the date of the 

4 enactment of this Act, implement the action plan en5 titled ‘‘Protecting People and Families from Radon: 

6 A Federal Action Plan for Saving Lives’’ (June 20, 

7 2011), working with the Secretary of Health and 

8 Human Services acting through the Director of the 

9 Centers for Disease Control and Prevention, and 

10 with the other Federal agencies mentioned in and as 

11 set forth in the action plan. 

12 (2) SPECIFIC STEPS.—In carrying out para13 graph (1), the Administrator shall take steps to 

14 achieve each of the following: 

15 (A) The recommendation that the 

16 workgroup comprised of the Federal agencies 

17 participating in the development of the action 

18 plan referred to in paragraph (1) implement 

19 specific steps within the current authority and 

20 activities of each Federal agency to reduce ex21 posure to radon. 

22 (B) The recommendation that such 

23 workgroup meet on the 1-year anniversary of 

24 the plan to assess and recognize achievements 

25 of the plan. 


emcdonald on DSK5VPTVN1PROD with BILLS
575 

•HR 2954 IH

1 (3) REPORT.—The Administrator shall report 

2 to the Congress on the 1-year assessment of the 

3 plan’s implementation, including the challenges re4 maining and the progress in reducing radon expo5 sure particularly to low-income and minority fami6 lies. 

7 SEC. 1003. GRANT PROGRAM. 

8 (a) DEFINITIONS.—In this section: 

9 (1) DIRECTOR.—The term ‘‘Director’’ means 

10 the Director of the Centers for Disease Control and 

11 Prevention, acting in collaboration with the Adminis12 trator of the Environmental Protection Agency and 

13 the Director of the National Institute of Environ14 mental Health Sciences. 

15 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti16 ty’’ means a State or local community that— 

17 (A) bears a disproportionate burden of ex18 posure to environmental health hazards; 

19 (B) has established a coalition— 

20 (i) with not less than 1 community21 based organization; and 

22 (ii) with not less than 1— 

23 (I) public health entity; 

24 (II) health care provider organi25 zation; or 


emcdonald on DSK5VPTVN1PROD with BILLS
576 

•HR 2954 IH

1 (III) academic institution, includ2 ing any minority-serving institution 

3 (including an Hispanic-serving institu4 tion, a historically Black college or 

5 university, and a tribal college or uni6 versity); 

7 (C) ensures planned activities and funding 

8 streams are coordinated to improve community 

9 health; and 

10 (D) submits an application in accordance 

11 with subsection (c). 

12 (b) ESTABLISHMENT.—The Director shall establish a 

13 grant program under which eligible entities shall receive 

14 grants to conduct environmental health improvement ac15 tivities. 

16 (c) APPLICATION.—To receive a grant under this sec17 tion, an eligible entity shall submit an application to the 

18 Director at such time, in such manner, and accompanied 

19 by such information as the Director may require. 

20 (d) COOPERATIVE AGREEMENTS.—An eligible entity 

21 may use a grant under this section— 

22 (1) to promote environmental health; and 

23 (2) to address environmental health disparities. 

24 (e) AMOUNT OF COOPERATIVE AGREEMENT.— 


emcdonald on DSK5VPTVN1PROD with BILLS
577 

•HR 2954 IH

1 (1) IN GENERAL.—The Director shall award 

2 grants to eligible entities at the 2 different funding 

3 levels described in this subsection. 

4 (2) LEVEL 1 COOPERATIVE AGREEMENTS.— 

5 (A) IN GENERAL.—An eligible entity 

6 awarded a grant under this paragraph shall use 

7 the funds to identify environmental health prob8 lems and solutions by— 

9 (i) establishing a planning and 

10 prioritizing council in accordance with sub11 paragraph (B); and 

12 (ii) conducting an environmental 

13 health assessment in accordance with sub14 paragraph (C). 

15 (B) PLANNING AND PRIORITIZING COUN16 CIL.— 

17 (i) IN GENERAL.—A prioritizing and 

18 planning council established under sub19 paragraph (A)(i) (referred to in this para20 graph as a ‘‘PPC’’) shall assist the envi21 ronmental health assessment process and 

22 environmental health promotion activities 

23 of the eligible entity. 

24 (ii) MEMBERSHIP.—Membership of a 

25 PPC shall consist of representatives from 


emcdonald on DSK5VPTVN1PROD with BILLS
578 

•HR 2954 IH

1 various organizations within public health, 

2 planning, development, and environmental 

3 services and shall include stakeholders 

4 from vulnerable groups such as children, 

5 the elderly, disabled, and minority ethnic 

6 groups that are often not actively involved 

7 in democratic or decisionmaking processes. 

8 (iii) DUTIES.—A PPC shall— 

9 (I) identify key stakeholders and 

10 engage and coordinate potential part11 ners in the planning process; 

12 (II) establish a formal advisory 

13 group to plan for the establishment of 

14 services; 

15 (III) conduct an in-depth review 

16 of the nature and extent of the need 

17 for an environmental health assess18 ment, including a local epidemiological 

19 profile, an evaluation of the service 

20 provider capacity of the community, 

21 and a profile of any target popu22 lations; and 

23 (IV) define the components of 

24 care and form essential programmatic 


emcdonald on DSK5VPTVN1PROD with BILLS
579 

•HR 2954 IH

1 linkages with related providers in the 

2 community. 

3 (C) ENVIRONMENTAL HEALTH ASSESS4 MENT.— 

5 (i) IN GENERAL.—A PPC shall carry 

6 out an environmental health assessment to 

7 identify environmental health concerns. 

8 (ii) ASSESSMENT PROCESS.—The 

9 PPC shall— 

10 (I) define the goals of the assess11 ment; 

12 (II) generate the environmental 

13 health issue list; 

14 (III) analyze issues with a sys15 tems framework; 

16 (IV) develop appropriate commu17 nity environmental health indicators; 

18 (V) rank the environmental 

19 health issues; 

20 (VI) set priorities for action; 

21 (VII) develop an action plan; 

22 (VIII) implement the plan; and 

23 (IX) evaluate progress and plan24 ning for the future. 


emcdonald on DSK5VPTVN1PROD with BILLS
580 

•HR 2954 IH

1 (D) EVALUATION.—Each eligible entity 

2 that receives a grant under this paragraph shall 

3 evaluate, report, and disseminate program find4 ings and outcomes. 

5 (E) TECHNICAL ASSISTANCE.—The Direc6 tor may provide such technical and other non7 financial assistance to eligible entities as the 

8 Director determines to be necessary. 

9 (3) LEVEL 2 COOPERATIVE AGREEMENTS.— 

10 (A) ELIGIBILITY.— 

11 (i) IN GENERAL.—The Director shall 

12 award grants under this paragraph to eli13 gible entities that have already— 

14 (I) established broad-based col15 laborative partnerships; and 

16 (II) completed environmental as17 sessments. 

18 (ii) NO LEVEL 1 REQUIREMENT.—To 

19 be eligible to receive a grant under this 

20 paragraph, an eligible entity is not re21 quired to have successfully completed a 

22 Level 1 Cooperative Agreement (as de23 scribed in paragraph (2)). 

24 (B) USE OF GRANT FUNDS.—An eligible 

25 entity awarded a grant under this paragraph 


emcdonald on DSK5VPTVN1PROD with BILLS
581 

•HR 2954 IH

1 shall use the funds to further activities to carry 

2 out environmental health improvement activi3 ties, including— 

4 (i) addressing community environ5 mental health priorities in accordance with 

6 paragraph (2)(C)(ii), including— 

7 (I) air quality; 

8 (II) water quality; 

9 (III) solid waste; 

10 (IV) land use; 

11 (V) housing; 

12 (VI) food safety; 

13 (VII) crime; 

14 (VIII) injuries; and 

15 (IX) health care services; 

16 (ii) building partnerships between 

17 planning, public health, and other sectors, 

18 to address how the built environment im19 pacts food availability and access and 

20 physical activity to promote healthy behav21 iors and lifestyles and reduce overweight 

22 and obesity, asthma, respiratory condi23 tions, dental, oral and mental health condi24 tions, poverty, and related co-morbidities; 


emcdonald on DSK5VPTVN1PROD with BILLS
582 

•HR 2954 IH

1 (iii) establishing programs to ad2 dress— 

3 (I) how environmental and social 

4 conditions of work and living choices 

5 influence physical activity and dietary 

6 intake; or 

7 (II) how those conditions influ8 ence the concerns and needs of people 

9 who have impaired mobility and use 

10 assistance devices, including wheel11 chairs and lower limb prostheses; and 

12 (iv) convening intervention programs 

13 that examine the role of the social environ14 ment in connection with the physical and 

15 chemical environment in— 

16 (I) determining access to nutri17 tional food; and 

18 (II) improving physical activity to 

19 reduce morbidity and increase quality 

20 of life. 

21 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

22 are authorized to be appropriated to carry out this sec23 tion— 

24 (1) $25,000,000 for fiscal year 2012; and 


emcdonald on DSK5VPTVN1PROD with BILLS
583 

•HR 2954 IH

1 (2) such sums as may be necessary for fiscal 

2 years 2013 through 2016. 

3 SEC. 1004. ADDITIONAL RESEARCH ON THE RELATIONSHIP 

4 BETWEEN THE BUILT ENVIRONMENT AND 

5 THE HEALTH OF COMMUNITY RESIDENTS. 

6 (a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 

7 section, the term ‘‘eligible institution’’ means a public or 

8 private nonprofit institution that submits to the Secretary 

9 of Health and Human Services (in this section referred 

10 to as the ‘‘Secretary’’) and the Administrator of the Envi11 ronmental Protection Agency (in this section referred to 

12 as the ‘‘Administrator’’) an application for a grant under 

13 the grant program authorized under subsection (b)(2) at 

14 such time, in such manner, and containing such agree15 ments, assurances, and information as the Secretary and 

16 Administrator may require. 

17 (b) RESEARCH GRANT PROGRAM.— 

18 (1) DEFINITION OF HEALTH.—In this section, 

19 the term ‘‘health’’ includes— 

20 (A) levels of physical activity; 

21 (B) consumption of nutritional foods; 

22 (C) rates of crime; 

23 (D) air, water, and soil quality; 

24 (E) risk of injury; 


emcdonald on DSK5VPTVN1PROD with BILLS
584 

•HR 2954 IH

1 (F) accessibility to health care services; 

2 and 

3 (G) other indicators as determined appro4 priate by the Secretary. 

5 (2) GRANTS.—The Secretary, in collaboration 

6 with the Administrator, shall provide grants to eligi7 ble institutions to conduct and coordinate research 

8 on the built environment and its influence on indi9 vidual and population-based health. 

10 (3) RESEARCH.—The Secretary shall support 

11 research that— 

12 (A) investigates and defines the causal 

13 links between all aspects of the built environ14 ment and the health of residents; 

15 (B) examines— 

16 (i) the extent of the impact of the 

17 built environment (including the various 

18 characteristics of the built environment) on 

19 the health of residents; 

20 (ii) the variance in the health of resi21 dents by— 

22 (I) location (such as inner cities, 

23 inner suburbs, and outer suburbs); 

24 and 


emcdonald on DSK5VPTVN1PROD with BILLS
585 

•HR 2954 IH

1 (II) population subgroup (such as 

2 children, the elderly, the disadvan3 taged); or 

4 (iii) the importance of the built envi5 ronment to the total health of residents, 

6 which is the primary variable of interest 

7 from a public health perspective; 

8 (C) is used to develop— 

9 (i) measures to address health and the 

10 connection of health to the built environ11 ment; and 

12 (ii) efforts to link the measures to 

13 travel and health databases; and 

14 (D) distinguishes carefully between per15 sonal attitudes and choices and external influ16 ences on observed behavior to determine how 

17 much an observed association between the built 

18 environment and the health of residents, versus 

19 the lifestyle preferences of the people that 

20 choose to live in the neighborhood, reflects the 

21 physical characteristics of the neighborhood; 

22 and 

23 (E)(i) identifies or develops effective inter24 vention strategies to promote better health 

25 among residents with a focus on behavioral 


emcdonald on DSK5VPTVN1PROD with BILLS
586 

•HR 2954 IH

1 interventions and enhancements of the built en2 vironment that promote increased use by resi3 dents; and 

4 (ii) in developing the intervention strate5 gies under clause (i), ensures that the interven6 tion strategies will reach out to high-risk popu7 lations, including racial and ethnic minorities 

8 and low-income urban and rural communities. 

9 (4) PRIORITY.—In providing assistance under 

10 the grant program authorized under paragraph (2), 

11 the Secretary and the Administrator shall give pri12 ority to research that incorporates— 

13 (A) minority-serving institutions as grant14 ees; 

15 (B) interdisciplinary approaches; or 

16 (C) the expertise of the public health, 

17 physical activity, urban planning, and transpor18 tation research communities in the United 

19 States and abroad. 

20 SEC. 1005. ENVIRONMENT AND PUBLIC HEALTH RESTORA21 TION. 

22 (a) FINDINGS.— 

23 (1) GENERAL FINDINGS.—The Congress finds 

24 as follows: 


emcdonald on DSK5VPTVN1PROD with BILLS
587 

•HR 2954 IH

1 (A) As human beings, we share our envi2 ronment with a wide variety of habitats and 

3 ecosystems that nurture and sustain a diversity 

4 of species. 

5 (B) The abundance of natural resources in 

6 our environment forms the basis for our econ7 omy and has greatly contributed to human de8 velopment throughout history. 

9 (C) The accelerated pace of human devel10 opment over the last several hundred years has 

11 significantly impacted our natural environment 

12 and its resources, the health and diversity of 

13 plant and animal wildlife, the availability of 

14 critical habitats, the quality of our air and our 

15 water, and our global climate. 

16 (D) The intervention of the Federal Gov17 ernment is necessary to minimize and mitigate 

18 human impact on the environment for the ben19 efit of public health, to maintain air quality and 

20 water quality, to sustain the diversity of plants 

21 and animals, to combat global climate change, 

22 and to protect the environment. 

23 (E) Laws and regulations in the United 

24 States have been created and promulgated to 

25 minimize and mitigate human impact on the enVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00587 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
588 

•HR 2954 IH

1 vironment for the benefit of public health, to 

2 maintain air quality and water quality, to sus3 tain wildlife, and to protect the environment. 

4 (F) Such laws include the Antiquities Act 

5 of 1906 (16 U.S.C. 431 et seq.) initiated by 

6 President Theodore Roosevelt to create the na7 tional park system, the National Environmental 

8 Policy Act of 1969 (42 U.S.C. 4321 et seq.), 

9 the Clean Air Act (42 U.S.C. 7401 et seq.), the 

10 Federal Water Pollution Control Act (33 U.S.C. 

11 1251 et seq.), the Comprehensive Environ12 mental Response, Compensation, and Liability 

13 Act of 1980 (Public Law 96–510), the Endan14 gered Species Act of 1973 (Public Law 93– 

15 205), and the National Forest Management Act 

16 of 1976 (Public Law 94–588). 

17 (G) Attempts to repeal or weaken key envi18 ronmental safeguards pose dangers to the pub19 lic health, air quality, water quality, wildlife, 

20 and the environment. 

21 (2) FINDINGS ON CHANGES AND PROPOSED

22 CHANGES IN LAW.—The Congress finds that, since 

23 2001, the following changes and proposed changes 

24 to existing law or regulations have negatively imVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00588 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
589 

•HR 2954 IH

1 pacted or will negatively impact the environment and 

2 public health: 

3 (A) CLEAN WATER.— 

4 (i) On May 9, 2002, the Environ5 mental Protection Agency (EPA) and the 

6 Army Corps of Engineers put forth a final 

7 rule that reconciled regulations imple8 menting section 404 of the Federal Water 

9 Pollution Control Act by redefining the 

10 term ‘‘fill material’’ and amending the def11 inition of the term ‘‘discharge of fill mate12 rial’’, reversing a 25-year-old regulation. 

13 The new rule fails to restrict the dumping 

14 of hardrock mining waste, construction de15 bris, and other industrial wastes into riv16 ers, streams, lakes, and wetlands. The rule 

17 further allows destructive mountaintop re18 moval coal mining companies to dump 

19 waste into streams and lakes, polluting the 

20 surrounding natural habitat and poisoning 

21 plants and animals that depend on those 

22 water sources. 

23 (ii) On February 12, 2003, the Envi24 ronmental Protection Agency published the 

25 rule ‘‘National Pollutant Discharge ElimiVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00589 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
590 

•HR 2954 IH

1 nation System Permit Regulation and Ef2 fluent Limitation Guidelines and Stand3 ards for Concentrated Animal Feeding Op4 erations’’, new livestock waste regulations 

5 that aimed to control factory farm pollu6 tion but which would severely undermine 

7 existing protections under the Federal 

8 Water Pollution Control Act. This regula9 tion allows large-scale animal factories to 

10 foul the Nation’s waters with animal 

11 waste, allows livestock owners to draft 

12 their own pollution-management plans and 

13 avoid ground water monitoring, legalizes 

14 the discharge of contaminated runoff water 

15 rich in nitrogen, phosphorus, bacteria, and 

16 metals, and ensures that large factory 

17 farms are not held liable for the environ18 mental damage they cause. In a 2005 Fed19 eral court decision (‘‘Waterkeeper Alliance, 

20 et al. v. Enviromental Protection Agency’’, 

21 399 F.3d 486 (2nd Cir. 2005)), major 

22 parts of the rule were upheld, others va23 cated, and still others remanded back to 

24 the EPA. On November 20, 2008, the En25 vironmental Protection Agency published a 


emcdonald on DSK5VPTVN1PROD with BILLS
591 

•HR 2954 IH

1 revised final rule which undermines envi2 ronmental protection provisions by remov3 ing mandatory permitting requirements 

4 and allowing large animal farms to self5 certify the absence of pollutant discharge 

6 activity. 

7 (iii) On March 19, 2003, the Environ8 mental Protection Agency published a new 

9 rule regarding the Total Maximum Daily 

10 Load program of the Federal Water Pollu11 tion Control Act that regulates the max12 imum amount of a particular pollutant 

13 that can be present in a body of water and 

14 still meet water quality standards. The new 

15 rule withdrew the existing regulation put 

16 forth on July 13, 2000, and halted mo17 mentum in cleaning up polluted waterways 

18 throughout the Nation. By abandoning the 

19 existing rule, the Environmental Protection 

20 Agency is undermining the effectiveness of 

21 clean-up plans and is allowing States to 

22 avoid cleaning polluted waters entirely by 

23 dropping them from their clean-up lists. 

24 Waterways play a crucial role in the lives 

25 of the people of the United States and are 


emcdonald on DSK5VPTVN1PROD with BILLS
592 

•HR 2954 IH

1 critical to the livelihood of fish and wildlife. 

2 The result of dropping the July 2000 rule 

3 is that the restoration of polluted rivers, 

4 shorelines, and lakes will be delayed, harm5 ing more fish and wildlife and worsening 

6 the quality of drinking water. 

7 (iv) On December 2, 2008, the Envi8 ronmental Protection Agency and the 

9 Army Corps of Engineers jointly issued a 

10 guidance document in the form of a legal 

11 memorandum, titled ‘‘Clean Water Act Ju12 risdiction Following the U.S. Supreme 

13 Court’s Decision in Rapanos v. United 

14 States & Carabell v. United States’’. This 

15 new guidance dictates enforcement actions 

16 under the Federal Water Pollution Control 

17 Act and calls for a complicated ‘‘case-by18 case’’ analysis to determine jurisdiction for 

19 waterways that do not flow all year. Such 

20 actions endanger small streams and wet21 lands that serve as important habitats for 

22 aquatic life, which play a fundamental role 

23 in safeguarding sources of clean drinking 

24 water and mitigate the risks and effects of 

25 floods and droughts. Further, the definiVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00592 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
593 

•HR 2954 IH

1 tion provided therein for ‘‘waters of the 

2 United States’’ is applicable to the Federal 

3 Water Pollution Control Act as a whole, 

4 potentially affecting programs that control 

5 industrial pollution and sewage levels, pre6 vent oil spills, and set water quality stand7 ards for all waters in the United States 

8 protected under the Federal Water Pollu9 tion Control Act. 

10 (B) FORESTS AND LAND MANAGEMENT.— 

11 (i) On December 3, 2003, the Presi12 dent signed into law the Healthy Forests 

13 Restoration Act of 2003 (Public Law 108– 

14 148; 16 U.S.C. 6501 et seq.). Although the 

15 law attempts to reduce the risk of cata16 strophic forest fires, it provides a boon to 

17 timber companies by accelerating the ag18 gressive thinning of backcountry forests 

19 that are far from at-risk communities. The 

20 law allows for increased logging of large, 

21 fire-resistant trees that are not in close 

22 proximity of homes and communities; it 

23 undermines critical protections for endan24 gered species by exempting Federal land 

25 management agencies from consulting with 


emcdonald on DSK5VPTVN1PROD with BILLS
594 

•HR 2954 IH

1 the United States Fish and Wildlife Serv2 ice before approving any action that could 

3 harm endangered plants or wildlife; and it 

4 limits public participation by reducing the 

5 number of environmental project reviews. 

6 (ii) On April 21, 2008, the Depart7 ment of Agriculture issued a Final Plan8 ning Rule and Record of Decision for Na9 tional Forest System Land Management 

10 Planning. Similar to rules enacted by the 

11 Administration on January 5, 2005, later 

12 remanded back to the agency in Federal 

13 district court for violating the National 

14 Environmental Policy Act of 1969, the En15 dangered Species Act of 1973, and the Ad16 ministrative Procedure Act (‘‘Citizens for 

17 Better Forestry v. United States Depart18 ment of Agriculture’’, 481 F. Supp. 2d 

19 1059 (N.D. Cal. 2007)), this revised rule 

20 eliminates strict forest planning standards 

21 established in 1982, and opens millions of 

22 acres of public lands to damaging and 

23 invasive logging, mining, and drilling oper24 ations. These regulations would reverse 

25 more than 20 years of protection for wildVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00594 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
595 

•HR 2954 IH

1 life and national forests by removing the 

2 overall goal of ensuring ecological sustain3 ability in managing the national forest sys4 tem, weakening the National Forest Man5 agement Act of 1976, and effectively end6 ing the review of forest management plans 

7 under the National Environmental Policy 

8 Act of 1969. 

9 (iii) On September 20, 2006, the Dis10 trict Court for the Northern District of 

11 California vacated the Protection of Inven12 toried Roadless Areas rule, enacted on May 

13 13, 2005, which gave State Governors 18 

14 months to petition the Federal Government 

15 to either restore the previous rule for their 

16 States, or submit a new management and 

17 development plan for national forest areas 

18 inventoried under the rule. Despite the 

19 enjoinment of the Administration’s 2005 

20 rule, and the subsequent restoration of the 

21 original Roadless Area Conservation Rule, 

22 the U.S. Forest Service has continued to 

23 allow States to petition for a special rule 

24 under the authority of the Administrative 

25 Procedure Act, publishing a final special 


emcdonald on DSK5VPTVN1PROD with BILLS
596 

•HR 2954 IH

1 rule for Idaho on October 16, 2008. As a 

2 result, 58.5 million acres of wild national 

3 forests are still vulnerable to logging, road 

4 building, and other developments that may 

5 fragment natural habitats and negatively 

6 impact fish and wildlife. 

7 (iv) On November 17, 2008, the De8 partment of the Interior’s Bureau of Land 

9 Management (BLM) signed the Record of 

10 Decision (ROD) amending 12 resource 

11 management plans in Colorado, Utah, and 

12 Wyoming, opening 2,000,000 acres of pub13 lic lands to commercial tar sands and oil 

14 shale exploration and development. On No15 vember 18, 2008, the BLM published a 

16 final rule for Oil Shale Management set17 ting the policies and procedures for a com18 mercial leasing program for the manage19 ment of federally owned oil shale in those 

20 three States. Previously barred by a con21 gressional moratorium on the commercial 

22 leasing regulations for oil shale until Sep23 tember 30, 2008, the development of oil 

24 shale on public lands poses a serious threat 

25 to land conservation, endangered and 


emcdonald on DSK5VPTVN1PROD with BILLS
597 

•HR 2954 IH

1 threatened species, and critical habitat. 

2 Domestic shale oil production allowed by 

3 these regulations is highly water and en4 ergy intensive, the impacts of which will in5 tensify existing water scarcity in the arid 

6 Western Region and potentially degrade 

7 air and water quality for surrounding pop8 ulations. 

9 (C) SCIENTIFIC REVIEW.—On December 

10 16, 2008, the United States Fish and Wildlife 

11 Service of the Department of the Interior and 

12 the National Oceanic and Atmospheric Admin13 istration of the Department of Commerce joint14 ly issued a new rule amending regulations gov15 erning interagency cooperation under section 7 

16 of the Endangered Species Act of 1973 (ESA). 

17 This rule undermines the intention of the ESA 

18 to protect species and the ecosystems upon 

19 which they depend by allowing Federal agencies 

20 to carry out, permit, or fund an action without 

21 proper environmental review and expert third22 party consultation from Federal wildlife ex23 perts. Under this new rule, Federal agencies 

24 can unilaterally circumvent the formal review 

25 process, eliminating longstanding and scientifVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00597 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
598 

•HR 2954 IH

1 ically grounded safeguards that serve to protect 

2 the biodiversity of our Nation’s ecosystems and 

3 avert harm to thousands of endangered and 

4 threatened species. 

5 (b) STATEMENT OF POLICY.—It is the policy of the 

6 United States Government to work in conjunction with 

7 States, territories, tribal governments, international orga8 nizations, and foreign governments in order to act as a 

9 steward of the environment for the benefit of public 

10 health, to maintain air quality and water quality, to sus11 tain the diversity of plant and animal species, to combat 

12 global climate change, and to protect the environment for 

13 future generations to enjoy. 

14 (c) STUDY AND REPORT ON PUBLIC HEALTH OR EN15 VIRONMENTAL IMPACT OF REVISED RULES, REGULA16 TIONS, LAWS, OR PROPOSED LAWS.— 

17 (1) STUDY.—Not later than 30 days after the 

18 date of enactment of this Act, the President shall 

19 enter into an arrangement under which the National 

20 Academy of Sciences will conduct a study to deter21 mine the impact on public health, air quality, water 

22 quality, wildlife, and the environment of the fol23 lowing regulations, laws, and proposed laws: 

24 (A) CLEAN WATER.— 


emcdonald on DSK5VPTVN1PROD with BILLS
599 

•HR 2954 IH

1 (i) Final revisions to the Federal 

2 Water Pollution Control Act regulatory 

3 definitions of ‘‘fill material’’ and ‘‘dis4 charge of fill material’’, finalized and pub5 lished in the Federal Register on May 9, 

6 2002 (67 FR 31129), amending part 232 

7 of title 40, Code of Federal Regulations. 

8 (ii) Revised National Pollutant Dis9 charge Elimination System Permit Regula10 tion and Effluent Limitation Guidelines 

11 and Standards for Concentrated Animal 

12 Feeding Operations in response to the 

13 ‘‘Waterkeeper Alliance, et al. v. 

14 Enviromental Protection Agency’’ decision, 

15 finalized and published in the Federal Reg16 ister on November 20, 2008 (73 FR 225), 

17 amending parts 9, 122, and 412 of title 

18 40, Code of Federal Regulations. 

19 (iii) A March 19, 2003, rule published 

20 in the Federal Register (68 FR 13608) 

21 withdrawing a July 13, 2000, rule revising 

22 the Total Maximum Daily Load program 

23 of the Federal Water Pollution Control Act 

24 (65 FR 43586), amending parts 9, 122, 


emcdonald on DSK5VPTVN1PROD with BILLS
600 

•HR 2954 IH

1 123, 124, and 130 of title 40, Code of 

2 Federal Regulations. 

3 (iv) Official Guidance Document, 

4 ‘‘Clean Water Act Jurisdiction Following 

5 the United States Supreme Court’s Deci6 sion in Rapanos v. United States & 

7 Carabell v. United States’’, issued on De8 cember 2, 2008, relating to jurisdiction 

9 under section 404 of the Federal Water 

10 Pollution Control Act. 

11 (B) FORESTS AND LAND MANAGEMENT.— 

12 (i) Healthy Forests Restoration Act of 

13 2003, signed into law on December 3, 

14 2003 (Public Law 108–148; 16 U.S.C. 

15 6501 et seq.). 

16 (ii) National Forest System Land 

17 Management Planning Rule, finalized and 

18 published in the Federal Register on April 

19 21, 2008 (73 FR 21468), replacing the 

20 2005 final rule (70 FR 1022, Jan. 5, 

21 2005), as amended March 3, 2006 (71 FR 

22 10837) and the 2000 final rule adopted on 

23 November 9, 2000 (65 FR 67514) as 

24 amended on September 29, 2004 (69 FR 


emcdonald on DSK5VPTVN1PROD with BILLS
601 

•HR 2954 IH

1 58055), amending title 36, Code of Fed2 eral Regulations, part 219. 

3 (iii) The application of the Adminis4 trative Procedure Act (5 U.S.C. 551 to 

5 559, 701 to 706, et seq.), such that States 

6 may petition for a special rule for the 

7 roadless areas in all or part of said State. 

8 (iv) Record of Decision, ‘‘Oil Shale 

9 and Tar Sands Resources Resource Man10 agement Plan Amendments’’, issued on 

11 November 17, 2008, along with the Final 

12 Rule, Oil Shale Management-General, pub13 lished in the Federal Register on Novem14 ber 18, 2008 (73 FR 223), amending title 

15 43, Code of Federal Regulations, parts 

16 3900, 3910, 3920, and 3930. 

17 (C) SCIENTIFIC REVIEW.—Final Rule, 

18 Interagency Cooperation Under the Endangered 

19 Species Act, published in the Federal Register 

20 on December 16, 2008, amending title 50, Code 

21 of Federal Regulations, part 402. 

22 (2) METHOD.—In conducting the study under 

23 paragraph (1), the National Academy of Sciences 

24 may utilize and compare existing scientific studies 


emcdonald on DSK5VPTVN1PROD with BILLS
602 

•HR 2954 IH

1 regarding the regulations, laws, and proposed laws 

2 listed in paragraph (1). 

3 (3) REPORT.—Under the arrangement entered 

4 into under paragraph (1), not later than 270 days 

5 after the date on which such arrangement is entered 

6 into, the National Academy of Sciences shall make 

7 publicly available and shall submit to the Congress 

8 and to the head of each department and agency of 

9 the Federal Government that issued, implements, or 

10 would implement a regulation, law, or proposed law 

11 listed in paragraph (1), a report containing— 

12 (A) a description of the impact of all such 

13 regulations, laws, and proposed laws on public 

14 health, air quality, water quality, wildlife, and 

15 the environment, compared to the impact of 

16 preexisting regulations, or laws in effect, includ17 ing— 

18 (i) any negative impacts to air quality 

19 or water quality; 

20 (ii) any negative impacts to wildlife; 

21 (iii) any delays in hazardous waste 

22 cleanup that are projected to be hazardous 

23 to public health; and 

24 (iv) any other negative impact on pub25 lic health or the environment; and 


emcdonald on DSK5VPTVN1PROD with BILLS
603 

•HR 2954 IH

1 (B) any recommendations that the Na2 tional Academy of Sciences considers appro3 priate to maintain, restore, or improve in whole 

4 or in part protections for public health, air 

5 quality, water quality, wildlife, and the environ6 ment for each of the regulations, laws, and pro7 posed laws listed in paragraph (1), which may 

8 include recommendations for the adoption of 

9 any regulation or law in place or proposed prior 

10 to January 1, 2001. 

11 (d) DEPARTMENT AND AGENCY REVISION OF EXIST12 ING RULES, REGULATIONS, OR LAWS.—Not later than 

13 180 days after the date on which the report is submitted 

14 pursuant to subsection (c)(3), the head of each depart15 ment and agency that has issued or implemented a regula16 tion or law listed in subsection (c)(1) shall submit to the 

17 Congress a plan describing the steps such department or 

18 such agency will take, or has taken, to restore or improve 

19 protections for public health and the environment in whole 

20 or in part that were in existence prior to the issuance of 

21 such regulation or law. 

22 SEC. 1006. HEALTHY FOOD FINANCING INITIATIVE. 

23 (a) IN GENERAL.—Subtitle D of the Department of 

24 Agriculture Reorganization Act of 1994 (7 U.S.C. 6951) 

25 is amended by adding at the end the following: 


emcdonald on DSK5VPTVN1PROD with BILLS
604 

•HR 2954 IH

1 ‘‘SEC. 242. HEALTHY FOOD FINANCING INITIATIVE. 

2 ‘‘(a) PURPOSE.—The purpose of this section is to es3 tablish a program to improve access to healthy foods in 

4 underserved areas, to create and preserve quality jobs, and 

5 to revitalize low-income communities by providing loans 

6 and grants to eligible fresh, healthy food retailers to over7 come the higher costs and initial barriers to entry in un8 derserved, urban, suburban, and rural areas. 

9 ‘‘(b) DEFINITIONS.—In this section: 

10 ‘‘(1) COMMUNITY DEVELOPMENT FINANCIAL IN11 STITUTION.—The term ‘community development fi12 nancial institution’ has the meaning given the term 

13 in section 103 of the Community Development 

14 Banking and Financial Institutions Act of 1994 (12 

15 U.S.C. 4702). 

16 ‘‘(2) FOOD ACCESS ORGANIZATION.—The term 

17 ‘food access organization’ means a nonprofit organi18 zation with expertise in improving access to healthy 

19 food in underserved communities. 

20 ‘‘(3) INITIATIVE.—The term ‘Initiative’ means 

21 the Healthy Food Financing Initiative established in 

22 the Department by subsection (c)(1). 

23 ‘‘(4) LOCAL FUNDS.—The term ‘local funds’ 

24 means the allocation of national funds and any other 

25 forms of financial assistance (including grants, 

26 loans, and equity investments) that are raised by 


emcdonald on DSK5VPTVN1PROD with BILLS
605 

•HR 2954 IH

1 partnerships to carry out the purposes of this sec2 tion. 

3 ‘‘(5) NATIONAL FUNDS.—The term ‘national 

4 funds’ means any Federal appropriation made to 

5 carry out this section and any other forms of finan6 cial assistance (including grants, loans, and equity 

7 investments) that are raised by the national fund 

8 manager to carry out the purposes of this section. 

9 ‘‘(6) NATIONAL FUND MANAGER.—The term 

10 ‘national fund manager’ means a community devel11 opment financial institution in existence as of the 

12 date of enactment of this section and certified by the 

13 Community Development Financial Institutions 

14 Fund of the Department of the Treasury that is des15 ignated by the Secretary to manage the Initiative for 

16 purposes of— 

17 ‘‘(A) raising private capital; 

18 ‘‘(B) providing financial and technical as19 sistance to partnerships; and 

20 ‘‘(C) funding eligible projects directly at 

21 the request of partnerships to attract fresh, 

22 healthy food retailers to underserved urban, 

23 suburban, and rural areas, in accordance with 

24 this section. 

25 ‘‘(7) PARTNERSHIP.— 


emcdonald on DSK5VPTVN1PROD with BILLS
606 

•HR 2954 IH

1 ‘‘(A) IN GENERAL.—The term ‘partner2 ship’ means a regional, State, or local public 

3 and private partnership that is organized to im4 prove access to fresh, healthy foods by pro5 viding financial and technical assistance to eli6 gible projects. 

7 ‘‘(B) INCLUSIONS.—The term ‘partnership’ 

8 includes— 

9 ‘‘(i) an unit of State, local, or tribal 

10 government or a quasi-public State or local 

11 government agency; 

12 ‘‘(ii) a food access or community 

13 health organization committed to improv14 ing access to healthy foods; 

15 ‘‘(iii) a community development finan16 cial institution or other organization that 

17 is capable of administering a loan and 

18 grant program in accordance with this sec19 tion; and 

20 ‘‘(iv) other organizations interested in 

21 improving access to healthy foods in under22 served areas. 

23 ‘‘(c) ESTABLISHMENT.— 

24 ‘‘(1) IN GENERAL.—There is established in the 

25 Department a Healthy Food Financing Initiative. 


emcdonald on DSK5VPTVN1PROD with BILLS
607 

•HR 2954 IH

1 ‘‘(2) MANAGEMENT.—Not later than 1 year 

2 after the date of enactment of this section, the Sec3 retary shall select and enter into a grant agreement 

4 with a national fund manager who shall be respon5 sible for the management of the Initiative nationally. 

6 ‘‘(3) ELIGIBLE PROJECTS.— 

7 ‘‘(A) IN GENERAL.—Subject to the re8 quirements of this paragraph, the national fund 

9 manager shall establish the eligibility criteria 

10 for projects to be assisted by the Initiative. 

11 ‘‘(B) REQUIREMENTS.—To be eligible to 

12 receive assistance through the Initiative, a 

13 project shall— 

14 ‘‘(i) include a supermarket, grocery 

15 store, farmers market, or other fresh, 

16 healthy food retailer; 

17 ‘‘(ii) consist of a for-profit business 

18 enterprise, a member- or worker-owned co19 operative, or a nonprofit organization; 

20 ‘‘(iii) meet the eligibility criteria es21 tablished under this section; 

22 ‘‘(iv) continue to be a viable business 

23 enterprise with a financial viability plan; 


emcdonald on DSK5VPTVN1PROD with BILLS
608 

•HR 2954 IH

1 ‘‘(v) require an investment of public 

2 funding to move forward and be competi3 tive; 

4 ‘‘(vi) operate on a self-service basis; 

5 ‘‘(vii) in accordance with subpara6 graph (C), expand or preserve the avail7 ability of healthy, fresh, high quality un8 prepared and unprocessed foods, particu9 larly fresh fruits and vegetables, in under10 served areas; and 

11 ‘‘(viii) agree to accept benefits under 

12 the supplemental nutrition assistance pro13 gram established under the Food and Nu14 trition Act of 2008 (7 U.S.C. 2011 et 

15 seq.). 

16 ‘‘(C) REQUIREMENTS.— 

17 ‘‘(i) DEFINITIONS.—In this subpara18 graph: 

19 ‘‘(I) PERISHABLE FOOD.— 

20 ‘‘(aa) IN GENERAL.—The 

21 term ‘perishable food’ means food 

22 that is fresh, refrigerated, or fro23 zen. 

24 ‘‘(bb) EXCLUSION.—The 

25 term ‘perishable food’ does not 


emcdonald on DSK5VPTVN1PROD with BILLS
609 

•HR 2954 IH

1 include packaged or canned 

2 goods. 

3 ‘‘(II) STAPLE FOOD.— 

4 ‘‘(aa) IN GENERAL.—The 

5 term ‘staple food’ means food 

6 that is a basic dietary item, in7 cluding bread, flour, fruits, vege8 tables, and meat. 

9 ‘‘(bb) EXCLUSIONS.—The 

10 term ‘staple food’ does not in11 clude snack or accessory food 

12 (such as chips, soda, coffee, con13 diments, and spices) or ready-to14 eat, prepared food. 

15 ‘‘(III) VARIETY.—The term ‘vari16 ety’ means an assortment of different 

17 types of food items. 

18 ‘‘(ii) IN GENERAL.—For purposes of 

19 subparagraph (B)(vii), to expand or pre20 serve the availability of fresh fruits and 

21 vegetables in underserved areas shall 

22 mean, with respect to a project, that the 

23 project maintains a store that— 

24 ‘‘(I) carries a full line of fresh 

25 produce, as defined by the national 


emcdonald on DSK5VPTVN1PROD with BILLS
610 

•HR 2954 IH

1 fund manager to reflect differences in 

2 project size and overall store size; 

3 ‘‘(II) sells food for home prepara4 tion and consumption; and 

5 ‘‘(III) at a minimum— 

6 ‘‘(aa) offers for sale at least 

7 3 different varieties of food in 

8 each of the 4 staple food groups 

9 (bread and grains, dairy, fruits 

10 and vegetables, and meat, poul11 try, and fish), with perishable 

12 food in at least 2 categories, on 

13 a daily basis; or 

14 ‘‘(bb) has a store at which 

15 at least 50 percent of the total 

16 sales of the store (including food 

17 and nonfood items or services) 

18 are from the sale of eligible sta19 ple food. 

20 ‘‘(D) INCOME CRITERIA.—Each eligible 

21 project shall be located in— 

22 ‘‘(i) a low- or moderate-income census 

23 tract, as determined by the Bureau of the 

24 Census of the Department of Commerce; 


emcdonald on DSK5VPTVN1PROD with BILLS
611 

•HR 2954 IH

1 ‘‘(ii) a population census tract that is 

2 treated as a low-income community under 

3 section 45D(e) of the Internal Revenue 

4 Code of 1986; or 

5 ‘‘(iii) an area that significantly serves 

6 an adjacent area that meets the criteria 

7 described in clause (i) or (ii), as approved 

8 by the national fund manager. 

9 ‘‘(E) UNDERSERVED CRITERIA.— 

10 ‘‘(i) IN GENERAL.—Each eligible 

11 project shall be located in an underserved 

12 area, as determined by the partnerships 

13 according to criteria established by the na14 tional fund manager. 

15 ‘‘(ii) FACTORS.—In determining 

16 whether an area is an underserved area, 

17 the following factors shall be taken into 

18 consideration: 

19 ‘‘(I) Population density. 

20 ‘‘(II) Below average supermarket 

21 density or sales. 

22 ‘‘(III) Car ownership. 

23 ‘‘(IV) Geographical or physical 

24 barriers, such as highways, moun25 tains, major parks, or bodies of water. 


emcdonald on DSK5VPTVN1PROD with BILLS
612 

•HR 2954 IH

1 ‘‘(iii) LOCATIONS.—On an annual 

2 basis, the national fund manager shall col3 lect data and publish maps that show the 

4 location of underserved areas. 

5 ‘‘(4) PRIORITY PROJECTS.— 

6 ‘‘(A) IN GENERAL.—Priority shall be given 

7 to projects that— 

8 ‘‘(i) are located in severely distressed 

9 low-income communities, as defined by the 

10 Community Development Financial Insti11 tutions Fund of the Department of the 

12 Treasury; and 

13 ‘‘(ii) include 1 or more of the fol14 lowing characteristics: 

15 ‘‘(I) The project will create or re16 tain quality jobs in the community, as 

17 determined in accordance with sub18 paragraph (B). 

19 ‘‘(II) The project has community 

20 support in terms of store quality, af21 fordability, site location, and coordina22 tion with local community plans or 

23 other programs promoting community 

24 and economic development. 


emcdonald on DSK5VPTVN1PROD with BILLS
613 

•HR 2954 IH

1 ‘‘(III) The project supports re2 gional food systems and locally grown 

3 foods, to the extent available. 

4 ‘‘(IV) In major metropolitan 

5 areas, the project is associated with a 

6 transit-oriented development project. 

7 ‘‘(V) In areas with public transit, 

8 the project is accessible by public 

9 transit. 

10 ‘‘(VI) The project involves the 

11 reuse of a building that is listed in or 

12 eligible for the National Register of 

13 Historic Places. 

14 ‘‘(VII) The project involves a 

15 brownfield or grayfield (as those 

16 terms are used in the Comprehensive 

17 Environmental Response, Compensa18 tion, and Liability Act of 1980 (42 

19 U.S.C. 9601 et seq.)). 

20 ‘‘(VIII) The estimated energy 

21 consumption of the project, calculated 

22 using building energy software ap23 proved by the Department of Energy, 

24 will qualify the project for designation 

25 under the Energy Star program estabVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00613 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
614 

•HR 2954 IH

1 lished by section 324A of the Energy 

2 Policy and Conservation Act (42 

3 U.S.C. 6294a). 

4 ‘‘(IX) The project involves 

5 women- and minority-owned busi6 nesses. 

7 ‘‘(B) QUALITY JOBS.—For purposes of 

8 subparagraph (A)(ii)(I), a quality job is a job 

9 that— 

10 ‘‘(i) provides wages that are com11 parable to or better than similar positions 

12 in existing businesses of similar size in 

13 similar local economies; 

14 ‘‘(ii) offers benefits that are com15 parable to or better than what is offered 

16 for similar positions in existing local busi17 nesses of similar size in similar local econo18 mies; and 

19 ‘‘(iii) is targeted for residents of 

20 neighborhoods with a high proportion of 

21 persons of low income (as that term is de22 fined in section 102(a) of the Housing and 

23 Community Development Act of 1974 (42 

24 U.S.C. 5302(a))) through local targeted 

25 hiring programs. 


emcdonald on DSK5VPTVN1PROD with BILLS
615 

•HR 2954 IH

1 ‘‘(d) DUTIES OF THE SECRETARY.— 

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

3 ‘‘(A) designate a national fund manager to 

4 manage national funds; 

5 ‘‘(B) oversee the Initiative nationally; 

6 ‘‘(C) work closely with the designated na7 tional fund manager— 

8 ‘‘(i) to ensure that funds are used ap9 propriately and in the most effective man10 ner practicable; and 

11 ‘‘(ii) to develop the program strategy 

12 into a detailed work plan, program, and 

13 operating budget; 

14 ‘‘(D) review and approve the operating 

15 budget for the national fund manager to ensure 

16 that the administrative costs are— 

17 ‘‘(i) reasonable (not more than 5 per18 cent of the total budget); 

19 ‘‘(ii) connected to the costs of oper20 ations; and 

21 ‘‘(iii) reflect efficient operations by the 

22 national fund manager; and 

23 ‘‘(E) make available to the public an an24 nual report, using data obtained from the De25 partment of Agriculture, the Department of 


emcdonald on DSK5VPTVN1PROD with BILLS
616 

•HR 2954 IH

1 Health and Human Services, and the Commu2 nity Development Financial Institutions, that 

3 describes the impacts of the Initiative, including 

4 tracking health and economic development indi5 cators at the local, State, and national levels to 

6 determine the impacts of individual projects 

7 and the collective impact in local areas and 

8 statewide of funded projects and the Initiative 

9 overall. 

10 ‘‘(2) NATIONAL FUND MANAGER.—The Sec11 retary shall— 

12 ‘‘(A) select the national fund manager 

13 through a competitive process from among com14 munity development financial institutions that 

15 have a proven and recent track record of suc16 cess and effectiveness in— 

17 ‘‘(i) attracting private capital; 

18 ‘‘(ii) developing and managing pro19 grams that provide grants and loans to 

20 support supermarkets and other fresh, 

21 healthy food retail business enterprises in 

22 low- and moderate-income communities, in23 cluding the development of grocery stores, 

24 farmers markets, and other fresh, healthy 

25 food retail models; 


emcdonald on DSK5VPTVN1PROD with BILLS
617 

•HR 2954 IH

1 ‘‘(iii) making and servicing loans that 

2 are similar to loans proposed in the Initia3 tive or having a record of otherwise suc4 cessfully investing in fresh, healthy food 

5 retail development projects; 

6 ‘‘(iv) effectively managing multiple 

7 contracts and subcontractors; 

8 ‘‘(v) effectively managing large capital 

9 pools, of at least $100,000,000; and 

10 ‘‘(vi) providing or contracting for the 

11 provision of technical assistance; and 

12 ‘‘(B) administer the Initiative by approving 

13 the disbursement of funds to the national fund 

14 manager in a manner that facilitates the imple15 mentation of the overall Initiative. 

16 ‘‘(3) COORDINATION.— 

17 ‘‘(A) IN GENERAL.—Not later than 45 

18 days after the date of receipt of an award, the 

19 national fund manager shall develop, with guid20 ance from and in consultation with the Sec21 retary, and submit to the Secretary, a detailed 

22 work plan. 

23 ‘‘(B) APPROVAL REQUIRED.—The Sec24 retary shall review and approve the work plan, 

25 program budget, and administrative costs under 


emcdonald on DSK5VPTVN1PROD with BILLS
618 

•HR 2954 IH

1 subsection (e)(4)(C) prior to entering into an 

2 agreement with the national fund manager to 

3 administer the Initiative. 

4 ‘‘(4) PERFORMANCE TARGETS.— 

5 ‘‘(A) IN GENERAL.—The Secretary shall 

6 conduct financial audits of, and establish per7 formance targets for, the national fund man8 ager, which shall include, at a minimum, the re9 quirements described in this paragraph. 

10 ‘‘(B) GEOGRAPHIC SPREAD.—Partnerships 

11 funded by the Initiative shall be geographically 

12 diverse and representative of the underserved 

13 areas across the United States. 

14 ‘‘(C) FOCUS ON LOW-INCOME COMMU15 NITIES.—A substantial portion of the projects 

16 funded by partnerships shall serve very low17 and low-income communities, as defined by the 

18 Bureau of the Census of the Department of 

19 Commerce. 

20 ‘‘(D) FINANCIAL EFFECTIVENESS OF THE

21 NATIONAL FUND MANAGER.—The national fund 

22 manager and any local financial institution in23 volved in a partnership shall demonstrate on24 going capacity and timeliness in raising private 


emcdonald on DSK5VPTVN1PROD with BILLS
619 

•HR 2954 IH

1 capital and disbursing funds as required under 

2 the Initiative. 

3 ‘‘(E) TECHNICAL ASSISTANCE EFFECTIVE4 NESS OF THE NATIONAL FUND MANAGER.—The 

5 provision of technical assistance by the national 

6 fund manager shall be evaluated based on— 

7 ‘‘(i) the responsiveness of the national 

8 fund manager to requests for assistance; 

9 and 

10 ‘‘(ii) the ability of the national fund 

11 manager to craft programs that develop 

12 needed new capacities in partnerships. 

13 ‘‘(F) IMPACT.—Performance targets shall 

14 address the allocation of funds by the national 

15 fund manager to partnerships and the tracking 

16 and reporting of the impacts of the funds in im17 proving access to fresh, healthy foods and in 

18 achieving other related impacts. 

19 ‘‘(e) DUTIES OF THE NATIONAL FUND MANAGER.— 

20 ‘‘(1) ALLOCATION OF FUNDS.— 

21 ‘‘(A) IN GENERAL.—The national fund 

22 manager shall— 

23 ‘‘(i) allocate at least 70 percent of any 

24 Federal appropriation made to carry out 

25 this section to partnerships that are seVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00619 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
620 

•HR 2954 IH

1 lected based on the criteria described in 

2 paragraph (3); and 

3 ‘‘(ii) retain not more than 30 percent 

4 of any Federal appropriation made to 

5 carry out this section to undertake financ6 ing activities described in subparagraph 

7 (C), including a reasonable amount for ad8 ministrative costs (not to exceed 5 percent) 

9 approved by the Secretary in accordance 

10 with paragraph (4)(C). 

11 ‘‘(B) USE OF THE NATIONAL FUNDS BY

12 PARTNERSHIP PROGRAMS.— 

13 ‘‘(i) IN GENERAL.—As a condition on 

14 the receipt of funds, each partnership shall 

15 use— 

16 ‘‘(I) the national funds received 

17 from the national fund manager under 

18 subparagraph (A)(i) to create 1 or 

19 more revolving loan programs or other 

20 revolving pools of capital or other 

21 products to facilitate financing of local 

22 projects as determined by the agree23 ment between the partnership and the 

24 national fund manager; and 


emcdonald on DSK5VPTVN1PROD with BILLS
621 

•HR 2954 IH

1 ‘‘(II) any remaining funds for 

2 grants, or, as approved, for innovative 

3 financing mechanisms. 

4 ‘‘(ii) LIMITATIONS.— 

5 ‘‘(I) IN GENERAL.—Use of funds 

6 for administrative costs and other 

7 purposes shall be— 

8 ‘‘(aa) limited in accordance 

9 with the terms of the agreement 

10 negotiated between the national 

11 fund manager and partnerships; 

12 ‘‘(bb) based on whether ad13 ministrative costs are reasonable, 

14 connected to the costs of oper15 ation, and reflect efficient oper16 ations by the partnership; and 

17 ‘‘(cc) determined using cri18 teria including geographic cov19 erage, program duration, and 

20 total funding amount. 

21 ‘‘(II) GOAL.—The goal of this 

22 clause to limit administrative costs to 

23 the maximum extent practicable, but 

24 in no case may the amount used for 


emcdonald on DSK5VPTVN1PROD with BILLS
622 

•HR 2954 IH

1 administrative costs exceed 10 percent 

2 of the Federal funds allocated. 

3 ‘‘(C) USE OF THE NATIONAL FUNDS BY

4 THE NATIONAL FUND MANAGER.—The national 

5 fund manager shall use national funds de6 scribed in subparagraph (A)(ii) to undertake fi7 nancing and other activities to enhance and 

8 maximize the effectiveness of the Initiative, as 

9 determined by the agreement with the Sec10 retary, including— 

11 ‘‘(i) attracting other forms of financial 

12 assistance to match or leverage the na13 tional funds; 

14 ‘‘(ii) awarding national funds to part15 nerships in accordance with paragraph (3); 

16 ‘‘(iii) creating and managing pools of 

17 grant or loan capital that blend or leverage 

18 national funds with other forms of finan19 cial assistance, including capital in the 

20 form of tax credits under section 45D of 

21 the Internal Revenue Code of 1986, for the 

22 benefit of partnerships; 

23 ‘‘(iv) creating and managing pools of 

24 grant or loan capital that blend or leverage 

25 the national funds with other forms of fiVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00622 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
623 

•HR 2954 IH

1 nancial assistance, including capital in the 

2 form of tax credits under section 45D of 

3 the Internal Revenue Code of 1986, to fi4 nance eligible local projects identified by 

5 partnerships or the national fund manager 

6 that have special or unique characteristics; 

7 ‘‘(v) providing loans or grants directly 

8 to eligible local projects as matching funds 

9 if requested by a partnership; 

10 ‘‘(vi) providing credit enhancement or 

11 other financial products and instruments 

12 for the benefit of partnerships or eligible 

13 local projects; 

14 ‘‘(vii) providing technical assistance; 

15 and 

16 ‘‘(viii) funding reasonable administra17 tive costs approved by the Secretary in ac18 cordance with paragraph (4)(C). 

19 ‘‘(2) RESPONSIBILITIES OF THE NATIONAL

20 FUND MANAGER.—The designated national fund 

21 manager shall— 

22 ‘‘(A) raise other forms of financial assist23 ance to match or leverage the national funds; 


emcdonald on DSK5VPTVN1PROD with BILLS
624 

•HR 2954 IH

1 ‘‘(B) use administrative funds to develop 

2 appropriate training programs and offer tech3 nical assistance services to— 

4 ‘‘(i) partnerships; 

5 ‘‘(ii) State, local, and tribal govern6 ments; 

7 ‘‘(iii) the food retail industry; and 

8 ‘‘(iv) food access and health advocacy 

9 organizations to augment local capacities; 

10 ‘‘(C) develop financial products such as 

11 loans, grants, and credit enhancement tools 

12 that can be used by partnerships to incentivize 

13 and support the development and retention of 

14 supermarkets and other fresh, healthy food re15 tail in underserved areas; 

16 ‘‘(D) award Initiative funds to eligible 

17 partnerships through an annual competitive 

18 process in accordance with paragraph (3); 

19 ‘‘(E) contract with a national food access 

20 organization to assist in the review of applica21 tions from partnerships and to provide technical 

22 assistance to local food access organizations in 

23 the proposed partnerships; 


emcdonald on DSK5VPTVN1PROD with BILLS
625 

•HR 2954 IH

1 ‘‘(F) award and disburse funds to partner2 ships or eligible local projects in a timely man3 ner; 

4 ‘‘(G) create and meet performance bench5 marks and reporting guidelines, as approved by 

6 the Secretary, including for— 

7 ‘‘(i) the amount of capital raised and 

8 leveraged from financial institutions, part9 nerships, and other resources; 

10 ‘‘(ii) the geographic diversity of part11 nerships; and 

12 ‘‘(iii) the proportion of projects fund13 ed by the partnership that are in severely 

14 distressed low-income communities; 

15 ‘‘(H) develop program guidelines and oper16 ating procedures for the Initiative, including— 

17 ‘‘(i) maximum grant and loan 

18 amounts for projects; 

19 ‘‘(ii) eligible uses of funds; 

20 ‘‘(iii) prudent underwriting criteria; 

21 ‘‘(iv) performance targets; 

22 ‘‘(v) reporting guidelines; 

23 ‘‘(vi) limits on administrative costs; 

24 and 

25 ‘‘(vii) implementation milestones; 


emcdonald on DSK5VPTVN1PROD with BILLS
626 

•HR 2954 IH

1 ‘‘(I) monitor the performance of partner2 ships; and 

3 ‘‘(J) collect data, compile information, and 

4 conduct such research studies as the national 

5 fund manager determines to be relevant to the 

6 successful implementation of the Initiative, in7 cluding— 

8 ‘‘(i) to assess national and local mar9 ket conditions; 

10 ‘‘(ii) to determine barriers to market 

11 entry; and 

12 ‘‘(iii) to identify opportunities for the 

13 development or retention of supermarkets 

14 and other fresh, healthy food retail enter15 prises in underserved communities. 

16 ‘‘(3) CRITERIA FOR AWARDING NATIONAL

17 FUNDS TO PARTNERSHIPS.— 

18 ‘‘(A) IN GENERAL.—The national fund 

19 manager shall award national funds to partner20 ships through a competitive process on an an21 nual basis. 

22 ‘‘(B) FIRST ROUND PRIORITY.—In the 

23 first round of funding, the national fund man24 ager shall give priority to existing partnerships 

25 that have demonstrable capacity to implement 


emcdonald on DSK5VPTVN1PROD with BILLS
627 

•HR 2954 IH

1 fresh food financing programs in underserved 

2 areas quickly. 

3 ‘‘(C) ADDITIONAL ROUNDS.—Additional 

4 rounds shall be designed to promote geographic 

5 diversity. 

6 ‘‘(D) CRITERIA.—In awarding national 

7 funds to partnerships, the national fund man8 ager shall consider— 

9 ‘‘(i) the amount of funds and other 

10 resources pledged by a partnership to 

11 match or leverage national funds; 

12 ‘‘(ii) the degree of State, local, or trib13 al government support of the partnership 

14 as evidenced by matching grant and loan 

15 funds or other types of support, such as al16 location of tax-exempt bonds, loan guaran17 tees, and coordination of resources from 

18 other State or local economic development 

19 programs; 

20 ‘‘(iii) the capacity of the partnership 

21 to successfully develop and manage loan 

22 and grant programs; 

23 ‘‘(iv) the lack of supermarkets and 

24 other fresh, healthy food retail enterprises 


emcdonald on DSK5VPTVN1PROD with BILLS
628 

•HR 2954 IH

1 in low- and moderate-income areas that 

2 would be served by the partnership; 

3 ‘‘(v) the experience of the food access 

4 or community health organization of the 

5 partnership in outreach about access to 

6 healthy foods and local healthy food access 

7 issues; 

8 ‘‘(vi) the degree of community engage9 ment and support in the development and 

10 retention of supermarkets and other fresh, 

11 healthy food retail enterprises; and 

12 ‘‘(vii) the contribution of the program 

13 of the partnership to the overall geographic 

14 diversity of the Initiative. 

15 ‘‘(4) ADMINISTRATIVE COSTS.— 

16 ‘‘(A) IN GENERAL.—Not later than 45 

17 days after the date of receipt of an award, the 

18 national fund manager shall submit to the Sec19 retary for approval a 3-year program and oper20 ating budget and detailed work plan that shall 

21 include— 

22 ‘‘(i) costs for research and evaluation, 

23 technical assistance, and training; and 

24 ‘‘(ii) program and operating costs. 


emcdonald on DSK5VPTVN1PROD with BILLS
629 

•HR 2954 IH

1 ‘‘(B) EARNED REVENUES.—Earned reve2 nues from loan fees and interest may be ex3 pended on program and operating costs in ac4 cordance with the budget approved by the Sec5 retary. 

6 ‘‘(C) BASIS OF REVIEW.—The Secretary 

7 shall base the review under subparagraph (A) 

8 on— 

9 ‘‘(i) the likelihood of the plan and ex10 penditures to further the purposes of this 

11 section; and 

12 ‘‘(ii) whether the administrative costs 

13 are reasonable, connected to the costs of 

14 operation, and reflect efficient operations 

15 by the national fund manager. 

16 ‘‘(f) PARTNERSHIPS.— 

17 ‘‘(1) IN GENERAL.—Each partnership that re18 ceives assistance through the Initiative shall provide 

19 financial and technical assistance to eligible fresh, 

20 healthy food retail projects in underserved areas 

21 within the defined communities of the partnership. 

22 ‘‘(2) ADMINISTRATION.—Each partnership shall 

23 designate a community development financial insti24 tution or other organization that is capable of ad25 ministering a loan and grant program— 


emcdonald on DSK5VPTVN1PROD with BILLS
630 

•HR 2954 IH

1 ‘‘(A) to execute grant agreements with the 

2 national fund manager; and 

3 ‘‘(B) to serve as the manager of local 

4 funds. 

5 ‘‘(3) RESPONSIBILITIES OF PARTNERSHIPS.—A 

6 partnership shall— 

7 ‘‘(A) raise other forms of financial assist8 ance to match the national funds received by 

9 the partnership; 

10 ‘‘(B) provide marketing and outreach to 

11 communities, the supermarket industry, other 

12 fresh, healthy food retailers, State and local 

13 government officials, and civic and public inter14 est organizations— 

15 ‘‘(i) to solicit applications from under16 served areas from across the State or local17 ity to be served by the partnership; and 

18 ‘‘(ii) to inform the communities and 

19 other persons about the availability of 

20 grants, loans, training, and technical as21 sistance; 

22 ‘‘(C) review and underwrite projects to de23 termine whether— 


emcdonald on DSK5VPTVN1PROD with BILLS
631 

•HR 2954 IH

1 ‘‘(i) a proposed project meets the cri2 teria for eligible projects under subsection 

3 (c)(3); and 

4 ‘‘(ii) a proposed project meets the cri5 teria for priority projects under subsection 

6 (c)(4); 

7 ‘‘(D) provide technical assistance services 

8 to eligible fresh, healthy food retail operators 

9 and developers; 

10 ‘‘(E) track and report outcomes, includ11 ing— 

12 ‘‘(i) the number of jobs created or re13 tained; 

14 ‘‘(ii) the quantity of fresh, healthy 

15 food retail space created or retained; and 

16 ‘‘(iii) such other health and economic 

17 indicators as are required by the national 

18 fund manager; 

19 ‘‘(F) monitor and audit funded projects to 

20 ensure compliance with the Initiative, the na21 tional fund manager, and partnership program 

22 requirements for a period of at least 3 years; 

23 ‘‘(G) submit an annual report to the na24 tional fund manager that describes— 

25 ‘‘(i) the activities of the partnership; 


emcdonald on DSK5VPTVN1PROD with BILLS
632 

•HR 2954 IH

1 ‘‘(ii) the expenditure of local funds; 

2 and 

3 ‘‘(iii) success in meeting performance 

4 targets and satisfying such other terms 

5 and conditions as are specified in the 

6 agreement between the partnership and the 

7 national fund manager; and 

8 ‘‘(H) coordinate with the national fund 

9 manager for the smooth operation of the Initia10 tive. 

11 ‘‘(4) ADMINISTRATIVE COSTS.— 

12 ‘‘(A) IN GENERAL.—As a condition on the 

13 receipt of assistance under this section, each 

14 partnership shall submit to the national fund 

15 manager for approval a 3-year budget and plan 

16 for all program and operating costs, includ17 ing— 

18 ‘‘(i) costs for research and evaluation, 

19 technical assistance, and training; and 

20 ‘‘(ii) administrative and operating 

21 costs. 

22 ‘‘(B) EARNED REVENUES.—Earned reve23 nues from loan fees and interest may be ex24 pended on program and operating costs in acVerDate Mar 15 2010 22:29 Sep 20, 2011 Jkt 099200 PO 00000 Frm 00632 Fmt 6652 Sfmt 6201 E:\BILLS\H2954.IH H2954

emcdonald on DSK5VPTVN1PROD with BILLS
633 

•HR 2954 IH

1 cordance with the budget approved by the na2 tional fund manager. 

3 ‘‘(C) BASIS OF REVIEW.—The national 

4 fund manager shall base the review under sub5 paragraph (A) on the likelihood of the budget 

6 and plan to further the purposes of this section. 

7 ‘‘(g) EVALUATION AND MONITORING.— 

8 ‘‘(1) IN GENERAL.—Program evaluation and fi9 nancial audits shall occur at all levels of the Initia10 tive to ensure that— 

11 ‘‘(A) national and local funds are used 

12 properly; and 

13 ‘‘(B) the objectives of the Initiative are 

14 met. 

15 ‘‘(2) PROGRAM EVALUATION AND FINANCIAL

16 AUDITS.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall— 

18 ‘‘(i) conduct periodic program evalua19 tions and financial audits of the national 

20 fund manager, partnerships, and projects 

21 funded by the Initiative; and 

22 ‘‘(ii) share with the national fund 

23 manager the results of the evaluations and 

24 audits. 


emcdonald on DSK5VPTVN1PROD with BILLS
634 

•HR 2954 IH

1 ‘‘(B) FUNDED PROJECTS.—The Secretary 

2 or the national fund manager shall evaluate 

3 partnerships to assess the health and economic 

4 impacts of projects funded by the Initiative. 

5 ‘‘(C) OTHER IMPACTS.— 

6 ‘‘(i) SECRETARY OF HEALTH AND

7 HUMAN SERVICES.—The Secretary of 

8 Health and Human Services shall conduct 

9 research studies and evaluate the health 

10 impacts of the Initiative. 

11 ‘‘(ii) COMMUNITY DEVELOPMENT FI12 NANCIAL INSTITUTIONS.—Representatives 

13 of the Community Development Financial 

14 Institutions shall conduct research studies 

15 and evaluate the economic impacts of the 

16 Initiative. 

17 ‘‘(D) PARTNERSHIPS.— 

18 ‘‘(i) IN GENERAL.—Each partnership 

19 shall— 

20 ‘‘(I) conduct periodic administra21 tive and financial audits of projects 

22 funded by the Initiative; and 

23 ‘‘(II) share with the national 

24 fund manager the results of the au25 dits. 


emcdonald on DSK5VPTVN1PROD with BILLS
635 

•HR 2954 IH

1 ‘‘(ii) FAILURE OF PARTNERSHIP.—In 

2 a case in which a partnership fails, the na3 tional fund manager shall take over the 

4 portfolio of the failed partnership. 

5 ‘‘(h) ADMINISTRATIVE PROVISIONS.—Not later than 

6 180 days after the date of enactment of this section, the 

7 Secretary shall promulgate such regulations as may be 

8 necessary to carry out this section, including regulations— 

9 ‘‘(1) for the conduct of a performance evalua10 tion at the end of the initial 5-year period; 

11 ‘‘(2) to terminate the contract for cause; and 

12 ‘‘(3) to extend the contract for an additional 5- 

13 year period. 

14 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

15 authorized to be appropriated to the Secretary to carry 

16 out this section $500,000,000, to remain available until 

17 expended.’’. 

18 (b) CONFORMING AMENDMENT.—Section 296(b) of 

19 the Department of Agriculture Reorganization Act of 

20 1994 (7 U.S.C. 7014(b)) is amended— 

21 (1) in paragraph (6)(C), by striking ‘‘or’’ at the 

22 end; 

23 (2) in paragraph (7), by striking the period at 

24 the end and inserting ‘‘; or’’; and 

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


emcdonald on DSK5VPTVN1PROD with BILLS
636 

•HR 2954 IH

1 ‘‘(8) the authority of the Secretary to establish 

2 in the Department the Healthy Food Financing Ini3 tiative in accordance with section 242.’’. 

4 SEC. 1007. GAO REPORT ON HEALTH EFFECTS OF DEEP5 WATER HORIZON OIL RIG EXPLOSION IN THE 

6 GULF COAST. 

7 (a) STUDY.—The Comptroller General of the United 

8 States shall conduct a study on the type and scope of 

9 health care services administered through the Department 

10 of Health and Human Services addressing the provision 

11 of health care to racial and ethnic minorities (whether 

12 residents, clean-up workers, or volunteers) affected by the 

13 explosion of the mobile offshore drilling unit Deepwater 

14 Horizon that occurred on April 20, 2010. 

15 (b) SPECIFIC COMPONENTS; REPORTING.—In car16 rying out subsection (a), the Comptroller General shall— 

17 (1) assess the type, size, and scope of programs 

18 administered by the Department of Health and 

19 Human Services that focus on provision of health 

20 care to communities in the Gulf Coast; 

21 (2) identify the merits and disadvantages asso22 ciated with each the programs; 

23 (3) perform an analysis of the costs and bene24 fits of the programs; 


emcdonald on DSK5VPTVN1PROD with BILLS
637 

•HR 2954 IH

1 (4) determine whether there is any duplication 

2 of programs; and 

3 (5) not later than 180 days after the date of 

4 the enactment of this Act, report findings and rec5 ommendations for improving access to health care 

6 for racial and ethnic minorities to the Congress. 

Æ 


emcdonald on DSK5VPTVN1PROD with BILLS