I 

111TH CONGRESS 

1ST SESSION H. R. 3090 

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

IN THE HOUSE OF REPRESENTATIVES 

JUNE 26, 2009 

Mrs. CHRISTENSEN (for herself, Mr. DAVIS of Illinois, Ms. BORDALLO, Ms. 

ROYBAL-ALLARD, Mr. CLYBURN, Mr. RANGEL, Ms. LEE of California, 

Mr. HONDA, Mr. CUMMINGS, Ms. JACKSON-LEE of Texas, Ms. CLARKE, 

Mr. WATT, Mr. CLAY, Mr. THOMPSON of Mississippi, Mr. MEEK of Florida, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. AL GREEN of Texas, 

Mr. JOHNSON of Georgia, Mr. CLEAVER, Mr. ELLISON, Ms. WATSON, 

Mr. JACKSON of Illinois, Mr. CARSON of Indiana, Mr. TOWNS, Ms. 

FUDGE, Ms. KILPATRICK of Michigan, Ms. RICHARDSON, Ms. BALDWIN, 

Mr. FATTAH, Mr. BISHOP of Georgia, Mr. SCOTT of Georgia, Mr. PAYNE, 

Mr. MEEKS of New York, Mr. GRIJALVA, Mr. SCOTT of Virginia, Mr. 

DAVIS of Alabama, Mr. GRAYSON, Ms. EDWARDS of Maryland, Ms. 

MOORE of Wisconsin, Ms. CORRINE BROWN of Florida, Ms. WATERS, Ms. 

HIRONO, Ms. DEGETTE, Mr. FALEOMAVAEGA, Ms. MATSUI, Mr. LEWIS

of Georgia, Mr. GONZALEZ, Mr. SABLAN, Mr. PIERLUISI, Mr. REYES, 

Mr. ORTIZ, Ms. VELA ́ZQUEZ, Mr. LUJA ́N, Mr. HASTINGS of Florida, and 

Mr. CUELLAR) 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 Labor, the Judiciary, Natural Resources, Armed Services, Veterans’ Affairs, and Agriculture, 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 

A BILL 

To improve the health of minority individuals, and for other 

purposes. 


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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 2009’’. 

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. 

TITLE I—CULTURALLY AND LINGUISTICALLY APPROPRIATE 

HEALTH CARE 

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

Sec. 102. Federal reimbursement for culturally and linguistically appropriate 

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

Health Insurance Program. 

Sec. 103. Increasing understanding of and improving health literacy. 

Sec. 104. Assurances for receiving Federal funds. 

Sec. 105. Report on Federal efforts to provide culturally and linguistically appropriate health care services. 

Sec. 106. English for speakers of other languages. 

Sec. 107. Definition. 

Sec. 108. Treatment of the Medicare part B program under title VI of the Civil 

Rights Act of 1964. 

Sec. 109. Implementation. 

TITLE II—HEALTH WORKFORCE DIVERSITY 

Sec. 201. Amendment to the Public Health Service Act. 

Sec. 202. Health Careers Opportunity Program. 

Sec. 203. Program of excellence in health professions education for underrepresented minorities. 

Sec. 204. Hispanic-Serving Health Professions Schools. 

Sec. 205. Health professions student loan fund; authorizations of appropriations regarding students from disadvantaged backgrounds. 

Sec. 206. National Health Service Corps; recruitment and fellowships for individuals from disadvantaged backgrounds. 

Sec. 207. Loan repayment program of Centers for Disease Control and Prevention. 

Sec. 208. Cooperative agreements for online degree programs at schools of public health and schools of allied health. 

Sec. 209. Mid-care health professions scholarship program. 

Sec. 210. National report on the preparedness of health professionals to care 

for diverse populations. 

Sec. 211. Scholarship and fellowship programs. 

Sec. 212. Advisory Committee on Health Professions Training for Diversity. 

Sec. 213. McNair Postbaccalaureate Achievement Program. 


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TITLE III—DATA COLLECTION AND REPORTING 

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

Sec. 302. Collection of race and ethnicity data by the Social Security Administration. 

Sec. 303. Revision of HIPAA claims standards. 

Sec. 304. National Center for Health Statistics. 

Sec. 305. Geo-access study. 

Sec. 306. Racial, ethnic, and linguistic data collected by the Federal Government. 

Sec. 307. Health information technology grants. 

Sec. 308. Study of health information technology in medically underserved communities. 

Sec. 309. Health information technology in medically underserved communities. 

Sec. 310. Data collection and analysis grants to minority-serving institutions. 

Sec. 311. Health information technology grants for rural health care providers. 

Sec. 312. Survey questions on sexual orientation and gender identity. 

Sec. 313. Disaggregation of comparative effectiveness research data. 

TITLE IV—ACCOUNTABILITY AND EVALUATION 

Subtitle A—General Provisions 

Sec. 401. Federal agency plan to eliminate disparities and improve the health 

of minority populations. 

Sec. 402. 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. 403. Accountability within the Department of Health and Human Services. 

Sec. 404. Office of Minority Health. 

Sec. 405. Establishment of the Indian Health Service as an agency of the Public Health Service. 

Sec. 406. Establishment of individual offices of minority health within agencies 

of the Public Health Service. 

Sec. 407. Office of Minority Health at the Centers for Medicare & Medicaid 

Services. 

Sec. 408. Office of Minority Affairs at the Food and Drug Administration. 

Sec. 409. Safety and effectiveness of drugs with respect to racial and ethnic 

background. 

Sec. 410. United States Commission on Civil Rights. 

Sec. 411. Sense of Congress concerning full funding of activities to eliminate 

racial and ethnic health disparities. 

Sec. 412. Guidelines for disease screening for minority patients. 

Sec. 413. National Institute for Minority Health and Health Disparities. 

Sec. 414. IOM report on LGBT health disparities. 

Subtitle B—Improving Environmental Justice 

Sec. 421. Codification of Executive Order 12898. 

Sec. 422. Implementation of recommendations by Environmental Protection 

Agency. 

Sec. 423. Grant program. 

Sec. 424. Additional research on the relationship between the built environment 

and the health of community residents. 

TITLE V—IMPROVEMENT OF HEALTH CARE SERVICES 


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Subtitle A—Health Empowerment Zones 

Sec. 501. Short title. 

Sec. 502. Findings. 

Sec. 503. Designation of health empowerment zones. 

Sec. 504. Assistance to those seeking designation. 

Sec. 505. Benefits of designation. 

Sec. 506. Definition. 

Sec. 507. Authorization of appropriations. 

Subtitle B—Other Improvements of Health Care Services 

CHAPTER 1—IN GENERAL

Sec. 511. Amendment to the Public Health Service Act. 

Sec. 512. Medicaid payment for certain aliens. 

Sec. 513. Medicaid payment parity for the territories. 

Sec. 514. Extension of Medicare secondary payer. 

Sec. 515. Border health grants. 

Sec. 516. Cancer prevention and treatment demonstration for ethnic and racial 

minorities. 

Sec. 517. Grants to promote positive health behaviors in women and children. 

Sec. 518. Exception for citizens of freely associated States. 

Sec. 519. Medicare graduate medical education. 

Sec. 520. HIV/AIDS reduction in racial and ethnic minority communities. 

Sec. 521. Grants for racial and ethnic approaches to community health. 

Sec. 522. Critical access hospital improvements. 

Sec. 523. Coverage of marriage and family therapist services and mental health 

counselor services under part B of the Medicare program. 

Sec. 524. Establishment of rural community hospital (RCH) program. 

Sec. 525. Medicare remote monitoring pilot projects. 

Sec. 526. Rural health quality advisory commission and demonstration projects. 

Sec. 527. Rural health care services. 

Sec. 528. Community health center collaborative access expansion. 

Sec. 529. Facilitating the provision of telehealth services across State lines. 

Sec. 530. Removing barriers to health care and nutrition assistance health coverage for children, pregnant women, and lawfully residing individuals. 

Sec. 531. Removing Medicare barrier to health care. 

CHAPTER 2—LUNG CANCER MORTALITY REDUCTION

Sec. 541. Short title. 

Sec. 542. Findings. 

Sec. 543. Sense of Congress concerning investment in lung cancer research. 

Sec. 544. Lung Cancer Mortality Reduction Program. 

Sec. 545. Department of defense and the department of veterans affairs. 

Sec. 546. Lung cancer advisory board. 

Sec. 547. Authorization of appropriations. 

TITLE VI—ELIMINATING DISPARITIES IN DIABETES PREVENTION 

ACCESS AND CARE ACT 

Subtitle A—NATIONAL INSTITUTES OF HEALTH 

Sec. 611. Research, treatment, and education. 


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Subtitle B—CENTERS FOR DISEASE CONTROL AND PREVENTION 

Sec. 621. Research, education, and other activities. 

Subtitle C—HEALTH RESOURCES AND SERVICES ADMINISTRATION 

Sec. 631. Research, education, and other activities. 

Subtitle D—ADDITIONAL PROGRAMS 

Sec. 641. Research, education, and other activities. 

1 TITLE I—CULTURALLY AND LIN2 GUISTICALLY APPROPRIATE 

3 HEALTH CARE 

4 SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

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

7 (1) Effective communication is essential to 

8 meaningful access to quality physical and mental 

9 health care. 

10 (2) Research establishes that the lack of lan11 guage services creates barriers to and diminishes the 

12 quality of health care and health status for limited 

13 English proficient individuals. 

14 (3) The number of limited English speaking 

15 residents in the United States who speak English 

16 less than very well and, therefore, cannot effectively 

17 communicate with health and social service providers 

18 continues to increase significantly. 

19 (4) The responsibility to fund language services 

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1 uals is a societal one that cannot fairly be visited 

2 solely upon the health care, public health or social 

3 services community. 

4 (5) Linguistic diversity in the health care and 

5 health care-related services workforce is important 

6 for providing all patients the environment most con7 ducive to positive health outcomes. 

8 (6) All members of the health care and health 

9 care-related services community should continue to 

10 educate their staff and constituents about limited 

11 English proficient issues and help them identify re12 sources to improve access to quality care for limited 

13 English proficient individuals. 

14 (7) Access to English as a Second Language in15 struction is an important mechanism for ensuring 

16 effective communication and eliminating the lan17 guage barriers that impede access to health care. 

18 (8) Competent languages services in health care 

19 settings should be available as a matter of course. 

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

21 (42 U.S.C. 201 et seq.) is amended by adding at the end 

22 the following: 


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1 ‘‘TITLE XXXI—CULTURALLY AND 

2 LINGUISTICALLY APPRO3 PRIATE HEALTH CARE 

4 ‘‘SEC. 3100. DEFINITIONS. 

5 ‘‘In this title: 

6 ‘‘(1) BILINGUAL.—The term ‘bilingual’ with re7 spect to an individual means a person who has suffi8 cient degree of proficiency in two languages. 

9 ‘‘(2) COMPETENT INTERPRETER SERVICES.— 

10 The term ‘competent interpreter services’ means a 

11 trans-language rendition of a spoken message in 

12 which the interpreter comprehends the source lan13 guage and can speak comprehensively in the target 

14 language to convey the meaning intended in the 

15 source language. The interpreter knows health and 

16 health-related terminology and provides accurate in17 terpretations by choosing equivalent expressions that 

18 convey the best matching and meaning to the source 

19 language and captures, to the greatest possible ex20 tent, all nuances intended in the source message. 

21 ‘‘(3) COMPETENT TRANSLATION SERVICES.— 

22 The term ‘competent translation services’ means a 

23 trans-language rendition of a written document in 

24 which the translator comprehends the source lan25 guage and can write comprehensively in the target 


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1 language to convey the meaning intended in the 

2 source language. The translator knows health and 

3 health-related terminology and provides accurate 

4 translations by choosing equivalent expressions that 

5 convey the best matching and meaning to the source 

6 language and captures, to the greatest possible ex7 tent, all nuances intended in the source document. 

8 ‘‘(4) EFFECTIVE COMMUNICATION.—The term 

9 ‘effective communication’ means an exchange of in10 formation between the provider of health care or 

11 health care-related services and the limited English 

12 proficient recipient of such services that enables lim13 ited English proficient individuals to access, under14 stand, and benefit from health care or health care15 related services. 

16 ‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 

17 term ‘grievance resolution process’ means all aspects 

18 of dispute resolution including filing complaints, 

19 grievance and appeal procedures and court action. 

20 ‘‘(6) HEALTH CARE GROUP.—The term ‘health 

21 care group’ means a group of physicians organized, 

22 at least in part, for the purposes of providing physi23 cians’ services under the Medicaid, SCHIP, or Medi24 care programs and may include a hospital and any 

25 other individual or entity furnishing services covered 


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1 under the Medicaid, SCHIP or Medicare programs 

2 that is affiliated with the health care group. 

3 ‘‘(7) HEALTH CARE SERVICES.—The term 

4 ‘health care services’ means services that address 

5 physical as well as mental health conditions in all 

6 care settings. 

7 ‘‘(8) HEALTH CARE-RELATED SERVICES.—The 

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

9 social services programs or activities that provide ac10 cess, referrals or links to health care. 

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

12 means any Indian tribe, band, nation, or other orga13 nized group or community, including any Alaska Na14 tive village or group or regional or village corpora15 tion as defined in or established pursuant to the 

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

17 (43 U.S.C. 1601 et seq.), which is recognized as eli18 gible for the special programs and services provided 

19 by the United States to Indians because of their sta20 tus as Indians. 

21 ‘‘(10) INTEGRATED HEALTH CARE DELIVERY

22 SYSTEM.—The term ‘integrated health care delivery 

23 system’ means a system comprised of more than one 

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1 ics, home health agencies, ambulatory surgery cen2 ters, skilled nursing facilities, rehabilitation facilities 

3 and clinics, and employed, independent or contracted 

4 physicians. 

5 ‘‘(11) INTERPRETING/INTERPRETATION.—The 

6 terms ‘interpreting’ and ‘interpretation’ mean the 

7 transmission of a spoken message from one language 

8 into another, faithfully, accurately, and objectively. 

9 ‘‘(12) LANGUAGE ACCESS.—The term ‘language 

10 access’ means the provision of language services to 

11 an LEP individual designed to enhance that individ12 ual’s access to, understanding of or benefit from 

13 health care or health care-related services. 

14 ‘‘(13) LANGUAGE SERVICES.—The term ‘lan15 guage services’ means provision of healthcare serv16 ices directly in a non-English language, interpreta17 tion, translation and non-English signage. 

18 ‘‘(14) LEP.—The term ‘LEP’ means limited 

19 English proficient. 

20 ‘‘(15) LEP RELATED DATA COLLECTION AC21 TIVITIES.—The term ‘LEP related data collection 

22 activities’ includes identifying, collecting, storing, 

23 tracking, and analyzing primary language data, and 

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1 guage access needs of limited English proficient in2 dividuals. 

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

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

5 the respective programs under titles XVIII, XIX, 

6 and XXI of the Social Security Act. 

7 ‘‘(17) MINORITY.— 

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

9 and ‘minorities’ refer to individuals from a mi10 nority group. 

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

12 with respect to populations, refers to racial and 

13 ethnic minority groups. 

14 ‘‘(18) MINORITY GROUP.—The term ‘minority 

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

16 ethnic minority group’. 

17 ‘‘(19) RACIAL AND ETHNIC MINORITY GROUP.— 

18 The term ‘racial and ethnic minority group’ means 

19 American Indians and Alaska Natives, African 

20 Americans (including Caribbean Blacks, Africans 

21 and other Blacks), Asian Americans, Hispanics (in22 cluding Latinos), and Native Hawaiians and other 

23 Pacific Islanders. 

24 ‘‘(20) ON-SITE INTERPRETING/INTERPRETA25 TION.—The term ‘on-site interpreting/interpretation’ 


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1 means a method of interpreting/interpretation for 

2 which the interpreter is in the physical presence of 

3 the provider of health care or health care-related 

4 services and the limited English proficient recipient 

5 of such services. 

6 ‘‘(21) SECRETARY.—The term ‘Secretary’ 

7 means the Secretary of Health and Human Services. 

8 ‘‘(22) SIGHT TRANSLATION.—The term ‘sight 

9 translation’ means the transmission of a written 

10 message in one language into a spoken message in 

11 another language. 

12 ‘‘(23) STATE.—The term ‘State’ means each of 

13 the several states, the District of Columbia, the 

14 Commonwealth of Puerto Rico, the Indian tribes, 

15 the U.S. Virgin Islands, Guam, American Samoa, 

16 and the Commonwealth of the Northern Mariana Is17 lands. 

18 ‘‘(24) TELEPHONIC INTERPRETATION.—The 

19 term ‘telephonic interpretation’ (also known as over 

20 the phone interpretation or OPI) means a method of 

21 interpreting/interpretation for which the interpreter 

22 is not in the physical presence of the provider of 

23 health care or related services and the limited 

24 English proficient recipient of such services but is 

25 connected via telephone. 


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1 ‘‘(25) TRANSLATION.—The term ‘translation’ 

2 means the transmission of a written message in one 

3 language into a written message in another lan4 guage. 

5 ‘‘(26) VIDEO INTERPRETATION.—The term 

6 ‘video interpretation’ means a method of inter7 preting/interpretation for which the interpreter is 

8 not in the physical presence of the provider of health 

9 care or related services and the limited English pro10 ficient recipient of such services but is connected via 

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

12 transmission. 

13 ‘‘(27) VITAL DOCUMENT.—The term ‘vital doc14 ument’ includes but is not limited to applications for 

15 government programs that provide health care serv16 ices; medical or financial consent forms; financial as17 sistance documents, letters containing important in18 formation regarding patient instructions (e.g., pre19 scriptions, referrals to other providers, discharge 

20 plans) and participation in a program (such as a 

21 Medicaid managed care program); notices pertaining 

22 to the reduction, denial or termination of services or 

23 benefits; notices of the right to appeal such actions; 

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1 viduals of the availability of free language services, 

2 and other outreach materials. 

3 ‘‘SEC. 3101. IMPROVING ACCESS TO SERVICES FOR INDIVID4 UALS WITH LIMITED ENGLISH PROFICIENCY. 

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

6 13166, it is the purpose of this section— 

7 ‘‘(1) to improve Federal agency performance re8 garding access to federally conducted and federally 

9 assisted programs and activities for individuals who 

10 are limited in their English proficiency; 

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

12 the services it provides and develop and implement 

13 a system by which limited English proficient individ14 uals can obtain meaningful access to those services 

15 consistent with, and without substantially burdening, 

16 the fundamental mission of the agency; 

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

18 that recipients of Federal financial assistance pro19 vide meaningful access to their limited English pro20 ficient applicants and beneficiaries; 

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 

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1 cess to their programs and activities by limited 

2 English proficient individuals; 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 to the 

13 federally conducted health care-related programs 

14 and activities of the agency by limited English pro15 ficient individuals. Each Federal agency must ensure 

16 that such plan is fully implemented not later than 

17 one year after the date of enactment of this Act. 

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

19 paragraph (1) shall include— 

20 ‘‘(A) the steps the agency will take to en21 sure that limited English proficient individuals 

22 have access to the agency’s federally conducted 

23 health care and health care-related programs 

24 and activities; 


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

3 needs of its limited English proficient bene4 ficiaries served by federally conducted programs 

5 and activities; 

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

7 federally conducted programs and activities to 

8 provide a range of language assistance options, 

9 notice to limited English proficient individuals 

10 of the right to competent language services, 

11 periodic training of staff, monitoring and qual12 ity assessment of the language services and, in 

13 appropriate circumstances, the translation of 

14 written materials; 

15 ‘‘(D) the steps the agency will take to en16 sure that applications, forms, and other rel17 evant documents for its federally conducted pro18 grams and activities are competently translated 

19 into the primary language of a limited English 

20 proficient client where such materials are need21 ed to improve access to federally conducted and 

22 federally assisted programs and activities for 

23 such a limited English proficient individual; and 

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

25 to assist recipients of Federal funds to improve 


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1 access to health care or health care related pro2 grams and activities for limited English pro3 ficient individuals. 

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

5 Department of Justice, which shall serve as the cen6 tral repository of the agencies’ plans. 

7 ‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI8 TIES.— 

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

10 after the date of enactment of this title, each Fed11 eral agency providing health care-related Federal fi12 nancial assistance shall ensure that the guidance for 

13 recipients of Federal financial assistance developed 

14 by the agency to ensure compliance with title VI of 

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

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

17 assistance. Each agency shall send a copy of such 

18 guidance to the Department of Justice which shall 

19 serve as the central repository of the agencies’ plans. 

20 After approval by the Department of Justice, each 

21 agency shall publish its guidance document in the 

22 Federal Register for public comment. 

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

24 guidance developed under paragraph (1) shall take 

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1 vided by the recipients, the individuals served by the 

2 recipients, and other factors set out in such stand3 ards. 

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

5 that has developed a guidance for purposes of title 

6 VI of the Civil Rights Act of 1964 shall examine 

7 such existing guidance, as well as the programs and 

8 activities to which such guidance applies, to deter9 mine if modification of such guidance is necessary to 

10 comply with this subsection. 

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

12 shall consult with the Department of Justice in es13 tablishing the guidances under this subsection. 

14 ‘‘(d) CONSULTATIONS.— 

15 ‘‘(1) IN GENERAL.—In carrying out this sec16 tion, each Federal agency that carriers out health 

17 care and health care-related activities shall ensure 

18 that stakeholders, such as limited English proficient 

19 individuals and their representative organizations, 

20 recipients of Federal assistance, and other appro21 priate individuals or entities, have an adequate op22 portunity to provide input with respect to the actions 

23 of the agency. 

24 ‘‘(2) EVALUATION.—Each Federal agency de25 scribed in paragraph (1) shall evaluate the— 


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1 ‘‘(A) particular needs of the limited 

2 English proficient individuals served by the 

3 agency; 

4 ‘‘(B) particular needs of the limited 

5 English proficient individuals served by the 

6 agency’s recipients of Federal financial assist7 ance; and 

8 ‘‘(C) burdens of compliance with the agen9 cy guidance and this section for the agency and 

10 its recipients. 

11 ‘‘SEC. 3102. NATIONAL STANDARDS FOR CULTURALLY AND 

12 LINGUISTICALLY APPROPRIATE SERVICES IN 

13 HEALTH CARE. 

14 ‘‘Recipients of Federal financial assistance from the 

15 Secretary shall, to the extent reasonable and practicable 

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

17 of the Guidance to Federal Financial Assistance Recipi18 ents Regarding Title VI Prohibition Against National Ori19 gin Discrimination Affecting Limited-English Proficient 

20 Persons (June 12, 2002)— 

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

22 promote individuals at all levels of the organization 

23 to maintain a diverse staff and leadership that can 

24 provide culturally and linguistically appropriate 


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1 health care to patient populations of the service area 

2 of the organization; 

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

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

6 appropriate service delivery; 

7 ‘‘(3) offer and provide language assistance serv8 ices, including trained bilingual staff and interpreter 

9 services, at no cost to each patient with limited 

10 English proficiency at all points of contact, in a 

11 timely manner during all hours of operation; 

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

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

16 by interpreters and bilingual staff, and ensure that 

17 family, particularly minor children, and friends are 

18 not used to provide interpretation services— 

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

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

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

23 services; 

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1 ited English proficient patients, including informa2 tion or notices about termination of benefits and 

3 post signage in the languages of the commonly en4 countered groups or groups represented in the serv5 ice area of the organization; 

6 ‘‘(7) develop and implement clear goals, poli7 cies, operational plans, and management account8 ability and oversight mechanisms to provide cul9 turally and linguistically appropriate services; 

10 ‘‘(8) conduct initial and ongoing organizational 

11 assessments of culturally and linguistically appro12 priate services-related activities and integrate valid 

13 linguistic competence-related measures into the in14 ternal audits, performance improvement programs, 

15 patient satisfaction assessments, and outcomes-based 

16 evaluations of the organization; 

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

18 protections provided for under the regulations pro19 mulgated under section 264(c) of the Health Insur20 ance Portability and Accountability Act of 1996 (42 

21 U.S.C. 1320d–2 note)— 

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

23 ethnicity, and primary language are collected in 

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1 tion’s management information systems, and 

2 periodically updated; and 

3 ‘‘(B) if the patient is a minor or is inca4 pacitated, the primary language of the parent 

5 or legal guardian is collected; 

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

7 and epidemiological profile of the community as well 

8 as a needs assessment to accurately plan for and im9 plement services that respond to the cultural and 

10 linguistic characteristics of the service area of the 

11 organization; 

12 ‘‘(11) develop participatory, collaborative part13 nerships with communities and utilize a variety of 

14 formal and informal mechanisms to facilitate com15 munity and patient involvement in designing and im16 plementing culturally and linguistically appropriate 

17 services-related activities; 

18 ‘‘(12) ensure that conflict and grievance resolu19 tion processes are culturally and linguistically sen20 sitive and capable of identifying, preventing, and re21 solving cross-cultural conflicts or complaints by pa22 tients; 

23 ‘‘(13) regularly make available to the public in24 formation about their progress and successful inno25 vations in implementing the standards under this 


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1 section and provide public notice in their commu2 nities about the availability of this information; and 

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

4 the head of each Federal entity from which Federal 

5 funds are received, information about their progress 

6 and successful innovations in implementing the 

7 standards under this section as required by the head 

8 of such entity. 

9 ‘‘SEC. 3103. ROBERT T. MATSUI CENTER FOR CULTURAL 

10 AND LINGUISTIC COMPETENCE IN HEALTH 

11 CARE. 

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

13 through the Director of the Agency for Healthcare Re14 search and Quality, shall establish and support a center 

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

16 and Linguistic Competence in Health Care’ (referred to 

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

18 activities: 

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

20 shall provide resources via the Internet to identify 

21 and link health care providers to competent inter22 preter and translation services. 

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

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

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1 petent translation services for providers of 

2 health care and health care-related services at 

3 no cost to such providers. Materials may be 

4 submitted for translation into non-English lan5 guages. Translation services shall be provided 

6 in a timely and reasonable manner and in ac7 cordance with the guidelines and standards set 

8 forth in subsection (c) when such standards be9 come available. The quality of such translation 

10 services shall be monitored and reported pub11 licly. 

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

13 by the Secretary that will be used by LEP indi14 viduals in health care or health care-related set15 tings, the Center shall translate the form, at a 

16 minimum, into the top 15 non-English lan17 guages in the United States according to the 

18 most recent data from the American Commu19 nity Survey or its replacement. The translation 

20 must be completed within 45 days of the Sec21 retary receiving final approval of the form from 

22 the Office of Management and Budget. 

23 ‘‘(3) TOLL-FREE CUSTOMER SERVICE TELE24 PHONE NUMBER.—The Center shall provide, 


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

2 for LEP individuals— 

3 ‘‘(A) to obtain information about federally 

4 conducted or funded health programs, including 

5 Medicare, Medicaid, and SCHIP; 

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

7 or accessing these programs and understanding 

8 Federal notices written in English; and 

9 ‘‘(C) to learn how to access language serv10 ices. 

11 ‘‘(4) HEALTH INFORMATION CLEARING12 HOUSE.— 

13 ‘‘(A) IN GENERAL.—The Center shall de14 velop and maintain an information clearing15 house to facilitate the provision of language 

16 services by providers of health care and health 

17 care-related services to reduce medical errors, 

18 improve medical outcomes, reduce health care 

19 costs caused by miscommunication with individ20 uals with limited English proficiency, and re21 duce or eliminate the duplication of effort to 

22 translate materials. The clearinghouse shall 

23 make such information available on the Internet 

24 and in print. Such information shall include the 


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1 information described in the succeeding provi2 sions of this paragraph. 

3 ‘‘(B) DOCUMENT TEMPLATES.—The Cen4 ter shall collect and evaluate for accuracy, de5 velop, and make available templates for stand6 ard documents that are necessary for patients 

7 and consumers to access and make educated de8 cisions about their health care, including the 

9 following: 

10 ‘‘(i) Administrative and legal docu11 ments, including— 

12 ‘‘(I) intake forms; 

13 ‘‘(II) Medicare, Medicaid, and 

14 SCHIP forms, including eligibility in15 formation; 

16 ‘‘(III) forms informing patient of 

17 HIPAA compliance and consent; and 

18 ‘‘(IV) documents concerning in19 formed consent, advanced directives, 

20 and waivers of rights. 

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

22 to take medications, how to prevent trans23 mission of a contagious disease, and other 

24 prevention and treatment instructions. 


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

2 and outreach materials, such as immuniza3 tion notices, health warnings, or screening 

4 notices. 

5 ‘‘(iv) Additional health or health care6 related materials as determined appro7 priate by the Director of the Center. 

8 ‘‘(C) STRUCTURE OF FORMS.—The oper9 ating the clearinghouse, the Center shall— 

10 ‘‘(i) ensure that the documents posted 

11 in English and non-English languages are 

12 culturally appropriate; 

13 ‘‘(ii) allow public review of the docu14 ments before dissemination in order to en15 sure that the documents are understand16 able and culturally appropriate for the tar17 get populations; 

18 ‘‘(iii) allow health care providers to 

19 customize the documents for their use; 

20 ‘‘(iv) facilitate access to these docu21 ments; 

22 ‘‘(v) provide technical assistance with 

23 respect to the access and use of such infor24 mation; and 


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

2 Secretary determines to be useful to fulfill 

3 the purposes of the clearinghouse. 

4 ‘‘(D) LANGUAGE ASSISTANCE PRO5 GRAMS.—The Center shall provide for the col6 lection and dissemination of information on cur7 rent examples of language assistance programs 

8 and strategies to improve language services for 

9 LEP individuals, including case studies using 

10 de-identified patient information, program sum11 maries, and program evaluations. 

12 ‘‘(E) CULTURAL AND LINGUISTIC COM13 PETENCE MATERIALS.—The Center shall pro14 vide information relating to culturally and lin15 guistically competent health care for minority 

16 populations residing in the United States to all 

17 health care providers and health care-related 

18 services at no cost. Such information shall in19 clude— 

20 ‘‘(i) tenets of culturally and linguis21 tically competent care; 

22 ‘‘(ii) cultural and linguistic com23 petence self-assessment tools; 

24 ‘‘(iii) cultural and linguistic com25 petence training tools; 


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1 ‘‘(iv) strategic plans to increase cul2 tural and linguistic competence in different 

3 types of providers of health care and 

4 health care-related services, including re5 gional collaborations among health care or6 ganizations; and 

7 ‘‘(v) cultural and linguistic com8 petence information for educators, practi9 tioners, and researchers. 

10 ‘‘(F) INFORMATION ABOUT PROGRESS.— 

11 The Center shall regularly collect and make 

12 publicly available information about the 

13 progress of entities receiving grants under sec14 tion 3104 regarding successful innovations in 

15 implementing the obligations under this sub16 section and provide public notice in the entities’ 

17 communities about the availability of this infor18 mation; 

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

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

21 to, the Director of the Agency for Healthcare Research 

22 and Quality. 

23 ‘‘(c) INTERPRETATION AND TRANSLATION GUIDE24 LINES AND STANDARDS.—The Center shall convene a 

25 working group to develop and adopt interpretation and 


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1 translation quality guidelines and standards for use by the 

2 Center. The guidelines and standards must be sufficient 

3 to ensure that LEP individuals have the equal opportunity 

4 to benefit from health care services to the same extent 

5 as non-LEP individuals. The guidelines and standards 

6 shall address the training, assessment and certification of 

7 individuals to provide competent interpreter and trans8 lator services to work in health care and health care-re9 lated settings and of bilingual staff who provide services 

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

11 develop different guidelines and standards for bilingual 

12 staff, interpreters, and translators. 

13 ‘‘(d) MEMBERSHIP.— 

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

15 shall consist of 14 members as follows: 

16 ‘‘(A) Four members from organizations 

17 that advocate on behalf of LEP individuals. 

18 ‘‘(B) One member who represents a profes19 sional interpreter association (that is not the 

20 National Council on Interpreting in Health 

21 Care) or translator association. 

22 ‘‘(C) One member from a non-profit com23 munity based organization that provides lan24 guage services. 


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1 ‘‘(D) Three members recommended by the 

2 National Council on Interpreting in Health 

3 Care, including one who individual who is a 

4 professional interpreter. 

5 ‘‘(E) Four members who are health care 

6 providers or represent health care provider as7 sociations, including one individual who rep8 resents a health care practice of fewer than 5 

9 clinicians. 

10 ‘‘(F) One member who works in or has ex11 tensive knowledge of issues related to health 

12 care risk management. 

13 ‘‘(2) GEOGRAPHIC REPRESENTATION.—The 

14 membership of the Working Group shall reflect a 

15 broad geographic representation including both 

16 urban and rural representatives, including represent17 atives of the United States territories. 

18 ‘‘(3) PROHIBITED APPOINTMENTS.—Members 

19 of the Working Group shall not include Members of 

20 Congress or other elected Federal, State, or local 

21 government officials. 

22 ‘‘(4) VACANCIES.—Any vacancies in the Work23 ing Group shall not affect the power and duties of 

24 the Working Group but shall be filled in the same 

25 manner as the original appointment. 


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

2 may establish subcommittees if doing so increases 

3 the efficiency of the Working Group in completing 

4 its tasks, including subcommittees to develop dif5 ferent guidelines and standards for interpreters, 

6 translators, and bilingual staff. 

7 ‘‘(6) ADVISORY PANEL TO THE WORKING

8 GROUP.—The Working Group shall consult with the 

9 Advisory Panel in the development of the guidelines 

10 and standards. The Advisory Panel shall include— 

11 ‘‘(A) representatives from the American 

12 Translators Association, Association of Lan13 guage Companies, the National Center for 

14 State Courts, and States which have developed 

15 interpreter standards such as California, Mas16 sachusetts and Oregon who have experience in 

17 the development or implementation of their or18 ganizations’ interpreter and translator certifi19 cation programs; 

20 ‘‘(B) Federal agencies including the Office 

21 for Civil Rights, the Office of Minority Health, 

22 and the Centers for Medicare & Medicaid Serv23 ices and the National Center on Minority 

24 Health and Health Disparities; and 


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1 ‘‘(C) other individuals or entities deter2 mined appropriate by the Secretary who have 

3 specific expertise that will be useful to the 

4 Working Group. 

5 ‘‘(7) PUBLICATION.— 

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

7 18 months after the date of enactment of this 

8 title, the Working Group shall— 

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

10 public through the Internet, the Federal 

11 Register, and other appropriate public 

12 channels, a proposed set of interpretation 

13 and translation guidelines and standards 

14 for training, assessment, and certification; 

15 and 

16 ‘‘(ii) accept public comment on such 

17 guidelines and standards for a period of 

18 not less than 90 days. 

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

20 120 days after the expiration of the public com21 ment period described in subparagraph (A), the 

22 Director of the Agency for Healthcare Research 

23 and Quality shall publish, after consultation 

24 with and the approval of the Working Group, 


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1 final guidelines and standards in the Federal 

2 Register and on the Internet. 

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

4 than 120 days after the publication of the final 

5 recommendations described in subparagraph 

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

7 Research and Quality shall, if deemed necessary 

8 by the Working Group, enter into a contract 

9 with an entity experienced in the development 

10 of designing certification tests in language re11 lated fields to develop such tests as may be nec12 essary to implement the guidelines and stand13 ards. 

14 ‘‘(D) PILOT PROJECT.— 

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

16 completion of the test development de17 scribed in subparagraph (C) or after publi18 cation of the final guidelines and stand19 ards, whichever is later, the Secretary shall 

20 design, fund, and implement a pilot project 

21 in up to 50 geographically and demo22 graphically diverse sites, two of which must 

23 be in the U.S. territory, to test and evalu24 ate implementation of the recommenda25 tions. 


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1 ‘‘(ii) The Secretary shall consult with 

2 the Working Group and the Advisory 

3 Panel in development of the pilot project 

4 and report progress to the Working Group 

5 on an ongoing basis. 

6 ‘‘(iii) The pilot project shall include 

7 interpreters and translators working with 

8 various provider types, including small 

9 group practices, hospitals, and community 

10 health clinics, and shall include broad geo11 graphic representation including both 

12 urban and rural representatives. 

13 ‘‘(iv) The pilot project shall operate 

14 for not less than two nor more than four 

15 years, as determined by the Secretary. 

16 ‘‘(v) If the Working Group determines 

17 that any revisions to guidelines and stand18 ards are necessary as a result of the pilot 

19 project, it shall revise such guidelines and 

20 standards and the Director of the Agency 

21 for Healthcare Research and Quality shall 

22 publish the revisions in the Federal Reg23 ister for notice and comment. Not later 

24 than 120 days after the expiration of the 

25 public comment period on such revisions, 


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1 the Director of the Agency for Healthcare 

2 Research and Quality shall publish, after 

3 consultation with and the approval of the 

4 Working Group, final revisions to the 

5 guidelines and standards in the Federal 

6 Register and on the Internet. 

7 ‘‘(8) ADMINISTRATION.— 

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

9 days after the date on which all members of the 

10 Working Group have been appointed under sub11 section (d), the Working Group shall designate 

12 its chairperson. 

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

14 the business of the Working Group (including 

15 travel time), a member of the Working Group 

16 or the Advisory Panel shall be entitled to com17 pensation at the per diem equivalent of the rate 

18 provided for level IV of the Executive Schedule 

19 under section 5315 of title 5, United States 

20 Code, and while so serving away from home and 

21 the member’s regular place of business, a mem22 ber may be allowed travel expenses, as author23 ized by the chairperson of the Working Group. 

24 For purposes of pay and employment benefits, 

25 rights, and privileges, all personnel of the 


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1 Working Group shall be treated as if they were 

2 employees of the House of Representatives. 

3 ‘‘(C) INFORMATION FROM FEDERAL AGEN4 CIES.—The Working Group may secure directly 

5 from any Federal department or agency such 

6 information as the Working Group considers 

7 necessary to carry out this section. Upon re8 quest of the Working Group, the head of such 

9 department or agency shall furnish such infor10 mation. Any information that contains individ11 ually identifiable information received by the 

12 Working Group shall not be disseminated or 

13 disclosed outside of the Working Group and 

14 shall not be used except by the Working Group. 

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

16 Government employees employed by the Depart17 ment of Health and Human Services may be 

18 detailed to staff the Working Group under this 

19 section without further reimbursement. Any de20 tail of an employee shall be without interruption 

21 or loss of civil service status or privilege. 

22 ‘‘(E) TEMPORARY AND INTERMITTENT

23 SERVICES.—The Working Group may procure 

24 temporary and intermittent services under sec25 tion 3109(b) of title 5, United States Code, at 


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1 rates for individuals which do not exceed the 

2 daily equivalent of the annual rate of basic pay 

3 prescribed for level V of the Executive Schedule 

4 under section 5316 of such title. 

5 ‘‘(F) AUTHORIZATION OF APPROPRIA6 TIONS.—There are authorized to be appro7 priated to carry out this section such sums as 

8 may be necessary for the activities of the Work9 ing Group and Advisory Panel for each of fiscal 

10 years 2010 through 2014, and for the funding 

11 of the pilot project. 

12 ‘‘(9) DEEMED STATUS.— 

13 ‘‘(A) CERTIFICATION BY PRIVATE ORGANI14 ZATION.—If a private accreditation organization 

15 establishes training, assessment, or certification 

16 standards for interpreters or translators in 

17 health care which the Secretary determines are 

18 at least equivalent to the training, assessment, 

19 or certification standards promulgated by the 

20 Secretary as described in subsection (c), the 

21 Secretary shall find that all organizations or in22 dividuals accredited by such organization com23 ply also with the standard described in sub24 section (c) if— 


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1 ‘‘(i) such organization or individual 

2 authorizes the organization to release to 

3 the Secretary upon the Secretary’s request 

4 (or such State agency as the Secretary 

5 may designate) a copy of the most current 

6 accreditation survey of such organization 

7 or individual made by the organization, to8 gether with any other information directly 

9 related to the survey as the Secretary may 

10 require (including corrective action plans); 

11 and 

12 ‘‘(ii) such organization releases such a 

13 copy and any such information to the Sec14 retary. 

15 ‘‘(B) CERTIFICATION BY A STATE OR LO16 CALITY.—If a State or locality has or estab17 lishes training, assessment, or certification 

18 standards for interpreters or translators in 

19 health care which the Secretary determines are 

20 at least equivalent to the training, assessment, 

21 or certification standards promulgated by the 

22 Secretary as described in subsection (c), the 

23 Secretary shall find that all organizations or in24 dividuals accredited by such State or locality 


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1 comply also with the standard described in sub2 section (c) if— 

3 ‘‘(i) such organization or individual 

4 authorizes the State or locality to release 

5 to the Secretary upon his request (or such 

6 State agency as the Secretary may des7 ignate) a copy of the most current accredi8 tation survey of such organization or indi9 vidual made by such State or locality, to10 gether with any other information directly 

11 related to the survey as the Secretary may 

12 require (including corrective action plans); 

13 and 

14 ‘‘(ii) such State or locality releases 

15 such a copy and any such information to 

16 the Secretary. 

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

18 The Secretary shall determine, within 210 days 

19 after the date the Secretary receives an applica20 tion by a private accrediting organization, 

21 State, or locality whether the process of the pri22 vate accrediting organization, State, or locality 

23 meets the requirements with respect to training, 

24 assessment, or certification standards for inter25 preters or translators with respect to which 


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1 standards the application is made. The Sec2 retary may not deny an application on the basis 

3 that it seeks to meet the requirements with re4 spect to only one, or more than one, training, 

5 assessment, or certification standards for inter6 preters or translators. 

7 ‘‘(D) DISCLOSURE OF ACCREDITATION

8 SURVEY.—The Secretary may not disclose any 

9 accreditation survey made and released to him 

10 by the National Council on Interpreting in 

11 Health Care or any State or locality of an ac12 credited organization or individual, except that 

13 the Secretary may disclose such a survey and 

14 information related to such a survey to the ex15 tent such survey and information relate to an 

16 enforcement action taken by the Secretary. 

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

18 finds that an accredited organization or indi19 vidual has significant deficiencies (as defined in 

20 regulations pertaining to the training, assess21 ment, or certification standards), the organiza22 tion or individual shall, after the date of notice 

23 of such finding to the organization and for such 

24 period as may be prescribed in regulations, be 

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1 ments the organization or individual has been 

2 treated as meeting pursuant to subparagraph 

3 (A). 

4 ‘‘(e) AVAILABILITY OF LANGUAGE ACCESS.—The Di5 rector shall collaborate with the Administrator of the Of6 fice of Minority Health, the Administrator of the Centers 

7 for Medicare & Medicaid Services, and the Administrator 

8 of the Health Resources and Services Administration to 

9 notify health care providers and health care organizations 

10 about the availability of language access services by the 

11 Center. 

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

13 contract, shall undertake a national education campaign 

14 to inform providers, LEP individuals, and health profes15 sional and graduate schools about— 

16 ‘‘(1) Federal and State laws and guidelines gov17 erning access to language services; 

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

19 the risks associated with using family members, 

20 friends, minors, and untrained bilingual staff; 

21 ‘‘(3) funding sources for developing and imple22 menting language services; and 

23 ‘‘(4) promising practices to effectively provide 

24 language services. 


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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—In ad2 dition to the amounts authorized under subsection 

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

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

5 of fiscal years 2010 through 2014. 

6 ‘‘SEC. 3104. INNOVATIONS IN CULTURAL AND LINGUISTIC 

7 COMPETENCE GRANTS. 

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

9 the Director of the Agency for Healthcare Research and 

10 Quality, shall award grants to eligible entities to enable 

11 such entities to design, implement, and evaluate innova12 tive, cost-effective programs to improve language access 

13 in health care for individuals with limited English pro14 ficiency. The Director of the Agency for Healthcare Re15 search and Quality shall coordinate with, and ensure the 

16 participation of, other agencies including but not limited 

17 to the Health Resources and Services Administration, the 

18 Center on Minority Health and Health Disparities at the 

19 National Institutes of Health, and the Office of Minority 

20 Health, regarding the design and evaluation of the grants 

21 program. 

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

23 under subsection (a) an entity shall— 

24 ‘‘(1) be— 


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

2 territory or subdivision thereof; 

3 ‘‘(B) an organization described in section 

4 501(c)(3) of the Internal Revenue Code of 

5 1986; 

6 ‘‘(C) a community health center or commu7 nity clinic; 

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

9 ‘‘(E) an integrated health care delivery 

10 system; 

11 ‘‘(F) public hospital; 

12 ‘‘(G) health care group, university, or col13 lege; or 

14 ‘‘(H) other entity designated by the Sec15 retary; and 

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

17 application, at such time, in such manner, and ac18 companied by such additional information as the 

19 Secretary may require. 

20 ‘‘(c) USE OF FUNDS.—An entity shall use funds re21 ceived under a grant under this section to— 

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

23 providing competence interpretation services through 

24 on-site interpretation, telephonic interpretation, or 

25 video interpretation; 


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1 ‘‘(2) 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 promote and provide language services to patient 

5 populations of the service area of the organization; 

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

7 that identifies the current demographic, cultural, 

8 and epidemiological profile of the community to ac9 curately plan for and implement language services 

10 needed in service area of the organization; 

11 ‘‘(4) develop a strategic plan to implement lan12 guage services; 

13 ‘‘(5) develop participatory, collaborative part14 nerships with communities encompassing the LEP 

15 patient populations being served to gain input in de16 signing and implementing language services; 

17 ‘‘(6) develop and implement grievance resolu18 tion processes that are culturally and linguistically 

19 sensitive and capable of identifying, preventing, and 

20 resolving complaints by LEP individuals; or 

21 ‘‘(7) develop short-term medical interpretation 

22 training courses and incentives for bilingual health 

23 care staff who are asked to interpret in the work24 place; 


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1 ‘‘(8) develop formal training programs for indi2 viduals interested in becoming dedicated health care 

3 interpreters and culturally competent providers; 

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

5 which shall include information on the practical limi6 tations of such instruction for non-native speakers; 

7 and 

8 ‘‘(10) develop other language assistance services 

9 as determined appropriate by the Secretary; and 

10 ‘‘(11) ensure that, consistent with the privacy 

11 protections provided for under the regulations pro12 mulgated under section 264(c) of the Health Insur13 ance Portability and Accountability Act of 1996 (42 

14 U.S.C. 1320d–2 note), and any applicable State pri15 vacy laws, data on the individual patient or recipi16 ent’s race, ethnicity, and primary language are col17 lected (and periodically updated) in health records 

18 and integrated into the organization’s information 

19 management systems or any similar system used to 

20 store and retrieve data; 

21 ‘‘(d) PRIORITY.—In awarding grants under this sec22 tion, the Secretary shall give priority to entities that pri23 marily engage in providing direct care and that have devel24 oped partnerships with community organizations or with 

25 agencies with experience language access. 


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1 ‘‘(e) EVALUATION.— 

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

3 section shall submit to the Secretary an evaluation 

4 that describes, in the manner and to the extent re5 quired by the Secretary, the activities carried out 

6 with funds received under the grant, and how such 

7 activities improved access to health and health care8 related services and the quality of health care for in9 dividuals with limited English proficiency. Such eval10 uation shall be collected and disseminated through 

11 the Robert T. Matsui Center for Cultural and Lin12 guistic Competence in Health Care established under 

13 section 3103. The Director of the Agency for 

14 Healthcare Research and Quality shall notify grant15 ees of the availability of technical assistance for the 

16 evaluation and provide such assistance upon request. 

17 ‘‘(2) The Director of the Agency for Healthcare 

18 Research and Quality shall evaluate or arrange with 

19 other individuals or organizations to evaluate 

20 projects funded under this section. 

21 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

22 is authorized to be appropriated to carry out this section, 

23 $5,000,000 for each of fiscal years 2010 through 2014. 


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1 ‘‘SEC. 3105. RESEARCH ON CULTURAL AND LANGUAGE COM2 PETENCE. 

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

4 the Director of the Agency for Healthcare Research and 

5 Quality, shall expand research concerning language access 

6 in the provision of health care. 

7 ‘‘(b) ELIGIBILITY.—The Director of the Agency for 

8 Healthcare Research and Quality may conduct the re9 search described in subsection (a) or enter into contracts 

10 with other individuals or organizations to do so. 

11 ‘‘(c) USE OF FUNDS.—Research under this section 

12 shall be designed to do one or more of the following: 

13 ‘‘(1) To identify the barriers to mental and be14 havioral services that are faced by LEP individuals. 

15 ‘‘(2) To identify health care providers’ and 

16 health administrators’ attitudes, knowledge, and 

17 awareness of the barriers to quality health care serv18 ices that are faced by LEP individuals. 

19 ‘‘(3) To identify optimal approaches for deliv20 ering language access. 

21 ‘‘(4) To identify best practices for data collec22 tion, including— 

23 ‘‘(A) the collection by providers of health 

24 care and health care-related services of data on 

25 the race, ethnicity, and primary language of re26 cipients of such services, taking into account exVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 isting research conducted by the Government or 

2 private sector; 

3 ‘‘(B) the development and implementation 

4 of data collection and reporting systems; and 

5 ‘‘(C) effective privacy safeguards for col6 lected data. 

7 ‘‘(5) To develop a minimum data collection set 

8 for primary language. 

9 ‘‘(6) To evaluate the most effective ways in 

10 which the Department can create or coordinate, and 

11 then subsidize or otherwise fund telephonic interpre12 tation providers for health care providers, taking 

13 into consideration, among other factors, the flexi14 bility necessary for such a system to accommodate 

15 variations in— 

16 ‘‘(A) provider type; 

17 ‘‘(B) languages needed and their frequency 

18 of use; 

19 ‘‘(C) type of encounter; 

20 ‘‘(D) time of encounter, including regular 

21 business hours and after hours; and 

22 ‘‘(E) location of encounter. 

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

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


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

2 2010 through 2014.’’. 

3 SEC. 102. FEDERAL REIMBURSEMENT FOR CULTURALLY 

4 AND LINGUISTICALLY APPROPRIATE SERV5 ICES UNDER THE MEDICARE, MEDICAID AND 

6 THE STATE CHILDREN’S HEALTH INSURANCE 

7 PROGRAM. 

8 (a) MEDICARE.—Title XVIII of the Social Security 

9 Act is amended by adding at the end the following new 

10 section: 

11 ‘‘MEDICARE SUPPORT FOR LANGUAGE SERVICES

12 ‘‘SEC. 1899. 

13 ‘‘(a) ENSURING APPROPRIATE PAYMENT FOR THE

14 FURNISHING OF LINGUISTICALLY APPROPRIATE LAN15 GUAGE SERVICES TO ALL MEDICARE BENEFICIARIES.— 

16 ‘‘(b) TEMPORARY COST-BASED PAYMENTS FOR LAN17 GUAGE SERVICES TO HOSPITALS.— 

18 ‘‘(1) IN GENERAL.—Not later than 90 days 

19 after enactment of this section, the Secretary shall 

20 initiate quarterly payments to all hospitals that are 

21 certified as Medicare providers (including short-term 

22 acute inpatient hospitals, long-term care hospitals, 

23 inpatient rehabilitation facilities, children’s, cancer, 

24 psychiatric, and critical access hospitals) to pay for 

25 the costs of providing language services to limited 

26 English proficient Medicare beneficiaries. These payVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00050 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 ments shall cover the provision of language services 

2 by hospitals in inpatient and outpatient settings. 

3 These payments shall continue until the Secretary 

4 develops and implements reimbursement standards 

5 for language services pursuant to the process set 

6 forth in subsection (b). 

7 ‘‘(2) DETERMINATION OF TEMPORARY PAY8 MENTS.—Payments under paragraph (1) shall be 

9 calculated based on the estimated numbers of LEP 

10 Medicare beneficiaries in a hospital’s service area 

11 utilizing— 

12 ‘‘(A) data on the numbers of LEP individ13 uals (defined for purposes of this paragraph as 

14 individuals who speak English less than ‘very 

15 well’) from the most recently available data 

16 from the Bureau of the Census; or 

17 ‘‘(B) the hospital’s own data if— 

18 ‘‘(i) the hospital routinely collects 

19 data on patients’ primary language or need 

20 for an interpreter in both in- and out-pa21 tient settings; 

22 ‘‘(ii) the data collection system used 

23 by the hospital is, as determined by the 

24 Secretary, likely to yield accurate data reVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00051 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 garding the number of LEP individuals 

2 served by the hospital, and, 

3 ‘‘(iii) the hospital’s data documents 

4 greater numbers of LEP individuals than 

5 does the data described in clause (i). 

6 ‘‘(C) DISTRIBUTION OF FUNDS.—On a 

7 quarterly basis, the Secretary shall pay 

8 amounts directly to eligible hospitals to pay for 

9 the costs of providing language services to LEP 

10 Medicare beneficiaries. 

11 ‘‘(D) METHODOLOGIES.—In establishing a 

12 methodology for temporary payments, the Sec13 retary may establish one or more payment 

14 methodologies for inpatient and outpatient set15 tings. 

16 ‘‘(3) REPORTING REQUIREMENTS.—Hospitals 

17 receiving payment under paragraph (1) shall provide 

18 the Secretary with two reports on— 

19 ‘‘(A) the number of Medicare beneficiaries 

20 to whom language services are provided; 

21 ‘‘(B) the languages of those Medicare 

22 beneficiaries; 

23 ‘‘(C) the types of language services pro24 vided (such as provision of services directly in 


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1 non-English language by a health care provider 

2 or use of an interpreter); 

3 ‘‘(D) type of interpretation (such as in-per4 son, telephonic, or video interpretation); 

5 ‘‘(E) the methods of providing language 

6 services (staff, contract with external inde7 pendent contractors, or agencies); 

8 ‘‘(F) the length of time for each interpre9 tation encounter; and 

10 ‘‘(G) the costs of providing language serv11 ices (whether actual or estimated, as deter12 mined by the Secretary). 

13 ‘‘(4) NO COST-SHARING.—There shall be no 

14 cost-sharing for language services provided as tem15 porary payments to hospitals. 

16 ‘‘(5) AUTHORIZATION OF APPROPRIATIONS.— 

17 There is authorized to be appropriated to carry out 

18 this subsection such sums as may be necessary for 

19 each of fiscal years 2010 through 2014. 

20 ‘‘(c) DEVELOPMENT OF PAYMENT AMOUNTS FOR

21 LANGUAGE SERVICES.— 

22 ‘‘(1) IN GENERAL.—Not later than 6 months 

23 after enactment of this section, the Secretary shall 

24 convene a Working Group to advise the Secretary on 

25 the development of payment amounts that are based 


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1 on hospital-reported costs for language services pro2 vided to LEP Medicare beneficiaries. Reimburse3 ment shall apply to all Medicare-covered services 

4 furnished by certified providers to eligible bene5 ficiaries, whether covered under parts A and B or 

6 under the Medicare Advantage program under 

7 part C. 

8 ‘‘(2) VARIATIONS.—The Secretary, in consulta9 tion with the Working Group, may establish vari10 ations within the reimbursement system based upon 

11 available delivery methods and costs for providing 

12 language services including such factors as— 

13 ‘‘(A) the type of language services provided 

14 (such as provision of services directly in a non15 English language by a health care provider or 

16 use of an interpreter); 

17 ‘‘(B) type of interpretation services pro18 vided (such as in-person, telephonic, or video in19 terpretation); 

20 ‘‘(C) the methods and costs of providing 

21 language services (including the costs of pro22 viding language services with internal staff or 

23 through contract with external independent con24 tractors or agencies); 


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1 ‘‘(D) providing services for languages not 

2 frequently encountered in the United States; 

3 and 

4 ‘‘(E) providing services in rural areas. 

5 ‘‘(3) NO COST-SHARING.—There shall be no 

6 cost-sharing for language services provided as pay7 ments to hospitals under this subsection. 

8 ‘‘(4) LIMITATIONS.— 

9 ‘‘(A) IN GENERAL.—Reimbursement shall 

10 only be provided to hospitals under this sub11 section that report their costs of providing lan12 guage services, including information on the 

13 factors described in paragraph (1) that are uti14 lized in establishing the reimbursement rates 

15 and any other information specified by the Sec16 retary. 

17 ‘‘(B) USE OF INTERPRETER OR TRANS18 LATION SERVICES.— 

19 ‘‘(i) IN GENERAL.—Reimbursement 

20 shall be provided under this subsection 

21 only to hospitals that utilize interpreter or 

22 translation services. 

23 ‘‘(ii) INTERPRETER SERVICES DE24 FINED.—In this paragraph the term ‘inter25 preter services’ means services designed to 


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1 provide a competent trans-language ren2 dition of a spoken message in which an in3 terpreter comprehends the source language 

4 and can speak comprehensively in the tar5 get language to convey the meaning in6 tended in the source language. Such inter7 preter shall know health and health-related 

8 terminology and provide accurate interpre9 tations by choosing equivalent expressions 

10 that convey the best matching and mean11 ing to the source language and captures, to 

12 the greatest possible extent, all nuances in13 tended in the source message. 

14 ‘‘(iii) INTERPRETER DEFINED.—In 

15 this paragraph, the he term ‘interpreter’ 

16 means an individual who transmits a spo17 ken message from one language into an18 other, faithfully, accurately, and objec19 tively. Such term includes an individual 

20 who provide in-person, telephonic, and 

21 video interpretation and also includes an 

22 individual who is employed or contracted 

23 by those who provide benefits under sec24 tion 1832. 


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1 ‘‘(iv) TRANSLATION.—In this para2 graph, the term ‘translation’ means the 

3 competent transmission of a written mes4 sage in one language into a written mes5 sage in another language. 

6 ‘‘(v) EXEMPTIONS.—The require7 ments of clauses (i) and (ii) shall not 

8 apply— 

9 ‘‘(I) when a individual (who has 

10 been informed in the individual’s pri11 mary language of the availability of 

12 free interpreter and translation serv13 ices) requests the use of family, 

14 friends or other persons untrained in 

15 interpretation or translation; and 

16 ‘‘(II) when a medical emergency 

17 exists and the delay directly associ18 ated with obtaining a competent inter19 preter or translation services would 

20 jeopardize the health of the individual. 

21 Nothing in this clause shall exempt emer22 gency rooms or similar entities that regu23 larly provide health care services in med24 ical emergencies from having in place sysVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00057 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 tems to provide competent interpreter and 

2 translation services without undue delay. 

3 ‘‘(5) WORKING GROUP.—The Secretary shall es4 tablish a Working Group (in this subsection referred 

5 to as the ‘Working Group’) to develop the payment 

6 amounts under this paragraph. Such Working Group 

7 include representatives from the American Hospital 

8 Association, National Association of Public Hos9 pitals and Health Systems, Association of Language 

10 Companies, the National Council of Interpreting in 

11 Health Care, organizations that advocate on behalf 

12 of limited English proficient individuals, and other 

13 individuals or entities determined appropriate by the 

14 Secretary, including those who have specific exper15 tise in either developing cost-based reimbursement 

16 or provision of language services, that will be useful. 

17 ‘‘(6) PUBLICATION.— 

18 ‘‘(A) PROPOSED REIMBURSEMENT STAND19 ARDS.—Not later than 18 months after the 

20 date of enactment of this section, the Secretary 

21 shall, contingent upon consultation with and ap22 proval of the Working Group— 

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

24 public through the Internet, the Federal 

25 Register, and other appropriate public 


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1 channels, proposed payment amounts 

2 under this subsection based on hospital-re3 ported costs; and 

4 ‘‘(ii) accept public comment on such 

5 reimbursement standards for a period of 

6 not less than 90 days. 

7 ‘‘(B) FINAL REIMBURSEMENT STAND8 ARDS.— 

9 ‘‘(i) IN GENERAL.—Not later than 

10 120 days after the expiration of the public 

11 comment period described in subparagraph 

12 (A), the Secretary shall publish, after con13 sultation with and the approval of the 

14 Working Group, final reimbursement 

15 standards in the Federal Register and on 

16 the Internet. The final reimbursement 

17 standards shall go into effect within six 

18 months of the date of such publication. 

19 ‘‘(ii) TRAINING.—Between such publi20 cation and effective dates, the Secretary 

21 shall provide training and technical assist22 ance to hospitals on the final reimburse23 ment standards. As necessary, the Sec24 retary shall continue to provide training 


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1 and technical assistance after the reim2 bursement standards becomes effective. 

3 ‘‘(iii) PHASE-OUT.—When the final 

4 reimbursement standards go into effect, 

5 the temporary adjustments described in 

6 subsection (a) shall be phased out over a 

7 one-year period as hospitals implement the 

8 new reimbursement rates. Final reimburse9 ment rates shall not be constrained at the 

10 level of total temporary adjustments. Re11 imbursement shall be set at the level of the 

12 costs of language services at eligible hos13 pitals. 

14 ‘‘(d) OTHER MEDICARE PAYMENT SYSTEMS.— 

15 ‘‘(1) PAYMENT SYSTEMS.— 

16 ‘‘(A) IN GENERAL.—Not later than two 

17 years after enactment of this Act, and using the 

18 guidelines described in subsection (b), the Sec19 retary shall make recommendations to include 

20 payments or adjustments for language services 

21 provided to limited English proficient Medicare 

22 beneficiaries for all of the remaining payment 

23 systems under this title, except the physician 

24 fee schedule under such 1848, including psy25 chiatric hospitals, skilled nursing facilities, 


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1 home health agencies, rehabilitation facilities, 

2 and long-term care hospitals, as well as the 

3 TEFRA per discharge limit for children’s and 

4 cancer hospitals excluded from the inpatient 

5 hospital prospective payment system under sec6 tion 1886(d), the ambulance fee schedule, and 

7 payments to critical access hospitals. Program 

8 costs for language services in critical access 

9 hospitals shall be considered allowable costs 

10 under this title and shall be calculated in the 

11 same manner as other Medicare costs on the 

12 cost report. These costs should be incorporated 

13 into interim payments. 

14 ‘‘(B) IMPLEMENTATION.—The Secretary 

15 shall implement these payments within three 

16 years. 

17 ‘‘(C) NO COST-SHARING.—There shall be 

18 no cost-sharing for such language services. 

19 ‘‘(2) MEDICARE REIMBURSEMENT FOR LAN20 GUAGE SERVICES PROVIDED IN SUPPORT OF PHYSI21 CIAN OFFICE SERVICES.— 

22 ‘‘(A) STUDY.—The Medicare Payment Ad23 visory Commission shall conduct a study that 

24 examines ways that Medicare can pay for lan25 guage services (including foreign language and 


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1 sign language) provided in support of physician 

2 office services and other services paid for 

3 through the physician fee schedule under sec4 tion 1848. The report on such study shall in5 clude the following: 

6 ‘‘(i) Recommendations and effective 

7 methods for adopting a payment method8 ology for on-site interpreters, pursuant to 

9 which such interpreters and agencies could 

10 directly bill Medicare for language services 

11 provided in support of benefits paid for 

12 under section 1832 for a limited English 

13 proficient Medicare patient. For purposes 

14 of this subparagraph, the term ‘on-site in15 terpreters’ include interpreters who work 

16 as independent contractors, for agencies 

17 that provide on-site interpretation, and 

18 who are employed by those who provide 

19 benefits provided under section 1832. 

20 ‘‘(ii) Recommendations and effective 

21 methods for Medicare contracting directly 

22 with agencies that provide off-site interpre23 tation, including telephonic and video in24 terpretation, pursuant to which such con25 tractors could directly bill Medicare for the 


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1 services provided in support of benefits 

2 provided under section 1832 for a limited 

3 English proficient Medicare patient. 

4 ‘‘(iii) Recommendations for modifying 

5 the existing Medicare resource-based rel6 ative value scale (RBRVS) by adding new 

7 procedure codes in the Health Care Com8 mon Procedure Coding System. 

9 ‘‘(B) REPORT.—Not later than 1 year 

10 after the date of the enactment of this section, 

11 the Commission shall submit to Congress and 

12 the Centers for Medicare & Medicaid Services a 

13 report on the study conducted under subpara14 graph (A), together with recommendations re15 garding the appropriateness of directly reim16 bursing interpreters versus physicians for lan17 guage services provided in support of benefits 

18 provided under section 1832. 

19 ‘‘(C) IMPLEMENTATION.— 

20 ‘‘(i) IN GENERAL.—Not later than 1 

21 year after the submission of the report des22 ignated in subparagraph (B), the Secretary 

23 shall publish, after consultation with and 

24 the approval of the Medicare Payment Ad25 visory Commission, final reimbursement 


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1 standards for language services provided in 

2 support of benefits provided under section 

3 1832. These standards shall be published 

4 in the Federal Register and on the Inter5 net and shall go into effect within six 

6 months of the date of such publication. 

7 The final standards must ensure that— 

8 ‘‘(I) for the first three years of 

9 implementation, the payments for lan10 guage services do not diminish other 

11 fees provided in support of benefits 

12 provided under section 1832; and 

13 ‘‘(II) enrollees do not have to pay 

14 any co-pays or cost-sharing for lan15 guage services provided in support of 

16 benefits provided under section 1832. 

17 ‘‘(ii) TRAINING.—Between such date 

18 of publication and the effective date, the 

19 Secretary shall provide training and tech20 nical assistance to providers covered by the 

21 physician fee schedule under section 1848 

22 on the final reimbursement standards. As 

23 necessary, the Secretary shall continue to 

24 provide training and technical assistance 


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1 after the reimbursement standards be2 comes effective.’’. 

3 (b) CONFORMING AMENDMENTS.— 

4 (1) TECHNICAL AMENDMENTS.— 

5 (A) Section 1861 of the Social Security 

6 Act (42 U.S.C. 1395x) is amended by adding at 

7 the end the following new subsection: 

8 ‘‘Language Services; Interpreter Services; Interpreter; 

9 Translation; LEP 

10 ‘‘(hhh)(1) The term ‘language services’ means the 

11 provision of healthcare services to limited English pro12 ficient enrollees directly in a non-English language, or 

13 through the provision of interpreter services, translation 

14 and non-English signage. 

15 ‘‘(2) For the purposes of this subsection, the term 

16 ‘interpreter services’ means services designed to provide 

17 a competent trans-language rendition of a spoken message 

18 in which an interpreter comprehends the source language 

19 and can speak comprehensively in the target language to 

20 convey the meaning intended in the source language and 

21 interpreter knows health and health-related terminology 

22 and provides accurate interpretations by choosing equiva23 lent expressions that convey the best matching and mean24 ing to the source language and captures, to the greatest 


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1 possible extent, all nuances intended in the source mes2 sage. 

3 ‘‘(3) The term ‘interpreter’ means an individual who 

4 transmits a spoken message from one language into an5 other, faithfully, accurately, and objectively. Such term in6 cludes individuals who provide in-person, telephonic, and 

7 video interpretation and such term ‘interpreter’ individ8 uals who are employed or contracted by those who provide 

9 benefits provided under section 1832. 

10 ‘‘(4) The term ‘translation’ means the competent 

11 transmission of a written message in one language into 

12 a written message in another language. 

13 ‘‘(5) The terms ‘limited English proficient’ and 

14 ‘LEP’, with respect to an individual, means an individual 

15 who speaks a primary language other than English.’’. 

16 (B) Subsection (aa)(1)(B) of such section 

17 is amended by inserting ‘‘, language services as 

18 defined in subsection (hhh),’’ after ‘‘clinical so19 cial worker (as defined in subsection (hh)(1)),’’. 

20 (C) Section 1833(a) of the Social Security 

21 Act (42 U.S.C. 1395l) is amended— 

22 (i) by redesignating paragraph (9) as 

23 paragraph (10); and 

24 (ii) by inserting after paragraph (8) 

25 the following new paragraph: 


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1 ‘‘(9) in the case of language services described 

2 in section 1861(hhh), 100 percent of the reasonable 

3 charges for such services.’’. 

4 (D) Section 1832(a)(2) of such Act (42 

5 U.S.C. 1395k(a)(2)) is amended— 

6 (i) by striking ‘‘and’’ at the end of 

7 subparagraph (I); 

8 (ii) by striking the period at the end 

9 of subparagraph (K) and inserting ‘‘and’’; 

10 and 

11 (iii) by adding at the end of subpara12 graph (K) the following: 

13 ‘‘(L) language services (as defined in sec14 tion 1861(hhh) furnished by a interpreter or 

15 translator, whether contracted or employed by 

16 the entity providing benefits under this sec17 tion.’’ 

18 (E) WAIVER OF BUDGET NEUTRALITY.— 

19 For the first 3 years after the effective date of 

20 this section, the budget neutrality provision of 

21 section 1848(c)(2)(B)(ii) of the Social Security 

22 Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 

23 apply to language services. 

24 (F) EFFECTIVE DATE.—These amend25 ments made by this subsection are effective 


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1 upon publication of the final reimbursement 

2 standards described in section 1899(b) of the 

3 Social Security Act, as added by subsection (a). 

4 (2) MEDICARE PART C AND PART D.—The Sec5 retary of Health and Human Services shall ensure 

6 Medicare Advantage plans participating in Medicare 

7 part C and prescription drug plans participating in 

8 Medicare part D effectively provide language serv9 ices to their enrollees. The Secretary shall require 

10 annual reporting for such plans that includes infor11 mation on internal policies and procedures related to 

12 cultural appropriateness in each of the following 

13 contexts: 

14 (A) Collection of data regarding the en15 rollee population. 

16 (B) Education of plan staff and contrac17 tors who have routine contact with enrollees re18 garding the diverse needs of the enrollee popu19 lation. 

20 (C) Recruitment and retention efforts that 

21 encourage workforce diversity. 

22 (D) Evaluation of the health plan’s lan23 guage services programs and services with re24 spect to the plan’s enrollee population, using 


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1 processes such as an analysis of complaints and 

2 satisfaction survey results. 

3 (E) Methods by which the plan provides in4 formation regarding the ethnic diversity of the 

5 plan’s enrollee population. 

6 (F) The periodic provision of educational 

7 information to plan enrollee on the plan’s lan8 guage services and programs. Plans may use 

9 existing means of communications. 

10 (c) IMPROVING LANGUAGE SERVICES IN MEDICAID

11 AND SCHIP.— 

12 (1) Section 1903(a)(2)(E) of the Social Secu13 rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended 

14 by— 

15 (A) striking ‘‘translation or interpretation 

16 services’’ and inserting ‘‘language services’’; 

17 and 

18 (B) striking ‘‘children of families’’ and in19 serting ‘‘individuals’’. 

20 (2) Section 1902(a)(10)(A) of the Social Secu21 rity Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 

22 striking ‘‘and (21)’’ and inserting ‘‘(21), and (28)’’. 

23 (3) Section 1905(a) of the Social Security Act 

24 (42 U.S.C. 1396d(a)) is amended by— 


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1 (A) in paragraph (27), by striking ‘‘and’’ 

2 at the end; 

3 (B) by redesignating paragraph (28) as 

4 paragraph (29); and 

5 (C) by inserting after paragraph (27) the 

6 following new paragraph: 

7 ‘‘(27) language services (including the provision 

8 of health care services directly in a non-English lan9 guage, interpretation, translation, and non-English 

10 signage), provided in a timely manner to limited 

11 English proficient individuals who need language 

12 services in connection with administrative and cov13 ered services; and’’. 

14 (4) Section 1916(a)(2) of the Social Security 

15 Act (42 U.S.C. 1396o(2)) is amended by— 

16 (A) by striking ‘‘or’’ at the end of subpara17 graph (D); 

18 (B) by striking ‘‘and’’ at the end of sub19 paragraph (E) and inserting ‘‘or’’; and 

20 (C) by adding at the end the following new 

21 subparagraph: 

22 ‘‘(F) language services described in section 

23 1905(a)(27); and’’. 

24 (5) Section 2103 of the Social Security Act (42 

25 U.S.C. 1397cc) is amended— 


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1 (A) in subsection (a), in the matter before 

2 paragraph (1), by striking ‘‘(7)’’ and inserting 

3 ‘‘, (7), and (9)’’; and 

4 (B) in subsection (c), by adding at the end 

5 the following new paragraph: 

6 ‘‘(9) LANGUAGE SERVICES.—The child health 

7 assistance provided to a targeted low-income child 

8 shall include coverage of language services (including 

9 the provision of health care services directly in a 

10 non-English language, interpretation, translation 

11 and non-English signage) provided in a timely man12 ner to limited English proficient individuals who 

13 need them, in connection with administrative and 

14 covered services.’’; and 

15 (C) in subsection (e)(2)— 

16 (i) in the heading, by striking ‘‘PRE17 VENTIVE’’ and inserting ‘‘CERTAIN’’; and 

18 (ii) by inserting ‘‘or subsection (c)(9)’’ 

19 after ‘‘subsection (c)(1)(C)’’. 

20 (6) Section 2110(a)(27) of the Social Security 

21 Act (42 U.S.C. 1397jj) is amended by striking 

22 ‘‘translation’’ and inserting ‘‘language services as 

23 described in section 2103(c)(7)’’. 

24 (7) Pursuant to the reporting requirement de25 scribed in section 2107(b)(1) of the Social Security 


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1 Act (42 U.S.C. 1397gg(b)(1)), the Secretary of 

2 Health and Human Services shall ensure that States 

3 collect data on the— 

4 (A) primary language of those assisted; 

5 and 

6 (B) for individuals who are minors or inca7 pacitated, the primary language of the individ8 ual’s parent or guardian. 

9 (8) Section 2105(c)(2)(A) of the Social Security 

10 Act (42 U.S.C. 1397ee(c)) is amended by inserting 

11 before the period ‘‘, except that expenditures pursu12 ant to section 2105(a)(1)(D)(iv) shall not count to13 wards this total’’. 

14 (d) FUNDING LANGUAGE SERVICES FURNISHED BY

15 PROVIDERS OF HEALTH CARE AND HEALTH CARE-RE16 LATED SERVICES THAT SERVE HIGH RATES OF UNIN17 SURED LEP INDIVIDUALS.— 

18 (1) PAYMENT OF COSTS.— 

19 (A) IN GENERAL.—Subject to subpara20 graph (B), the Secretary of Health and Human 

21 Services shall make payments (on a quarterly 

22 basis) directly to eligible entities to support the 

23 provision of language services to limited English 

24 proficient individuals in an amount equal to an 


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1 entity’s eligible costs for such services for the 

2 quarter. 

3 (B) LIMITATION.—If the amount of funds 

4 appropriated under subparagraph (C) to carry 

5 out this subsection for a fiscal year is insuffi6 cient to ensure that each eligible entity can re7 ceive full payment under subparagraph (A), the 

8 Secretary shall reduce in a pro rata manner the 

9 amount of such payment to each such entity. 

10 (C) FUNDING.—Out of any funds in the 

11 Treasury not otherwise appropriated, there are 

12 appropriated to the Secretary of Health and 

13 Human Services such sums as may be nec14 essary for each of fiscal years 2010 through 

15 2014. 

16 (D) LANGUAGE SERVICES.—In this sub17 section, the term ‘‘language services’’ has the 

18 meaning given such term in section 3100 of the 

19 Public Health Service Act. 

20 (2) ELIGIBLE COSTS DEFINED.— 

21 (A) IN GENERAL.—In this subsection, the 

22 term ‘‘eligible costs’’ means, with respect to an 

23 eligible entity that provides language services to 

24 LEP individuals, the product of— 


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1 (i) the average per person cost of lan2 guage services, determined according to 

3 the methodology devised under subpara4 graph (B), and 

5 (ii) the number of limited English 

6 proficient individuals who are provided lan7 guage services by the entity and for whom 

8 no reimbursement is available for such 

9 services under the amendments made by 

10 subsections (a), (b), or (c) or by private 

11 health insurance. 

12 (B) METHODOLOGY.—The Secretary shall 

13 devise a methodology to determine the average 

14 per person cost of language services. In estab15 lishing a payment methodology, the Secretary 

16 may establish different methodologies for dif17 ferent types of eligible entities. The Secretary 

18 shall not require eligible entities to provide indi19 vidual claims for language services for each in20 dividual patient to be provided payment under 

21 this subsection. 

22 (3) ELIGIBLE ENTITY.—In order to receive 

23 grants under this paragraph, an entity must— 

24 (A) be— 

25 (i) an individual provider; 


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1 (ii) a hospital with a low income utili2 zation rate (as defined in section 

3 1923(b)(3) of the Social Security Act (42 

4 U.S.C. 1396r–4(b)(3))) of greater than 25 

5 percent; or 

6 (iii) a Federally-qualified health cen7 ter (as defined in section 1905(l)(2)(B) of 

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

9 1396d(l)(2)(B))); 

10 (B) provide language services to at least 8 

11 percent of the entity’s total number of patients; 

12 and 

13 (C) prepare and submit an application to 

14 the Secretary, at such time, in such manner, 

15 and accompanied by such information as the 

16 Secretary may require to ascertain the entities’ 

17 eligibility for funding under this subsection. 

18 (4) RELATION TO MEDICAID DSH.—Payments 

19 under this subsection shall not offset or reduce pay20 ments under section 1923 of the Social Security Act, 

21 nor shall payments under such section be considered 

22 when determining uncompensated costs associated 

23 with the provision of language services. 

24 (5) REPORTING REQUIREMENTS.—Entities re25 ceiving payment under this subsection shall provide 


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1 the Secretary with a quarterly report on such pay2 ments. Such report shall contain aggregate (and not 

3 individualized) data and shall otherwise be in a form 

4 and manner determined by the Secretary. For pur5 poses of this subsection, the Secretary shall create a 

6 standard data collection instrument that is con7 sistent with any existing reporting requirements by 

8 the Secretary or relevant accrediting organizations 

9 regarding the number of individuals to whom lan10 guage access are provided. 

11 (6) GUIDANCE.— 

12 (A) ESTABLISHMENT.—Not later than 6 

13 months after the date of enactment of this Act, 

14 the Secretary of Health and Human Services 

15 shall establish guidelines concerning the imple16 mentation of this subsection. 

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

18 the date of enactment of this Act, and every 2 

19 years thereafter, the Secretary shall submit a 

20 report to Congress concerning the implementa21 tion of such guidelines. 

22 (e) EFFECTIVE DATE.—The amendments made by 

23 this section take effect on October 1, 2009. 


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1 SEC. 103. INCREASING UNDERSTANDING OF AND IMPROV2 ING HEALTH LITERACY. 

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

4 Director of the Agency for Healthcare Research and Qual5 ity and the Administrator of the Health Resources and 

6 Services Administration, in consultation with the National 

7 Center on Minority Health and Health Disparities and the 

8 Office of Minority Health, shall award grants to eligible 

9 entities to improve health care for patient populations that 

10 have low functional health literacy. 

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

12 under subsection (a), an entity shall— 

13 (1) be a hospital, health center or clinic, health 

14 plan, or other health entity (including a nonprofit 

15 minority health organization or association); and 

16 (2) prepare and submit to the Secretary an ap17 plication at such time, in such manner, and con18 taining such information as the Secretary may re19 quire. 

20 (c) USE OF FUNDS.— 

21 (1) AGENCY FOR HEALTHCARE RESEARCH AND

22 QUALITY.—Grants awarded under subsection (a) 

23 through the Agency for Healthcare Research and 

24 Quality shall be used— 

25 (A) to define and increase the under26 standing of health literacy; 


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1 (B) to investigate the correlation between 

2 low health literacy and health and health care; 

3 (C) to clarify which aspects of health lit4 eracy have an effect on health outcomes; and 

5 (D) for any other activity determined ap6 propriate by the Director of the Agency. 

7 (2) HEALTH RESOURCES AND SERVICES ADMIN8 ISTRATION.—Grants awarded under subsection (a) 

9 through the Health Resources and Services Adminis10 tration shall be used to conduct demonstration 

11 projects for interventions for patients with low 

12 health literacy that may include— 

13 (A) the development of new disease man14 agement programs for patients with low health 

15 literacy; 

16 (B) the tailoring of existing disease man17 agement programs addressing mental, physical, 

18 oral, and behavioral health conditions for pa19 tients with low health literacy; 

20 (C) the translation of written health mate21 rials for patients with low health literacy; 

22 (D) the identification, implementation, and 

23 testing of low health literacy screening tools; 


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1 (E) the conduct of educational campaigns 

2 for patients and providers about low health lit3 eracy; and 

4 (F) other activities determined appropriate 

5 by the Administrator of the Health Resources 

6 and Services Administration. 

7 (d) DEFINITIONS.—In this section, the term ‘‘low 

8 health literacy’’ means the inability of an individual to ob9 tain, process, and understand basic health information 

10 and services needed to make appropriate health decisions. 

11 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

14 2010 through 2014. 

15 SEC. 104. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 

16 (a) IN GENERAL.—Entities that receive Federal 

17 funds under sections 101 or 102 (including under the 

18 amendments made by such section), in order to ensure the 

19 right of LEP individuals to receive access to quality health 

20 care, shall— 

21 (1) ensure that appropriate clinical and support 

22 staff receive ongoing education and training in lin23 guistically appropriate service delivery; 

24 (2) offer and provide appropriate language serv25 ices at no additional charge to each patient with limVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00079 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 ited English proficiency at all points of contact, in 

2 a timely manner during all hours of operation; 

3 (3) notify patients of their right to receive lan4 guage services in their primary language; and 

5 (4) utilize only competent interpreter or trans6 lation services which— 

7 (A) until adoption of the Interpreter and 

8 Translator Guidelines and Standards described 

9 in section 3103(c) of the Public Health Service 

10 Act, are defined in section 3100 of the Public 

11 Health Service Act; and 

12 (B) after adoption of the Interpreter and 

13 Translator Guidelines and Standards described 

14 in section 3103(c) of the Public Health Service 

15 Act, meet those guidelines and standards; 

16 (b) EXEMPTIONS.—The requirements of subsection 

17 (a)(4) shall not apply as follows: 

18 (1) When a patient (who has been informed in 

19 his or her primary language of the availability of 

20 free interpreter and translation services) requests 

21 the use of family, friends or other persons untrained 

22 in interpretation or translation if the following con23 ditions are met: 

24 (A) The interpreter requested by the pa25 tient is over the age of 18. 


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1 (B) The recipient informs the patient that 

2 he or she has the option of having the recipient 

3 provide an interpreter for him/her without 

4 charge, or of using his/her own interpreter. 

5 (C) The recipient informs the patient that 

6 the recipient may not require an LEP person to 

7 use a family member or friend as an inter8 preter. 

9 (D) The recipient evaluates whether the 

10 person the patient wishes to use as an inter11 preter is competent. If the recipient has reason 

12 to believe that the interpreter is not competent, 

13 the recipient provides its own interpreter to 

14 protect the recipient from liability if the pa15 tient’s interpreter is later found not competent. 

16 (E) If the recipient has reason to believe 

17 that there is a conflict of interest between the 

18 interpreter and patient, the recipient may not 

19 use the patient’s interpreter. 

20 (F) The recipient has the patient sign a 

21 waiver, witnessed by at least one individual not 

22 related to the patient, that includes the infor23 mation stated in subparagraphs (A) through 

24 (E) and is translated into the patient’s lan25 guage. 


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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. 105. 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 to health care and health 

22 care-related services. Such report shall include— 

23 (1) a description and evaluation of the activities 

24 carried out under this Act; 


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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 2010 through 2014. 

18 SEC. 106. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 

19 (a) GRANTS AUTHORIZED.—The Secretary of Edu20 cation is authorized to provide grants to States for the 

21 provision of English as a second language (hereafter re22 ferred to as ‘‘ESL’’) instruction and shall determine, after 

23 consultation with appropriate stakeholders, the mecha24 nism for administering and distributing such grants. 


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1 (b) APPLICATION.—A State may apply for a grant 

2 under this section by submitting such information as the 

3 Secretary may require and in such form and manner as 

4 the Secretary may require. 

5 (c) USE OF GRANT.—As a condition of receiving a 

6 grant under this section, a State shall— 

7 (1) develop and implement a plan for assuring 

8 the availability of ESL instruction that effectively 

9 integrates information about the nature of the 

10 United States health care system, how to access 

11 care, and any special language skills that may be re12 quired for them to access and regularly negotiate the 

13 system effectively; 

14 (2) develop a plan, including, where appro15 priate, public-private partnerships, for making ESL 

16 instruction progressively available to all individuals 

17 seeking instruction; and 

18 (3) maintain current ESL instruction efforts by 

19 using the additional funds to supplement rather 

20 than supplant any funds expended for ESL instruc21 tion in the State as of January 1, 2006. 

22 (d) ADDITIONAL DUTIES OF THE SECRETARY.—The 

23 Secretary of Education shall— 


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1 (1) collect and publicize annual data on how 

2 much Federal, State, and local governments spend 

3 on ESL instruction; 

4 (2) collect data from state and local govern5 ments to identify the unmet needs of English lan6 guage learners for appropriate ESL instruction, in7 cluding— 

8 (A) the extent of waiting lists including 

9 how many programs maintain waiting lists and, 

10 for programs that do not have waiting lists, the 

11 reasons why not; 

12 (B) the availability of programs to geo13 graphically isolated communities; 

14 (C) the impact of course enrollment poli15 cies, including open enrollment, on the avail16 ability of ESL instruction; 

17 (D) the number individuals in the State 

18 and each participating locality; 

19 (E) the effectiveness of the instruction in 

20 meeting the needs of individuals receiving in21 struction and those needing instruction; 

22 (F) as assessment of the need for pro23 grams that integrate job training and ESL in24 struction, to assist individuals to obtain better 

25 jobs; and 


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1 (G) the availability of ESL slots by State 

2 and locality; 

3 (3) determine the cost and most appropriate 

4 methods of making ESL instruction available to all 

5 English language learners seeking instruction; and 

6 (4) within 1 year of the date of enactment of 

7 this Act, issue a report to Congress that assesses the 

8 information collected in subparagraphs (1), (2), and 

9 (3) and makes recommendations on steps that 

10 should be taken to progressively realize the goal of 

11 making ESL instruction available to all English lan12 guage learners seeking instruction. 

13 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to the Secretary of Edu15 cation for each of fiscal years 2010 through 2013 

16 $250,000,000 to carry out this section. 

17 SEC. 107. DEFINITION. 

18 In this title, the definitions contained in section 3100 

19 of the Public Health Service Act, as added by section 101, 

20 shall apply. 

21 SEC. 108. TREATMENT OF THE MEDICARE PART B PRO22 GRAM UNDER TITLE VI OF THE CIVIL RIGHTS 

23 ACT OF 1964. 

24 A payment to a provider of services, physician, or 

25 other supplier under part B, C, ord D of title XVIII of 


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1 the Social Security Act shall be deemed a grant, and not 

2 a contract of insurance or guaranty, for the purposes of 

3 title VI of the Civil Rights Act of 1964. 

4 SEC. 109. IMPLEMENTATION. 

5 (a) GENERAL PROVISIONS.— 

6 (1) A State shall not be immune under the 

7 Eleventh Amendment of the Constitution of the 

8 United States from suit in Federal court for failing 

9 to provide the language access funded pursuant to 

10 this Act. 

11 (2) In a suit against a State for a violation of 

12 this Act, remedies (including remedies at both at law 

13 and in equity) are available for such a violation to 

14 the same extent as such remedies are available for 

15 such a violation in the suit against any public or pri16 vate entity other than a State. 

17 (b) RULE OF CONSTRUCTION.—Nothing in this Act 

18 shall be construed to limit otherwise existing obligations 

19 of recipients of Federal financial assistance under title VI 

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

21 seq.) or any other statute. 


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1 TITLE II—HEALTH WORKFORCE 

2 DIVERSITY 

3 SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

4 ACT. 

5 Title XXXI of the Public Health Service Act, as 

6 added by section 201, is amended by adding at the end 

7 the following: 

8 ‘‘Subtitle A—Diversifying the 

9 Healthcare Workplace 

10 ‘‘SEC. 3111. REPORT ON WORKFORCE DIVERSITY. 

11 ‘‘(a) IN GENERAL.—Not later than July 1, 2010, 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; 


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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 


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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. 3112. 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), the grantee shall en18 sure that the group has representation from the following 

19 entities: 

20 ‘‘(1) The Health Resources and Services Ad21 ministration. 

22 ‘‘(2) The Department of Health and Human 

23 Services Data Council. 

24 ‘‘(3) The Office of Minority Health. 


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1 ‘‘(4) The Bureau of Labor Statistics of the De2 partment of Labor. 

3 ‘‘(5) The Public Health Practice Program Of4 fice—Office of Workforce Policy and Planning. 

5 ‘‘(6) The National Center on Minority Health 

6 and Health Disparities. 

7 ‘‘(7) The Agency for Healthcare Research and 

8 Quality. 

9 ‘‘(8) The Institute of Medicine Study Com10 mittee for the 2004 workforce diversity report. 

11 ‘‘(9) The Indian Health Service. 

12 ‘‘(10) Academic institutions. 

13 ‘‘(11) Consumer organizations. 

14 ‘‘(12) Health professional associations, includ15 ing those that represent underrepresented minority 

16 populations. 

17 ‘‘(13) Researchers in the area of health work18 force. 

19 ‘‘(14) Health workforce accreditation entities. 

20 ‘‘(15) Private foundations that have sponsored 

21 workforce diversity initiatives. 

22 ‘‘(16) Not less than 5 health professions stu23 dents representing various health profession fields 

24 and levels of training. 


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1 ‘‘(c) ACTIVITIES.—The working group established 

2 under subsection (a) shall convene at least twice each year 

3 to complete the following activities: 

4 ‘‘(1) Review current public and private health 

5 workforce diversity initiatives. 

6 ‘‘(2) Identify successful health workforce diver7 sity programs and practices. 

8 ‘‘(3) Examine challenges relating to the devel9 opment and implementation of health workforce di10 versity initiatives. 

11 ‘‘(4) Draft a national strategic work plan for 

12 health workforce diversity, including recommenda13 tions for public and private sector initiatives. 

14 ‘‘(5) Develop a framework and methods for the 

15 evaluation of current and future health workforce di16 versity initiatives. 

17 ‘‘(6) Develop recommended standards for work18 force diversity that could be applicable to all health 

19 professions programs and programs funded under 

20 this Act. 

21 ‘‘(7) Develop curriculum guidelines for diversity 

22 training. 

23 ‘‘(8) Develop a strategy for the inclusion of 

24 community members on admissions committees for 

25 health profession schools. 


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1 ‘‘(9) Other activities determined appropriate by 

2 the Secretary. 

3 ‘‘(d) ANNUAL REPORT.—Not later than 1 year after 

4 the establishment of the working group under subsection 

5 (a), and annually thereafter, the working group shall pre6 pare and make available to the general public for com7 ment, an annual report on the activities of the working 

8 group. Such report shall include the recommendations of 

9 the working group for improving health workforce diver10 sity. 

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

12 is authorized to be appropriated to carry out this section, 

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

14 2010 through 2015. 

15 ‘‘SEC. 3113. TECHNICAL CLEARINGHOUSE FOR HEALTH 

16 WORKFORCE DIVERSITY. 

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

18 the Office of Minority Health, and in collaboration with 

19 the Bureau of Health Professions within the Health Re20 sources and Services Administration, the National Center 

21 on Minority Health and Health Disparities, shall establish 

22 a technical clearinghouse on health workforce diversity 

23 within the Office of Minority Health and coordinate cur24 rent and future clearinghouses. 


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1 ‘‘(b) INFORMATION AND SERVICES.—The clearing2 house established under subsection (a) shall offer the fol3 lowing information and services: 

4 ‘‘(1) Information on the importance of health 

5 workforce diversity. 

6 ‘‘(2) Statistical information relating to under7 represented minority representation in health and al8 lied health professions and occupations. 

9 ‘‘(3) Model health workforce diversity practices 

10 and programs. 

11 ‘‘(4) Admissions policies that promote health 

12 workforce diversity and are in compliance with Fed13 eral and State laws. 

14 ‘‘(5) Lists of scholarship, loan repayment, and 

15 loan cancellation grants as well as fellowship infor16 mation for underserved populations for health pro17 fessions schools. 

18 ‘‘(6) Foundation and other large organizational 

19 initiatives relating to health workforce diversity. 

20 ‘‘(c) CONSULTATION.—In carrying out this section, 

21 the Secretary shall consult with non-Federal entities which 

22 may include minority health professional associations to 

23 ensure the adequacy and accuracy of information. 

24 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

25 is authorized to be appropriated to carry out this section, 


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

2 2010 through 2015. 

3 ‘‘SEC. 3114. EVALUATION OF WORKFORCE DIVERSITY INI4 TIATIVES. 

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

6 the Bureau of Health Professions within the Health Re7 sources and Services Administration, shall award grants 

8 to eligible entities for the conduct of an evaluation of cur9 rent health workforce diversity initiatives funded by the 

10 Department of Health and Human Services. 

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

12 under subsection (a) an entity shall— 

13 ‘‘(1) be a city, county, Indian tribe, State, terri14 tory, community-based nonprofit organization, 

15 health center, university, college, or other entity de16 termined appropriate by the Secretary; 

17 ‘‘(2) with respect to an entity that is not an 

18 academic medical center, university, or private re19 search institution, carry out activities under the 

20 grant in partnership with an academic medical cen21 ter, university, or private research institution; and 

22 ‘‘(3) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 


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1 ‘‘(c) USE OF FUNDS.—Amounts awarded under a 

2 grant under subsection (a) shall be used to support the 

3 following evaluation activities: 

4 ‘‘(1) Determinations of measures of health 

5 workforce diversity success. 

6 ‘‘(2) The short- and long-term tracking of par7 ticipants in health workforce diversity pipeline pro8 grams funded by the Department of Health and 

9 Human Services. 

10 ‘‘(3) Assessments of partnerships formed 

11 through activities to increase health workforce diver12 sity. 

13 ‘‘(4) Assessments of barriers to health work14 force diversity. 

15 ‘‘(5) Assessments of policy changes at the Fed16 eral, State, and local levels. 

17 ‘‘(6) Assessments of coordination within and be18 tween Federal agencies and other institutions. 

19 ‘‘(7) Other activities determined appropriate by 

20 the Secretary and the Working Group established 

21 under section 3112. 

22 ‘‘(d) REPORT.—Not later than 1 year after the date 

23 of enactment of this title, the Bureau of Health Profes24 sions within the Health Resources and Services Adminis25 tration shall prepare and make available for public comVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00096 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 ment a report that summarizes the findings made by enti2 ties under grants under this section. 

3 ‘‘(e) 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 2010 through 2015. 

7 ‘‘SEC. 3115. DATA COLLECTION AND REPORTING BY 

8 HEALTH PROFESSIONAL SCHOOLS. 

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

10 the Bureau of Health Professions of the Health Resources 

11 and Services Administration and the Office of Minority 

12 Health, shall establish an aggregated database on health 

13 professional students. 

14 ‘‘(b) REQUIREMENT TO COLLECT DATA.—Each 

15 health professional school (including medical, dental, and 

16 nursing schools) and allied health profession school and 

17 program that receives Federal funds shall collect race, eth18 nicity, and language proficiency data concerning those stu19 dents enrolled at such schools or in such programs. In col20 lecting such data, a school or program shall— 

21 ‘‘(1) at a minimum, use the categories for race 

22 and ethnicity described in the 1997 Office of Man23 agement and Budget Standards for Maintaining, 

24 Collecting, and Presenting Federal Data on Race 

25 and Ethnicity and available language standards; and 


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1 ‘‘(2) if practicable, collect data on additional 

2 population groups if such data can be aggregated 

3 into the minimum race and ethnicity data categories. 

4 ‘‘(c) USE OF DATA.—Data on race, ethnicity, pri5 mary language, gender, and sexual orientation collected 

6 under this section shall be reported to the database estab7 lished under subsection (a) on an annual basis. Such data 

8 shall be available for public use. 

9 ‘‘(d) PRIVACY.—The Secretary shall ensure that all 

10 data collected under this section is protected from inap11 propriate internal and external use by any entity that col12 lects, stores, or receives the data and that such data is 

13 collected without personally identifiable information. 

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

15 is authorized to be appropriated to carry out this section, 

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

17 2010 through 2015. 

18 ‘‘SEC. 3116. SUPPORT FOR INSTITUTIONS COMMITTED TO 

19 WORKFORCE DIVERSITY. 

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

21 the Administrator of the Health Resources and Services 

22 Administration, shall award grants to eligible entities that 

23 demonstrate a commitment to health workforce diversity. 

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

25 under subsection (a), an entity shall— 


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1 ‘‘(1) be an educational institution or entity that 

2 historically produces or trains meaningful numbers 

3 of underrepresented minority health professionals, 

4 including— 

5 ‘‘(A) Historically Black Colleges and Uni6 versities; 

7 ‘‘(B) Hispanic-Serving Health Professions 

8 Schools; 

9 ‘‘(C) Hispanic-Serving Institutions; 

10 ‘‘(D) Tribal Colleges and Universities; 

11 ‘‘(E) Asian American and Pacific Islander12 serving institutions; 

13 ‘‘(F) institutions that have programs to re14 cruit and retain underrepresented minority 

15 health professionals, in which a significant 

16 number of the enrolled participants are under17 represented minorities; 

18 ‘‘(G) health professional associations, 

19 which may include underrepresented minority 

20 health professional associations; and 

21 ‘‘(H) institutions— 

22 ‘‘(i) located in communities with pre23 dominantly underrepresented minority pop24 ulations; 


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1 ‘‘(ii) with whom partnerships have 

2 been formed for the purpose of increasing 

3 workforce diversity; and 

4 ‘‘(iii) in which at least 20 percent of 

5 the enrolled participants are underrep6 resented minorities; 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.—Amounts received under a 

11 grant under subsection (a) shall be used to expand existing 

12 workforce diversity programs, implement new workforce 

13 diversity programs, or evaluate existing or new workforce 

14 diversity programs, including with respect to mental 

15 health care professions. Such programs shall enhance di16 versity by considering minority status as part of an indi17 vidualized consideration of qualifications. Possible activi18 ties may include— 

19 ‘‘(1) educational outreach programs relating to 

20 opportunities in the health professions; 

21 ‘‘(2) scholarship, fellowship, grant, loan repay22 ment, and loan cancellation programs; 

23 ‘‘(3) post-baccalaureate programs; 


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1 ‘‘(4) academic enrichment programs, particu2 larly targeting those who would not be competitive 

3 for health professions schools; 

4 ‘‘(5) kindergarten through 12th grade and 

5 other health pipeline programs; 

6 ‘‘(6) mentoring programs; 

7 ‘‘(7) internship or rotation programs involving 

8 hospitals, health systems, health plans and other 

9 health entities; 

10 ‘‘(8) community partnership development for 

11 purposes relating to workforce diversity; or 

12 ‘‘(9) leadership training. 

13 ‘‘(d) REPORTS.—Not later than 1 year after receiving 

14 a grant under this section, and annually for the term of 

15 the grant, a grantee shall submit to the Secretary a report 

16 that summarizes and evaluates all activities conducted 

17 under the grant. 

18 ‘‘(e) DEFINITION.—In this section, the term ‘Asian 

19 American and Pacific Islander-serving institutions’ means 

20 institutions— 

21 ‘‘(1) that are eligible institutions under section 

22 312(b) of the Higher Education Act of 1965; and 

23 ‘‘(2) that, at the time of their application, have 

24 an enrollment of undergraduate students that is 


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1 made up of at least 10 percent Asian American and 

2 Pacific Islander students. 

3 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

4 is authorized to be appropriated to carry out this section, 

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

6 2010 through 2015. 

7 ‘‘SEC. 3117. CAREER DEVELOPMENT FOR SCIENTISTS AND 

8 RESEARCHERS. 

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

10 the Director of the National Institutes of Health, the Di11 rector of the Centers for Disease Control and Prevention, 

12 the Commissioner of Food and Drugs, and the Director 

13 of the Agency for Healthcare Research and Quality, shall 

14 award grants that expand existing opportunities for sci15 entists and researchers and promote the inclusion of 

16 underrepresented minorities in the health professions. 

17 ‘‘(b) RESEARCH FUNDING.—The head of each entity 

18 within the Department of Health and Human Services 

19 shall establish or expand existing programs to provide re20 search funding to scientists and researchers in-training. 

21 Under such programs, the head of each such entity shall 

22 give priority in allocating research funding to support 

23 health research in traditionally underserved communities, 

24 including underrepresented minority communities, and re25 search classified as community or participatory. 


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1 ‘‘(c) DATA COLLECTION.—The head of each entity 

2 within the Department of Health and Human Services 

3 shall collect data on the number (expressed as an absolute 

4 number and a percentage) of underrepresented minority 

5 and nonminority applicants who receive and are denied 

6 agency funding at every stage of review. Such data shall 

7 be reported annually to the Secretary and the appropriate 

8 committees of Congress. 

9 ‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec10 retary shall establish a student loan reimbursement pro11 gram to provide student loan reimbursement assistance to 

12 researchers who focus on racial and ethnic disparities in 

13 health. The Secretary shall promulgate regulations to de14 fine the scope and procedures for the program under this 

15 subsection. 

16 ‘‘(e) STUDENT LOAN CANCELLATION.—The Sec17 retary shall establish a student loan cancellation program 

18 to provide student loan cancellation assistance to research19 ers who focus on racial and ethnic disparities in health. 

20 Students participating in the program shall make a min21 imum 5-year commitment to work at an accredited health 

22 profession school. The Secretary shall promulgate addi23 tional regulations to define the scope and procedures for 

24 the program under this subsection. 


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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

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

4 2010 through 2015. 

5 ‘‘SEC. 3118. CAREER SUPPORT FOR NON-RESEARCH 

6 HEALTH PROFESSIONALS. 

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

8 the Director of the Centers for Disease Control and Pre9 vention, the Administrator of the Substance Abuse and 

10 Mental Health Services Administration, the Administrator 

11 of the Health Resources and Services Administration, and 

12 the Administrator of the Centers for Medicare and Med13 icaid Services shall establish a program to award grants 

14 to eligible individuals for career support in non-research15 related healthcare. 

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

17 under subsection (a) an individual shall— 

18 ‘‘(1) be a student in a health professions school, 

19 a graduate of such a school who is working in a 

20 health profession, or a faculty member of such a 

21 school; and 

22 ‘‘(2) submit to the Secretary an application at 

23 such time, in such manner, and containing such in24 formation as the Secretary may require. 


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1 ‘‘(c) USE OF FUNDS.—An individual shall use 

2 amounts received under a grant under this section to— 

3 ‘‘(1) support the individual’s health activities or 

4 projects that involve underserved communities, in5 cluding racial and ethnic minority communities; 

6 ‘‘(2) support health-related career advancement 

7 activities; and 

8 ‘‘(3) to pay, or as reimbursement for payments 

9 of, student loans for individuals who are health pro10 fessionals and are focused on health issues affecting 

11 underserved communities, including racial and eth12 nic minority communities. 

13 ‘‘(d) DEFINITION.—In this section, the term ‘career 

14 in non-research-related healthcare’ means employment or 

15 intended employment in the field of public health, health 

16 policy, health management, health administration, medi17 cine, nursing, pharmacy, allied health, community health, 

18 or other fields determined appropriate by the Secretary, 

19 other than in a position that involves research. 

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

21 is authorized to be appropriated to carry out this section, 

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

23 2010 through 2015. 


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1 ‘‘SEC. 3119. RESEARCH ON THE EFFECT OF WORKFORCE DI2 VERSITY ON QUALITY. 

3 ‘‘(a) IN GENERAL.—The Director of the Agency for 

4 Healthcare Research and Quality, in collaboration with 

5 the Director of the Office of Minority Health and the Di6 rector of the National Center on Minority Health and 

7 Health Disparities, shall award grants to eligible entities 

8 to expand research on the link between health workforce 

9 diversity and quality healthcare. 

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 research entity or other entity determined ap14 propriate by the Director; and 

15 ‘‘(2) submit to the Secretary an application at 

16 such time, in such manner, and containing such in17 formation as the Secretary may require. 

18 ‘‘(c) USE OF FUNDS.—Amounts received under a 

19 grant awarded under subsection (a) shall be used to sup20 port research that investigates the effect of health work21 force diversity on— 

22 ‘‘(1) language access; 

23 ‘‘(2) cultural competence; 

24 ‘‘(3) patient satisfaction; 

25 ‘‘(4) timeliness of care; 

26 ‘‘(5) safety of care; 


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1 ‘‘(6) effectiveness of care; 

2 ‘‘(7) efficiency of care; 

3 ‘‘(8) patient outcomes; 

4 ‘‘(9) community engagement; 

5 ‘‘(10) resource allocation; 

6 ‘‘(11) organizational structure; 

7 ‘‘(12) other topics determined appropriate by 

8 the Director; or 

9 ‘‘(13) compliance of care. 

10 ‘‘(d) PRIORITY.—In awarding grants under sub11 section (a), the Director shall give individualized consider12 ation to all relevant aspects of the applicant’s background. 

13 Consideration of prior research experience involving the 

14 health of underserved communities shall be such a factor. 

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

16 is authorized to be appropriated to carry out this section, 

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

18 2010 through 2015. 

19 ‘‘SEC. 3120. HEALTH DISPARITIES EDUCATION PROGRAM. 

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

21 through the National Center on Minority Health and 

22 Health Disparities and in collaboration with the Office of 

23 Minority Health, the Office for Civil Rights, the Centers 

24 for Disease Control and Prevention, the Centers for Medi25 care and Medicaid Services, the Health Resources and 


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1 Services Administration, and other appropriate public and 

2 private entities, shall establish and coordinate a health and 

3 healthcare disparities education program to support, de4 velop, and implement educational initiatives and outreach 

5 strategies that inform healthcare professionals and the 

6 public about the existence of and methods to reduce racial 

7 and ethnic disparities in health and healthcare. 

8 ‘‘(b) ACTIVITIES.—The Secretary, through the edu9 cation program established under subsection (a) shall, 

10 through the use of public awareness and outreach cam11 paigns targeting the general public and the medical com12 munity at large— 

13 ‘‘(1) disseminate scientific evidence for the ex14 istence and extent of racial and ethnic disparities in 

15 healthcare, including disparities that are not other16 wise attributable to known factors such as access to 

17 care, patient preferences, or appropriateness of 

18 intervention, as described in the 2002 Institute of 

19 Medicine Report, Unequal Treatment; 

20 ‘‘(2) disseminate new research findings to 

21 healthcare providers and patients to assist them in 

22 understanding, reducing, and eliminating health and 

23 healthcare disparities; 

24 ‘‘(3) disseminate information about the impact 

25 of linguistic and cultural barriers on healthcare qualVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00108 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 ity and the obligation of health providers who receive 

2 Federal financial assistance to ensure that people 

3 with limited English proficiency have access to lan4 guage access services; 

5 ‘‘(4) disseminate information about the impor6 tance and legality of racial, ethnic, and primary lan7 guage data collection, analysis, and reporting; 

8 ‘‘(5) design and implement specific educational 

9 initiatives to health care providers relating to health 

10 and health care disparities; and 

11 ‘‘(6) assess the impact of the programs estab12 lished under this section in raising awareness of 

13 health and healthcare disparities and providing in14 formation on available resources. 

15 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

16 is authorized to be appropriated to carry out this section, 

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

18 2010 through 2015. 

19 ‘‘SEC. 3120A. CULTURAL COMPETENCE TRAINING FOR 

20 HEALTHCARE PROFESSIONALS. 

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

22 the Administrator of the Health Resources and Services 

23 Administration, the Director of the Office of Minority 

24 Health, and the Director of the National Center for Mi25 nority Health and Health Disparities, shall award grants 


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1 to eligible entities to test, implement, and evaluate models 

2 of cultural competence training, including continuing edu3 cation, for healthcare providers in coordination with the 

4 initiative under section 3120(a). 

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

6 under subsection (a), an entity shall— 

7 ‘‘(1) be an academic medical center, a health 

8 center or clinic, a hospital, a health plan, a health 

9 system, or a health care professional guild (including 

10 a mental health care professional guild); 

11 ‘‘(2) partner with a minority serving institution, 

12 minority professional association, or community13 based organization representing minority popu14 lations, in addition to a research institution to carry 

15 out activities under this grant; and 

16 ‘‘(3) prepare and submit to the Secretary an 

17 application at such time, in such manner, and con18 taining such information as the Secretary may re19 quire. 

20 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

21 is authorized to be appropriated to carry out this section, 

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

23 2010 through 2015.’’. 


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1 SEC. 202. HEALTH CAREERS OPPORTUNITY PROGRAM. 

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

3 diversify the healthcare workforce by increasing the num4 ber of individuals from disadvantaged backgrounds in the 

5 health and allied health professions by enhancing the aca6 demic skills of students from disadvantaged backgrounds 

7 and supporting them in successfully competing, entering, 

8 and graduating from health professions training pro9 grams. 

10 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

11 740(c) of the Public Health Service Act (42 U.S.C. 

12 293d(c)) is amended by striking ‘‘$29,400,000’’ and all 

13 that follows through ‘‘2002’’ and inserting ‘‘$50,000,000 

14 for fiscal year 2010, and such sums as may be necessary 

15 for each of fiscal years 2011 through 2015’’. 

16 SEC. 203. PROGRAM OF EXCELLENCE IN HEALTH PROFES17 SIONS EDUCATION FOR UNDERREP18 RESENTED MINORITIES. 

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

20 diversify the healthcare workforce by supporting programs 

21 of excellence in designated health professions schools that 

22 demonstrate a commitment to underrepresented minority 

23 populations with a focus on minority health issues, cul24 tural and linguistic competence, and eliminating health 

25 disparities. 


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1 (b) AUTHORIZATION OF APPROPRIATION.—Section 

2 736(h)(1) of the Public Health Service Act (42 U.S.C. 

3 293(h)(1)) is amended to read as follows: 

4 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

5 For the purpose of making grants under subsection 

6 (a), there are authorized to be appropriated 

7 $50,000,000 for fiscal year 2010, and such sums as 

8 may be necessary for each of the fiscal years 2011 

9 through 2015.’’. 

10 SEC. 204. HISPANIC-SERVING HEALTH PROFESSIONS 

11 SCHOOLS. 

12 Part B of title VII of the Public Health Service Act 

13 (42 U.S.C. 293 et seq.) is amended by adding at the end 

14 the following: 

15 ‘‘SEC. 742. HISPANIC-SERVING HEALTH PROFESSIONS 

16 SCHOOLS. 

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

18 the Administrator of the Health Resources and Services 

19 Administration, shall award grants to Hispanic-serving 

20 health professions schools for the purpose of carrying out 

21 programs to recruit Hispanic individuals to enroll in and 

22 graduate from such schools, which may include providing 

23 scholarships and other financial assistance as appropriate. 


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1 ‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His2 panic-serving health professions school’ means an entity 

3 that— 

4 ‘‘(1) is a school or program under section 

5 799B; 

6 ‘‘(2) has an enrollment of full-time equivalent 

7 students that is made up of at least 9 percent His8 panic students; 

9 ‘‘(3) has been effective in carrying out pro10 grams to recruit Hispanic individuals to enroll in 

11 and graduate from the school; 

12 ‘‘(4) has been effective in recruiting and retain13 ing Hispanic faculty members; and 

14 ‘‘(5) has a significant number of graduates who 

15 are providing health services to medically under16 served populations or to individuals in health profes17 sional shortage areas.’’. 

18 SEC. 205. HEALTH PROFESSIONS STUDENT LOAN FUND; AU19 THORIZATIONS OF APPROPRIATIONS RE20 GARDING STUDENTS FROM DISADVANTAGED 

21 BACKGROUNDS. 

22 Section 724(f)(1) of the Public Health Service Act 

23 (42 U.S.C. 292t(f)(1)) is amended by striking 

24 ‘‘$8,000,000’’ and all that follows and inserting 

25 ‘‘$35,000,000 for fiscal year 2010, and such sums as may 


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1 be necessary for each of the fiscal years 2011 through 

2 2015.’’. 

3 SEC. 206. NATIONAL HEALTH SERVICE CORPS; RECRUIT4 MENT AND FELLOWSHIPS FOR INDIVIDUALS 

5 FROM DISADVANTAGED BACKGROUNDS. 

6 (a) IN GENERAL.—Section 331(b) of the Public 

7 Health Service Act (42 U.S.C. 254d(b)) is amended by 

8 adding at the end the following: 

9 ‘‘(3) The Secretary shall ensure that the individuals 

10 with respect to whom activities under paragraphs (1) and 

11 (2) are carried out include individuals from disadvantaged 

12 backgrounds, including activities carried out to provide 

13 health professions students with information on the Schol14 arship and Repayment Programs.’’. 

15 (b) ASSIGNMENT OF CORPS PERSONNEL.—Section 

16 333(a) of the Public Health Service Act (42 U.S.C. 

17 254f(a)) is amended by adding at the end the following: 

18 ‘‘(4) In assigning Corps personnel under this section, 

19 the Secretary shall give preference to applicants who re20 quest assignment to a Federally-qualified health center (as 

21 defined in section 1905(l)(2)(B) of the Social Security 

22 Act) or to a provider organization that has a majority of 

23 patients who are minorities or individuals from low-income 

24 families (families with a family income that is less than 

25 200 percent of the Official Poverty Line).’’. 


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1 SEC. 207. 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 2010, and such sums as 

8 may be necessary for each of the fiscal years 2011 

9 through 2015.’’. 

10 SEC. 208. 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 204, 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 Director of the Office of Minority Health, 

24 shall award cooperative agreements to schools of public 

25 health and schools of allied health to design and imple26 ment online degree programs. 


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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 2010 through 2015.’’. 

19 SEC. 209. MID-CAREER HEALTH PROFESSIONS SCHOLAR20 SHIP PROGRAM. 

21 Part B of title VII of the Public Health Service Act 

22 (as amended by section 208) is further amended by adding 

23 at the end the following: 


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1 ‘‘SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLAR2 SHIP PROGRAM. 

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

4 to eligible schools for awarding scholarships to eligible in5 dividuals to attend the school involved, for the purpose of 

6 enabling the individuals to make a career change from a 

7 non-health profession to a health profession. 

8 ‘‘(b) EXPENSES.—Amounts awarded as a scholarship 

9 under this section— 

10 ‘‘(1) subject to paragraph (2), may be expended 

11 only for tuition expenses, other reasonable edu12 cational expenses, and reasonable living expenses in13 curred in the attendance of the school involved; and 

14 ‘‘(2) may be expended for stipends to eligible 

15 individuals for the enrolled period at eligible schools, 

16 except that such a stipend may not be provided to 

17 an individual for more than 4 years, and such a sti18 pend may not exceed $35,000 per year (notwith19 standing any other provision of law regarding the 

20 amount of stipends). 

21 ‘‘(c) DEFINITIONS.—In this section: 

22 ‘‘(1) ELIGIBLE SCHOOL.—The term ‘eligible 

23 school’ means a school of medicine, osteopathic med24 icine, dentistry, nursing (as defined in section 801), 

25 pharmacy, podiatric medicine, optometry, veterinary 

26 medicine, public health, chiropractic, or allied health, 


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1 a school offering a graduate program in mental and 

2 behavioral health practice, or an entity providing 

3 programs for the training of physician assistants 

4 and nurse midwives. 

5 ‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 

6 individual’ means an individual who has obtained a 

7 secondary school diploma or its recognized equiva8 lent. 

9 ‘‘(d) PRIORITY.—In providing scholarships to eligible 

10 individuals, eligible schools shall give to individuals from 

11 disadvantaged backgrounds. 

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 2010 through 2015.’’. 

16 SEC. 210. NATIONAL REPORT ON THE PREPAREDNESS OF 

17 HEALTH PROFESSIONALS TO CARE FOR DI18 VERSE POPULATIONS. 

19 The Secretary of Health and Human Services, in col20 laboration with the Bureau of Health Professions, the Of21 fice of Minority Health and the National Center on Minor22 ity Health and Health Disparities, shall prepare and dis23 seminate a report that details and assesses the prepared24 ness of health professionals to care for racially and eth25 nically diverse populations. Such information, which shall 


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1 be collected by the Bureau of Health Professions, shall 

2 include— 

3 (1) with respect to health professions education, 

4 the number and percentage of hours of classroom 

5 discussion relating to minority health issues, includ6 ing cultural competence; 

7 (2) a description of the coursework involved in 

8 such education; 

9 (3) a description of the results of an evaluation 

10 of the preparedness of students in such education; 

11 (4) a description of the types of exposure that 

12 students have during their education to minority pa13 tient populations; and 

14 (5) a description of model programs and prac15 tices. 

16 SEC. 211. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 

17 Subtitle A of title XXXI of the Public Health Service 

18 Act, as amended by section 201, is further amended by 

19 adding at the end the following: 

20 ‘‘SEC. 3120B. DAVID SATCHER PUBLIC HEALTH AND 

21 HEALTH SERVICES CORPS. 

22 ‘‘(a) IN GENERAL.—The Administrator of the Health 

23 Resources and Services Administration and Director of 

24 the Centers for Disease Control and Prevention, in col25 laboration with the Director of the Office of Minority 


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1 Health, shall award grants to eligible entities to increase 

2 awareness among post-primary and post-secondary stu3 dents of career opportunities in the health professions. 

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

5 under subsection (a) an entity shall— 

6 ‘‘(1) be a clinical, public health or health serv7 ices organization, community-based or non-profit en8 tity, or other entity determined appropriate by the 

9 Director of the Centers for Disease Control and Pre10 vention; 

11 ‘‘(2) serve a health professional shortage area, 

12 as determined by the Secretary; 

13 ‘‘(3) work with students, including those from 

14 racial and ethnic minority backgrounds, that have 

15 expressed an interest in the health professions; and 

16 ‘‘(4) submit to the Secretary an application at 

17 such time, in such manner, and containing such in18 formation as the Secretary may require. 

19 ‘‘(c) USE OF FUNDS.—Grant awards under sub20 section (a) shall be used to support internships that will 

21 increase awareness among students of non-research based 

22 and career opportunities in the following health profes23 sions: 

24 ‘‘(1) Medicine. 

25 ‘‘(2) Nursing. 


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1 ‘‘(3) Public Health. 

2 ‘‘(4) Pharmacy. 

3 ‘‘(5) Health Administration and Management. 

4 ‘‘(6) Health Policy. 

5 ‘‘(7) Psychology. 

6 ‘‘(8) Dentistry. 

7 ‘‘(9) International Health. 

8 ‘‘(10) Social Work. 

9 ‘‘(11) Allied Health. 

10 ‘‘(12) Psychiatry. 

11 ‘‘(13) Hospice care. 

12 ‘‘(14) Other professions deemed appropriate by 

13 the Director of the Centers for Disease Control and 

14 Prevention. 

15 ‘‘(d) PRIORITY.—In awarding grants under sub16 section (a), the Director of the Centers for Disease Con17 trol and Prevention shall give priority to those entities 

18 that— 

19 ‘‘(1) serve a high proportion of individuals from 

20 disadvantaged backgrounds; 

21 ‘‘(2) have experience in health disparity elimi22 nation programs; 

23 ‘‘(3) facilitate the entry of disadvantaged indi24 viduals into institutions of higher education; and 


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1 ‘‘(4) provide counseling or other services de2 signed to assist disadvantaged individuals in success3 fully completing their education at the post-sec4 ondary level. 

5 ‘‘(e) STIPENDS.—The Secretary may approve sti6 pends under this section for individuals for any period of 

7 education in student-enhancement programs (other than 

8 regular courses) at health professions schools, programs, 

9 or entities, except that such a stipend may not be provided 

10 to an individual for more than 6 months, and such a sti11 pend may not exceed $20 per day (notwithstanding any 

12 other provision of law regarding the amount of stipends). 

13 ‘‘(f) 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 2010 through 2015. 

17 ‘‘SEC. 3120C. LOUIS STOKES PUBLIC HEALTH SCHOLARS 

18 PROGRAM. 

19 ‘‘(a) IN GENERAL.—The Director of the Centers for 

20 Disease Control and Prevention, in collaboration with the 

21 Director of the Office of Minority Health, shall award 

22 scholarships to postsecondary students who seek a career 

23 in public health. 

24 ‘‘(b) ELIGIBILITY.—To be eligible to receive a schol25 arship under subsection (a) an individual shall— 


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1 ‘‘(1) have experience in public health research 

2 or public health practice, or other health professions 

3 as determined appropriate by the Director of the 

4 Centers for Disease Control and Prevention; 

5 ‘‘(2) reside in a health professional shortage 

6 area as determined by the Secretary; 

7 ‘‘(3) have expressed an interest in public health; 

8 ‘‘(4) demonstrate promise for becoming a leader 

9 in public health; 

10 ‘‘(5) secure admission to a 4-year institution of 

11 higher education; 

12 ‘‘(6) comply with subsection (f); and 

13 ‘‘(7) submit to the Secretary an application at 

14 such time, in such manner, and containing such in15 formation as the Secretary may require. 

16 ‘‘(c) USE OF FUNDS.—Amounts received under an 

17 award under subsection (a) shall be used to support oppor18 tunities for students to become public health professionals. 

19 ‘‘(d) PRIORITY.—In awarding grants under sub20 section (a), the Director shall give priority to those stu21 dents that— 

22 ‘‘(1) are from disadvantaged backgrounds; 

23 ‘‘(2) have secured admissions to a minority 

24 serving institution; and 


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1 ‘‘(3) have identified a health professional as a 

2 mentor at their school or institution and an aca3 demic advisor to assist in the completion of their 

4 baccalaureate degree. 

5 ‘‘(e) SCHOLARSHIPS.—The Secretary may approve 

6 payment of scholarships under this section for such indi7 viduals for any period of education in student under8 graduate tenure, except that such a scholarship may not 

9 be provided to an individual for more than 4 years, and 

10 such scholarships may not exceed $10,000 per academic 

11 year (notwithstanding any other provision of law regard12 ing the amount of scholarship). 

13 ‘‘(f) 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 2010 through 2015. 

17 ‘‘SEC. 3120D. PATSY MINK HEALTH AND GENDER RESEARCH 

18 FELLOWSHIP PROGRAM. 

19 ‘‘(a) IN GENERAL.—The Director of the Centers for 

20 Disease Control and Prevention, in collaboration with the 

21 Director of the Office of Minority Health, the Adminis22 trator of the Substance Abuse and Mental Health Services 

23 Administration, and the Director of the Indian Health 

24 Services, shall award research fellowships to post-bacca25 laureate students to conduct research that will examine 


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1 gender and health disparities and to pursue a career in 

2 the health professions. 

3 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow4 ship under subsection (a) an individual shall— 

5 ‘‘(1) have experience in health research or pub6 lic health practice; 

7 ‘‘(2) reside in a health professional shortage 

8 area as determined by the Secretary; 

9 ‘‘(3) have expressed an interest in the health 

10 professions; 

11 ‘‘(4) demonstrate promise for becoming a leader 

12 in the field of women’s health; 

13 ‘‘(5) secure admission to a health professions 

14 school or graduate program with an emphasis in 

15 gender studies; 

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 researchers and advance 

23 the research base on the intersection between gender and 

24 health. 


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1 ‘‘(d) PRIORITY.—In awarding grants under sub2 section (a), the Director of the Centers for Disease Con3 trol and Prevention shall give priority to those applicants 

4 that— 

5 ‘‘(1) are from disadvantaged backgrounds; and 

6 ‘‘(2) have identified a mentor and academic ad7 visor who will assist in the completion of their grad8 uate or professional degree and have secured a re9 search assistant position with a researcher working 

10 in the area of gender and health. 

11 ‘‘(e) FELLOWSHIPS.—The Director of the Centers for 

12 Disease Control and Prevention may approve fellowships 

13 for individuals under this section for any period of edu14 cation in the student’s graduate or health profession ten15 ure, except that such a fellowship may not be provided 

16 to an individual for more than 3 years, and such a fellow17 ship may not exceed $18,000 per academic year (notwith18 standing any other provision of law regarding the amount 

19 of fellowship). 

20 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

21 is authorized to be appropriated to carry out this section, 

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

23 2010 through 2015. 


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1 ‘‘SEC. 3120E. PAUL DAVID WELLSTONE INTERNATIONAL 

2 HEALTH FELLOWSHIP PROGRAM. 

3 ‘‘(a) IN GENERAL.—The Director of the Agency for 

4 Healthcare Research and Quality, in collaboration with 

5 the Director of the Office of Minority Health, shall award 

6 research fellowships to college students or recent grad7 uates to advance their understanding of international 

8 health. 

9 ‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow10 ship under subsection (a) an individual shall— 

11 ‘‘(1) have educational experience in the field of 

12 international health; 

13 ‘‘(2) reside in a health professional shortage 

14 area as determined by the Secretary; 

15 ‘‘(3) demonstrate promise for becoming a leader 

16 in the field of international health; 

17 ‘‘(4) be a college senior or recent graduate of 

18 a four year higher education institution; 

19 ‘‘(5) comply with subsection (f); and 

20 ‘‘(6) submit to the Secretary an application at 

21 such time, in such manner, and containing such in22 formation as the Secretary may require. 

23 ‘‘(c) USE OF FUNDS.—Amounts received under an 

24 award under subsection (a) shall be used to support oppor25 tunities for students to become health professionals and 


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1 to advance their knowledge about international issues re2 lating to healthcare access and quality. 

3 ‘‘(d) PRIORITY.—In awarding grants under sub4 section (a), the Director shall give priority to those appli5 cants that— 

6 ‘‘(1) are from a disadvantaged background; and 

7 ‘‘(2) have identified a mentor at a health pro8 fessions school or institution, an academic advisor to 

9 assist in the completion of their graduate or profes10 sional degree, and an advisor from an international 

11 health Non-Governmental Organization, Private Vol12 unteer Organization, or other international institu13 tion or program that focuses on increasing 

14 healthcare access and quality for residents in devel15 oping countries. 

16 ‘‘(e) FELLOWSHIPS.—The Secretary shall approve 

17 fellowships for college seniors or recent graduates, except 

18 that such a fellowship may not be provided to an indi19 vidual for more than 6 months, may not be awarded to 

20 a graduate that has not been enrolled in school for more 

21 than 1 year, and may not exceed $4,000 per academic year 

22 (notwithstanding any other provision of law regarding the 

23 amount of fellowship). 

24 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

25 is authorized to be appropriated to carry out this section, 


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

2 2010 through 2015. 

3 ‘‘SEC. 3120F. EDWARD R. ROYBAL HEALTHCARE 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 and Medicare, and the Administrator for 

8 Health Resources and Services Administration, in collabo9 ration with the Director of the Office of Minority Health, 

10 shall award grants to eligible entities to expose entering 

11 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 non-profit 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. 


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1 ‘‘(c) USE OF FUNDS.—Amounts received under a 

2 grant awarded under subsection (a) shall be used to sup3 port opportunities that expose students to non-research 

4 based health professions, including— 

5 ‘‘(1) public health policy; 

6 ‘‘(2) healthcare and pharmaceutical policy; 

7 ‘‘(3) healthcare 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 post-secondary level. 

24 ‘‘(e) STIPENDS.—The Secretary may approve the 

25 payment of stipends for individuals under this section for 


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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 2010 through 2015.’’. 

11 SEC. 212. 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. 


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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 


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(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 


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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.— 


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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. 213. 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: 


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1 ‘‘(g) COLLABORATION IN HEALTH PROFESSION DI2 VERSITY TRAINING PROGRAMS.—The Secretary of Edu3 cation shall coordinate with the Secretary of Health and 

4 Human Services to ensure that there is collaboration be5 tween the goals of the program under this section and pro6 grams of the Health Resources and Services Administra7 tion that promote health workforce diversity. The Sec8 retary of Education shall take such measures as may be 

9 necessary to encourage participants in programs under 

10 this section to 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 2010 

16 through 2016.’’. 

17 TITLE III—DATA COLLECTION 

18 AND REPORTING 

19 SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

20 ACT. 

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

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

23 ethnicity, and primary language among federally sup24 ported health programs. 


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1 (b) AMENDMENT.—Title XXXI of the Public Health 

2 Service Act, as amended by title II of this Act, is further 

3 amended by adding at the end the following: 

4 ‘‘Subtitle B—Strengthening Data 

5 Collection, Improving Data 

6 Analysis, and Expanding Data 

7 Reporting 

8 ‘‘SEC. 3131. DATA ON RACE, ETHNICITY, AND PRIMARY LAN9 GUAGE. 

10 ‘‘(a) REQUIREMENTS.— 

11 ‘‘(1) IN GENERAL.—Each health-related pro12 gram operated by or that receives funding or reim13 bursement, in whole or in part, either directly or in14 directly from the Department of Health and Human 

15 Services shall— 

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

17 or program involved, of data on the race, eth18 nicity, primary language, and sexual orientation 

19 of each applicant for and recipient of health-re20 lated assistance under such program— 

21 ‘‘(i) using, at a minimum, the cat22 egories for race and ethnicity described in 

23 the 1997 Office of Management and Budg24 et Standards for Maintaining, Collecting, 


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1 and Presenting Federal Data on Race and 

2 Ethnicity; 

3 ‘‘(ii) using the standards developed 

4 under subsection (e) for the collection of 

5 language data; 

6 ‘‘(iii) collecting data for additional 

7 population groups if such groups can be 

8 aggregated into the minimum race and 

9 ethnicity categories; and 

10 ‘‘(iv) where practicable, through self11 report; 

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

13 data described in subparagraph (A) for appli14 cants and recipients who are minors or other15 wise legally incapacitated, require that— 

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

17 parent or legal guardian of such an appli18 cant or recipient; and 

19 ‘‘(ii) the preferred language of the 

20 parent or legal guardian of such an appli21 cant or recipient be collected; 

22 ‘‘(C) systematically analyze such data 

23 using the smallest appropriate units of analysis 

24 feasible to detect racial and ethnic disparities as 

25 well as disparities along lines of sexual orientaVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 tion in health and health care and when appro2 priate, for men and women separately, and re3 port the results of such analysis to the Sec4 retary, the Director of the Office for Civil 

5 Rights, the Committee on Health, Education, 

6 Labor, and Pensions and the Committee on Fi7 nance of the Senate, and the Committee on En8 ergy and Commerce and the Committee on 

9 Ways and Means of the House of Representa10 tives; 

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

12 at least an annual basis; and 

13 ‘‘(E) ensure that the provision of assist14 ance to an applicant or recipient of assistance 

15 is not denied or otherwise adversely affected be16 cause of the failure of the applicant or recipient 

17 to provide race, ethnicity, primary language, 

18 gender, and sexual orientation data. 

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

20 this subsection shall be construed to— 

21 ‘‘(A) permit the use of information col22 lected under this subsection in a manner that 

23 would adversely affect any individual providing 

24 any such information; and 


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1 ‘‘(B) require health care providers to col2 lect data. 

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

4 ensure (through the promulgation of regulations or other5 wise) that all data collected pursuant to subsection (a) is 

6 protected— 

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

8 Secretary applies to other health data under the reg9 ulations promulgated under section 264(c) of the 

10 Health Insurance Portability and Accountability Act 

11 of 1996 (Public Law 104–191; 110 Stat. 2033) re12 lating to the privacy of individually identifiable 

13 health information and other protections; and 

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

15 entity that collects, stores, or receives the data, in16 cluding use of such data in determinations of eligi17 bility (or continued eligibility) in health plans, and 

18 from other inappropriate uses, as defined by the 

19 Secretary. 

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

21 Secretary shall develop and implement a national plan to 

22 ensure the collection of data in a culturally appropriate 

23 and competent manner, and to improve the collection, 

24 analysis, and reporting of racial, ethnic, and primary lan25 guage data at the Federal, State, territorial, Tribal, and 


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1 local levels, including data to be collected under subsection 

2 (a). The Data Council of the Department of Health and 

3 Human Services, in consultation with the National Com4 mittee on Vital Health Statistics, the Office of Minority 

5 Health, and other appropriate public and private entities, 

6 shall make recommendations to the Secretary concerning 

7 the development, implementation, and revision of the na8 tional plan. Such plan shall include recommendations on 

9 how to— 

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

11 the cost and administrative burdens of data collec12 tion and reporting; 

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

14 States, territories, Indian tribes, health providers, 

15 health plans, health insurance issuers, and the gen16 eral public that data collection, analysis, and report17 ing by race, ethnicity, and primary language is legal 

18 and necessary to assure equity and non-discrimina19 tion in the quality of health care services; 

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

21 have data code sets for racial, ethnic, primary lan22 guage, and sexual orientation identifiers and that 

23 such identifiers can be retrieved from clinical 

24 records, including records transmitted electronically; 


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1 ‘‘(4) improve health and health care data collec2 tion and analysis for more population groups if such 

3 groups can be aggregated into the minimum race 

4 and ethnicity categories, including exploring the fea5 sibility of enhancing collection efforts in States for 

6 racial and ethnic groups that comprise a significant 

7 proportion of the population of the State; 

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

9 racial, ethnic, and primary language data, subject to 

10 privacy and confidentiality regulations; and 

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

12 collected under subsection (a). 

13 ‘‘(d) COMPLIANCE WITH STANDARDS.—Data col14 lected under subsection (a) shall be obtained, maintained, 

15 and presented (including for reporting purposes) in ac16 cordance with the 1997 Office of Management and Budget 

17 Standards for Maintaining, Collecting, and Presenting 

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

19 ‘‘(e) LANGUAGE COLLECTION STANDARDS.—Not 

20 later than 1 year after the date of enactment of this title, 

21 the Deputy Assistant Secretary for Minority Health, in 

22 consultation with the Office for Civil Rights of the Depart23 ment of Health and Human Services, shall develop and 

24 disseminate Standards for the Classification of Federal 

25 Data on Preferred Written and Spoken Language. 


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1 ‘‘(f) TECHNICAL ASSISTANCE FOR THE COLLECTION

2 AND REPORTING OF DATA.— 

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

4 directly or through grant or contract, provide tech5 nical assistance to enable a health care program or 

6 an entity operating under such program to comply 

7 with the requirements of this section. 

8 ‘‘(2) TYPES OF ASSISTANCE.—Assistance pro9 vided under this subsection may include assistance 

10 to— 

11 ‘‘(A) enhance or upgrade computer tech12 nology that will facilitate racial, ethnic, and pri13 mary language data collection and analysis; 

14 ‘‘(B) improve methods for health data col15 lection and analysis including additional popu16 lation groups beyond the Office of Management 

17 and Budget categories if such groups can be 

18 aggregated into the minimum race and ethnicity 

19 categories; 

20 ‘‘(C) develop mechanisms for submitting 

21 collected data subject to existing privacy and 

22 confidentiality regulations; and 

23 ‘‘(D) develop educational programs to in24 form health insurance issuers, health plans, 

25 health providers, health-related agencies, and 


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1 the general public that data collection and re2 porting by race, ethnicity, and preferred lan3 guage are legal and essential for eliminating 

4 health and health care disparities. 

5 ‘‘(g) ANALYSIS OF RACIAL AND ETHNIC DATA.—The 

6 Secretary, acting through the Director of the Agency for 

7 Healthcare Research and Quality and in coordination with 

8 the Administrator of the Centers for Medicare & Medicaid 

9 Services, shall provide technical assistance to agencies of 

10 the Department of Health and Human Services in meeting 

11 Federal standards for race, ethnicity, and primary lan12 guage data collection and analysis of racial and ethnic dis13 parities in health and health care in public programs by— 

14 ‘‘(1) identifying appropriate quality assurance 

15 mechanisms to monitor for health disparities; 

16 ‘‘(2) specifying the clinical, diagnostic, or thera17 peutic measures which should be monitored; 

18 ‘‘(3) developing new quality measures relating 

19 to racial and ethnic disparities in health and health 

20 care; 

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

22 should be conducted; and 

23 ‘‘(5) sharing data with external organizations 

24 for research and quality improvement purposes. 


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

2 of enactment of this title, and biennially thereafter, the 

3 Secretary shall submit to the appropriate committees of 

4 Congress a report on the effectiveness of data collection, 

5 analysis, and reporting on race, ethnicity, and primary 

6 language under the programs and activities of the Depart7 ment of Health and Human Services and under other Fed8 eral data collection systems with which the Department 

9 interacts to collect relevant data on race and ethnicity. 

10 The report shall evaluate the progress made in the De11 partment with respect to the national plan under sub12 section (c) or subsequent revisions thereto. 

13 ‘‘(i) DEFINITION.—In this section, the term ‘health14 related program’ mean a program— 

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

16 301 et seq.) that pay for health care and services; 

17 and 

18 ‘‘(2) under this Act that provide Federal finan19 cial assistance for health care, biomedical research, 

20 health services research, and programs designed to 

21 improve the public’s health. 

22 ‘‘(j) AUTHORIZATION OF APPROPRIATIONS.—There 

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

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

25 2010 through 2015. 


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1 ‘‘SEC. 3132. PROVISIONS RELATING TO NATIVE AMERICANS. 

2 ‘‘(a) ESTABLISHMENT OF EPIDEMIOLOGY CEN3 TERS.—The Secretary shall establish an epidemiology cen4 ter in each service area to carry out the functions de5 scribed in subsection (b). Any new center established after 

6 the date of the enactment of the Health Equity and Ac7 countability Act of 2009 may be operated under a grant 

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

9 grant shall not be divisible. 

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

11 and upon the request of Indian Tribes, Tribal Organiza12 tions, and Urban Indian Organizations, each service area 

13 epidemiology center established under this subsection 

14 shall, with respect to such service area— 

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

16 progress made toward meeting, each of the health 

17 status objectives of the Service, the Indian Tribes, 

18 Tribal Organizations, and Urban Indian Organiza19 tions in the service area; 

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

21 systems, and other systems that impact the improve22 ment of Indian health; 

23 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

24 and Urban Indian Organizations in identifying their 

25 highest priority health status objectives and the 


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1 services needed to achieve such objectives, based on 

2 epidemiological data; 

3 ‘‘(4) make recommendations for the targeting 

4 of services needed by the populations served; 

5 ‘‘(5) make recommendations to improve health 

6 care delivery systems for Indians and Urban Indi7 ans; 

8 ‘‘(6) provide requested technical assistance to 

9 Indian Tribes, Tribal Organizations, and Urban In10 dian Organizations in the development of local 

11 health service priorities and incidence and prevalence 

12 rates of disease and other illness in the community; 

13 and 

14 ‘‘(7) provide disease surveillance and assist In15 dian Tribes, Tribal Organizations, and Urban Indian 

16 Organizations to promote public health. 

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

18 Centers for Disease Control and Prevention shall provide 

19 technical assistance to the centers in carrying out the re20 quirements of this subsection. 

21 ‘‘(d) GRANTS FOR STUDIES.— 

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

23 grants to Indian Tribes, Tribal Organizations, 

24 Urban Indian Organizations, and eligible intertribal 


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1 consortia to conduct epidemiological studies of In2 dian communities. 

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

4 intertribal consortium is eligible to receive a grant 

5 under this subsection if— 

6 ‘‘(A) the intertribal consortium is incor7 porated for the primary purpose of improving 

8 Indian health; and 

9 ‘‘(B) the intertribal consortium is rep10 resentative of the Indian Tribes or urban In11 dian communities in which the intertribal con12 sortium is located. 

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

14 grant under this subsection shall be submitted in 

15 such manner and at such time as the Secretary shall 

16 prescribe. 

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

18 grant under this subsection shall— 

19 ‘‘(A) demonstrate the technical, adminis20 trative, and financial expertise necessary to 

21 carry out the functions described in paragraph 

22 (5); 

23 ‘‘(B) consult and cooperate with providers 

24 of related health and social services in order to 

25 avoid duplication of existing services; and 


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1 ‘‘(C) demonstrate cooperation from Indian 

2 tribes or Urban Indian Organizations in the 

3 area to be served. 

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

5 paragraph (1) may be used— 

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

7 in subsection (b); 

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

9 with tribal leaders, urban Indian community 

10 leaders, and related health staff on health care 

11 and health service management issues; and 

12 ‘‘(C) in collaboration with Indian Tribes, 

13 Tribal Organizations, and urban Indian com14 munities, to provide the Service with informa15 tion regarding ways to improve the health sta16 tus of Indians. 

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

18 center operated by a grantee pursuant to a grant awarded 

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

20 authority for purposes of the Health Insurance Portability 

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

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

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

24 regulation). The Secretary shall grant such grantees ac25 cess to and use of data, data sets, monitoring systems, 


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1 delivery systems, and other protected health information 

2 in the possession of the Secretary.’’. 

3 SEC. 302. COLLECTION OF RACE AND ETHNICITY DATA BY 

4 THE SOCIAL SECURITY ADMINISTRATION. 

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

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

7 the following: 

8 ‘‘SEC. 1150A. COLLECTION OF RACE AND ETHNICITY DATA 

9 BY THE SOCIAL SECURITY ADMINISTRATION. 

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

11 Security, in consultation with the Administrator of the 

12 Centers for Medicare & Medicaid Services, shall— 

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

14 ethnicity, and primary language of all applicants for 

15 social security account numbers or benefits under 

16 title II or part A of title XVIII and all individuals 

17 with respect to whom the Commissioner maintains 

18 records of wages and self-employment income in ac19 cordance with reports received by the Commissioner 

20 or the Secretary of the Treasury— 

21 ‘‘(A) using, at a minimum, the categories 

22 for race and ethnicity described in the 1997 Of23 fice of Management and Budget Standards for 

24 Maintaining, Collecting, and Presenting Federal 


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1 Data on Race and Ethnicity and available lan2 guage standards; and 

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

4 additional population groups if such groups can 

5 be aggregated into the minimum race and eth6 nicity categories; 

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

8 described in paragraph (1) for applicants who are 

9 under 18 years of age or otherwise legally incapaci10 tated, require that— 

11 ‘‘(A) such data be collected from the par12 ent or legal guardian of such an applicant; and 

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

14 or legal guardian of such an applicant or recipi15 ent be used; 

16 ‘‘(3) require that such data be uniformly ana17 lyzed and reported at least annually to the Commis18 sioner of Social Security; 

19 ‘‘(4) be responsible for storing the data re20 ported under paragraph (3); 

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

22 Medicare & Medicaid Services and other Federal 

23 health agencies; 

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

25 least an annual basis; and 


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

2 an applicant is not denied or otherwise adversely af3 fected because of the failure of the applicant to pro4 vide race, ethnicity, and primary language data. 

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

6 Social Security shall ensure (through the promulgation of 

7 regulations or otherwise) that all data collected pursuant 

8 subsection (a) is protected— 

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

10 Secretary applies to health data under the regula11 tions promulgated under section 264(c) of the 

12 Health Insurance Portability and Accountability Act 

13 of 1996 (Public Law 104–191; 110 Stat. 2033) re14 lating to the privacy of individually identifiable 

15 health information and other protections; and 

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

17 entity that collects, stores, or receives the data, in18 cluding use of such data in determinations of eligi19 bility (or continued eligibility) in health plans, and 

20 from other inappropriate uses, as defined by the 

21 Secretary. 

22 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec23 tion shall be construed to permit the use of information 

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1 versely affect any individual providing any such informa2 tion. 

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

4 either directly or by grant or contract, provide technical 

5 assistance to enable any health entity to comply with the 

6 requirements of this section. 

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

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

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

10 2010 through 2015.’’. 

11 SEC. 303. REVISION OF HIPAA CLAIMS STANDARDS. 

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

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

14 Human Services shall revise the regulations promulgated 

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

16 U.S.C. 1320d et seq.), as added by the Health Insurance 

17 Portability and Accountability Act of 1996 (Public Law 

18 104–191), relating to the collection of data on race, eth19 nicity, and primary language in a health-related trans20 action to require— 

21 (1) the use, at a minimum, of the categories for 

22 race and ethnicity described in the 1997 Office of 

23 Management and Budget Standards for Maintain24 ing, Collecting, and Presenting Federal Data on 

25 Race and Ethnicity; 


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1 (2) the establishment of a new data code set for 

2 primary language; and 

3 (3) the designation of the racial, ethnic, and 

4 primary language code sets as ‘‘required’’ for claims 

5 and enrollment data. 

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

7 Human Services shall disseminate the new standards de8 veloped under subsection (a) to all health entities that are 

9 subject to the regulations described in such subsection and 

10 provide technical assistance with respect to the collection 

11 of the data involved. 

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

13 Human Services shall require that health entities comply 

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

15 later than 2 years after the final promulgation of such 

16 standards. 

17 SEC. 304. NATIONAL CENTER FOR HEALTH STATISTICS. 

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

19 U.S.C. 242k(n)) is amended— 

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

21 inserting ‘‘2014’’; 

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

23 striking ‘‘2003’’ and inserting ‘‘2014’’; and 

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

25 inserting ‘‘2014’’. 


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1 SEC. 305. GEO-ACCESS STUDY. 

2 The Administrator of the Substance Abuse and Men3 tal Health Services Administration shall— 

4 (1) conduct a study to— 

5 (A) determine which geographic areas of 

6 the United States have shortages of specialty 

7 mental health providers; and 

8 (B) assess the preparedness of speciality 

9 mental health providers to deliver culturally and 

10 linguistically appropriate services; and 

11 (2) submit a report to the Congress on the re12 sults of such study. 

13 SEC. 306. RACIAL, ETHNIC, AND LINGUISTIC DATA COL14 LECTED BY THE FEDERAL GOVERNMENT. 

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

16 days after the date of the enactment of this Act, and Jan17 uary 31st of each year thereafter, each department, agen18 cy, and office of the Federal Government that has col19 lected racial, ethnic, or linguistic data during the pre20 ceding calendar year shall submit such data to the Sec21 retary of Health and Human Services. 

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

23 Not later than April 30, 2010, and each April 30th there24 after, the Secretary of Health and Human Services, acting 

25 through the Director of the National Center on Minority 


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1 Health and Health Disparities and the Deputy Assistant 

2 Secretary for Minority Health, shall— 

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

4 linguistic data submitted under subsection (a) for 

5 the preceding calendar year; 

6 (2) make publicly available such data and the 

7 results of such analysis; and 

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

9 data and analysis. 

10 SEC. 307. HEALTH INFORMATION TECHNOLOGY GRANTS. 

11 (a) AUTHORITY.—The Deputy Assistant Secretary 

12 for Minority Health, in coordination with the Office of the 

13 National Coordinator for Health Information Technology, 

14 the Health Resources and Services Administration, the 

15 Substance Abuse and Mental Health Services Administra16 tion, and the National Center on Minority Health and 

17 Health Disparities, may award grants to appropriate enti18 ties for the purpose of ensuring appropriate and best prac19 tices to collect appropriate data and documents on the re20 duction of health disparities. 

21 (b) USE OF FUNDS.—A grant received under sub22 section (a) shall be used to achieve the purpose described 

23 in such subsection through one or more of the following: 

24 (1) Purchasing new, or enhancing existing, 

25 health information technology. 


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1 (2) Providing support and training to providers 

2 concerning such technology. 

3 (3) Conducting outreach and education on 

4 health information technology and its benefits to pa5 tients, physicians, allied health professionals, and 

6 advocacy groups in medically underserved commu7 nities (as defined in section 799B of the Public 

8 Health Service Act (42 U.S.C. 295p)). 

9 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

10 out this section, there are authorized to be appropriated 

11 $20,000,000 for each of fiscal years 2010 through 2015. 

12 SEC. 308. STUDY OF HEALTH INFORMATION TECHNOLOGY 

13 IN MEDICALLY UNDERSERVED COMMU14 NITIES. 

15 (a) STUDY.—The National Coordinator for Health 

16 Information Technology shall conduct a study on the de17 velopment and implementation of health information tech18 nology in medically underserved communities. The study 

19 shall— 

20 (1) identify barriers to successful implementa21 tion of health information technology in these com22 munities; 

23 (2) examine the impact of health information 

24 technology on providing quality care and reducing 

25 the cost of care to these communities; 


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1 (3) examine urban and rural community health 

2 systems and determine the impact that health infor3 mation technology may have on the capacity of pri4 mary health providers; and 

5 (4) assess the feasibility and the costs of associ6 ated with the use of health information technology 

7 in these communities. 

8 (b) REPORT.—Not later than 18 months after the 

9 date of the enactment of this Act, the National Coordi10 nator for Health Information Technology shall submit to 

11 the Congress a report on the study conducted under sub12 section (a) and shall include in such report such rec13 ommendations for legislation or administrative action as 

14 the Coordinator determines appropriate. 

15 SEC. 309. HEALTH INFORMATION TECHNOLOGY IN MEDI16 CALLY UNDERSERVED COMMUNITIES. 

17 The National Coordinator for Health Information 

18 Technology shall— 

19 (1) identify sources of funds that will be made 

20 available to promote and support the planning and 

21 adoption of health information technology in medi22 cally underserved communities (as defined in section 

23 799B of the Public Health Service Act (42 U.S.C. 

24 295p)), including in urban and rural areas, either 

25 through grants or technical assistance; 


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1 (2) coordinate with the funding sources to help 

2 such communities connect to identified funding; and 

3 (3) collaborate with the Agency for Healthcare 

4 Research and Quality, the Health Resources and 

5 Services Administration, and other Federal agencies 

6 to support technical assistance, knowledge dissemi7 nation, and resource development, to such commu8 nities seeking to plan for and adopt technology and 

9 establish electronic health information networks 

10 across providers. 

11 SEC. 310. DATA COLLECTION AND ANALYSIS GRANTS TO MI12 NORITY-SERVING INSTITUTIONS. 

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

14 Human Services, acting through the Center on Minority 

15 Health and Health Disparities and the Office of Minority 

16 Health, may award grants to access and analyze racial and 

17 ethnic, and where possible, primary language data to mon18 itor and report on progress to reduce and eliminate racial 

19 and ethnic disparities in health and health care. 

20 (b) ELIGIBLE ENTITY.—In this section, the term ‘‘el21 igible entity’’ means a historically Black college or univer22 sity, an Hispanic-serving institution, a tribal college or 

23 university, or an Asian American and Pacific Islander24 serving institution with an accredited public health, health 

25 policy, or health services research program. 


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1 SEC. 311. HEALTH INFORMATION TECHNOLOGY GRANTS 

2 FOR RURAL HEALTH CARE PROVIDERS. 

3 Title II of the Public Health Service Act is amended 

4 by adding at the end the following new part: 

5 ‘‘PART D—HEALTH INFORMATION TECHNOLOGY 

6 GRANTS 

7 ‘‘SEC. 271. GRANTS TO FACILITATE THE WIDESPREAD 

8 ADOPTION OF INTEROPERABLE HEALTH IN9 FORMATION TECHNOLOGY IN RURAL AREAS. 

10 ‘‘(a) COMPETITIVE GRANTS TO ELIGIBLE ENTITIES

11 IN RURAL AREAS.— 

12 ‘‘(1) IN GENERAL.—The Secretary may award 

13 competitive grants to eligible entities in rural areas 

14 to facilitate the purchase and enhance the utilization 

15 of qualified health information technology systems to 

16 improve the quality and efficiency of health care. 

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

18 grant under paragraph (1) an entity shall— 

19 ‘‘(A) submit to the Secretary an applica20 tion at such time, in such manner, and con21 taining such information as the Secretary may 

22 require; 

23 ‘‘(B) submit to the Secretary a strategic 

24 plan for the implementation of data sharing 

25 and interoperability measures; 

26 ‘‘(C) be a rural health care provider; 


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1 ‘‘(D) adopt any applicable core interoper2 ability guidelines (endorsed under other provi3 sions of law); 

4 ‘‘(E) agree to notify patients if their indi5 vidually identifiable health information is 

6 wrongfully disclosed; 

7 ‘‘(F) demonstrate significant financial 

8 need; and 

9 ‘‘(G) provide matching funds in accordance 

10 with paragraph (4). 

11 ‘‘(3) USE OF FUNDS.—Amounts received under 

12 a grant under this subsection shall be used to facili13 tate the purchase and enhance the utilization of 

14 qualified health information technology systems and 

15 training personnel in the use of such technology. 

16 ‘‘(4) MATCHING REQUIREMENT.—To be eligible 

17 for a grant under this subsection an entity shall con18 tribute non-Federal contributions to the costs of car19 rying out the activities for which the grant is award20 ed in an amount equal to $1 for each $3 of Federal 

21 funds provided under the grant. 

22 ‘‘(5) LIMIT ON GRANT AMOUNT.—In no case 

23 shall the payment amount under this subsection with 

24 respect to the purchase or enhanced utilization of 

25 qualified health information technology for a rural 


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1 health care provider, in addition to the amount of 

2 any loan made to the provider from a grant to a 

3 State under subsection (b) for such purpose, exceed 

4 100 percent of the provider’s costs for such purchase 

5 or enhanced utilization (taking into account costs for 

6 training, implementation, and maintenance). 

7 ‘‘(6) PREFERENCE IN AWARDING GRANTS.—In 

8 awarding grants to eligible entities under this sub9 section, the Secretary shall give preference to each 

10 of the following types of applicants: 

11 ‘‘(A) An entity that is located in a frontier 

12 or other rural underserved area as determined 

13 by the Secretary. 

14 ‘‘(B) An entity that will link, to the extent 

15 practicable, the qualified health information 

16 system to a local or regional health information 

17 plan or plans. 

18 ‘‘(C) A rural health care provider that is a 

19 nonprofit hospital or a Federally qualified 

20 health center. 

21 ‘‘(D) A rural health care provider that is 

22 an individual practice or group practice. 

23 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.— 

24 ‘‘(1) IN GENERAL.—For the purpose of car25 rying out this section, there are authorized to be apVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 propriated $20,000,000 for fiscal year 2010, 

2 $30,000,000 for fiscal year 2011, and such sums as 

3 may be necessary, but not to exceed $30,000,000 for 

4 each of fiscal years 2012 through 2014. 

5 ‘‘(2) AVAILABILITY.—Amounts appropriated 

6 under paragraph (1) shall remain available through 

7 fiscal year 2013. 

8 ‘‘(c) DEFINITIONS.—In this section: 

9 ‘‘(1) FEDERALLY QUALIFIED HEALTH CEN10 TER.—The term ‘Federally qualified health center’ 

11 has the meaning given that term in section 

12 1861(aa)(4) of the Social Security Act (42 U.S.C. 

13 1395x(aa)(4)). 

14 ‘‘(2) GROUP PRACTICE.—The term ‘group prac15 tice’ has the meaning given that term in section 

16 1877(h)(4) of the Social Security Act (42 U.S.C. 

17 1395nn(h)(4)). 

18 ‘‘(3) HEALTH CARE PROVIDER.—The term 

19 ‘health care provider’ means a hospital, skilled nurs20 ing facility, home health agency (as defined in sub21 section (o) of section 1861 of the Social Security 

22 Act, 42 U.S.C. 1395x), health care clinic, rural 

23 health clinic, Federally qualified health center, group 

24 practice, a pharmacist, a pharmacy, a laboratory, a 

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1 tion), a practitioner (as defined in section 

2 1842(b)(18)(CC) of such Act, 42 U.S.C. 

3 1395u(b)(18)(CC)), a health facility operated by or 

4 pursuant to a contract with the Indian Health Serv5 ice, and any other category of facility or clinician de6 termined appropriate by the Secretary. 

7 ‘‘(4) HEALTH INFORMATION; INDIVIDUALLY

8 IDENTIFIABLE HEALTH INFORMATION.—The terms 

9 ‘health information’ and ‘individually identifiable 

10 health information’ have the meanings given those 

11 terms in paragraphs (4) and (6), respectively, of sec12 tion 1171 of the Social Security Act (42 U.S.C. 

13 1320d). 

14 ‘‘(5) LABORATORY.—The term ‘laboratory’ has 

15 the meaning given that term in section 353. 

16 ‘‘(6) PHARMACIST.—The term ‘pharmacist’ has 

17 the meaning given that term in section 804(a)(2) of 

18 the Federal Food, Drug, and Cosmetic Act (21 

19 U.S.C. 384(a)(2)). 

20 ‘‘(7) QUALIFIED HEALTH INFORMATION TECH21 NOLOGY.—The term ‘qualified health information 

22 technology’ means a system or components of health 

23 information technology that meet any applicable core 

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1 face software that allows for interoperability in ac2 cordance with such guidelines. 

3 ‘‘(8) RURAL AREA.—The term ‘rural area’ has 

4 the meaning given such term for purposes of section 

5 1886(d)(2)(D) of the Social Security Act (42 U.S.C. 

6 1395ww(d)(2)(D)). 

7 ‘‘(9) RURAL HEALTH CARE PROVIDER.—The 

8 term ‘rural health care provider’ means a health 

9 care provider that is located in a rural area.’’. 

10 SEC. 312. SURVEY QUESTIONS ON SEXUAL ORIENTATION 

11 AND GENDER IDENTITY. 

12 The Secretary of Health and Human Services, acting 

13 through the Director of the Centers for Disease Control 

14 and Prevention, shall include in the National Health Inter15 view Survey (or any successor survey) questions to identify 

16 the sexual orientation and gender identity of individuals 

17 participating in the survey. 

18 SEC. 313. DISAGGREGATION OF COMPARATIVE EFFECTIVE19 NESS RESEARCH DATA. 

20 The Secretary of Health and Human Services may 

21 not make available any Federal funds for comparative ef22 fectiveness health care research, unless the recipient of the 

23 funds agrees to ensure that the research data will be 

24 disaggregated by race, ethnicity, and gender to detect and 

25 measure differences among subpopulations. 


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1 TITLE IV—ACCOUNTABILITY 

2 AND EVALUATION 

3 Subtitle A—General Provisions 

4 SEC. 401. FEDERAL AGENCY PLAN TO ELIMINATE DISPARI5 TIES AND IMPROVE THE HEALTH OF MINOR6 ITY POPULATIONS. 

7 (a) IN GENERAL.—Not later than September 1, 

8 2010, each Federal health agency shall develop and imple9 ment a national strategic action plan to eliminate dispari10 ties on the basis of race, ethnicity, and primary language 

11 and improve the health and health care of minority popu12 lations, through programs relevant to the mission of the 

13 agency. 

14 (b) PUBLICATION.—Each action plan described in 

15 paragraph (1) shall— 

16 (1) be publicly reported in draft form for public 

17 review and comment; 

18 (2) include a response to the review and com19 ment described in paragraph (1) in the final plan; 

20 (3) include the agency response to the 2002 In21 stitute of Medicine report, Unequal Treatment— 

22 Confronting Racial and Ethnic Disparities in 

23 Healthcare; 

24 (4) respond to data and analyses presented in 

25 the National Healthcare Disparities Report and the 


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1 National Healthcare Quality Report published annu2 ally by the Agency for Healthcare Research and 

3 Quality; 

4 (5) demonstrate progress in meeting the 

5 Healthy People 2010 objectives; and 

6 (6) be updated, including progress reports, for 

7 inclusion in an annual report to Congress. 

8 SEC. 402. PROHIBITION ON DISCRIMINATION IN FEDERAL 

9 ASSISTED HEALTH CARE SERVICES AND RE10 SEARCH PROGRAMS ON THE BASIS OF SEX, 

11 RACE, COLOR, NATIONAL ORIGIN, SEXUAL 

12 ORIENTATION, GENDER IDENTITY, OR DIS13 ABILITY STATUS. 

14 No person in the United States shall, on the basis 

15 of sex, race, color, national origin, sexual orientation, gen16 der identity, or disability status, be excluded from partici17 pation in, be denied the benefits of, or be subjected to dis18 crimination under any health care service or research pro19 gram or activity receiving Federal financial assistance. 

20 SEC. 403. ACCOUNTABILITY WITHIN THE DEPARTMENT OF 

21 HEALTH AND HUMAN SERVICES. 

22 Title XXXI of the Public Health Service Act, as 

23 amended by titles II and III of this Act, is further amend24 ed by adding at the end the following: 


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1 ‘‘Subtitle C—Strengthening 

2 Accountability 

3 ‘‘SEC. 3141. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 

4 ‘‘(a) IN GENERAL.—The Secretary shall establish 

5 within the Office for Civil Rights an Office of Health Dis6 parities, which shall be headed by a director to be ap7 pointed by the Secretary. 

8 ‘‘(b) PURPOSE.—The Office of Health Disparities 

9 shall ensure that the health programs, activities, and oper10 ations of health entities which receive Federal financial as11 sistance are in compliance with title VI of the Civil Rights 

12 Act, which prohibits discrimination on the basis of race, 

13 color, or national origin. The activities of the Office shall 

14 include the following: 

15 ‘‘(1) The development and implementation of 

16 an action plan to address racial and ethnic health 

17 care disparities, which shall address concerns relat18 ing to the Office for Civil Rights as released by the 

19 United States Commission on Civil Rights in the re20 port entitled ‘Health Care Challenge: Acknowledging 

21 Disparity, Confronting Discrimination, and Ensur22 ing Equity’ (September, 1999) in conjunction with 

23 the reports by the Institute of Medicine entitled ‘Un24 equal Treatment: Confronting Racial and Ethnic 

25 Disparities in Health Care’, ‘Crossing the Quality 


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1 Chasm: A New Health System for the 21st Cen2 tury’, and ‘In the Nation’s Compelling Interest: En3 suring Diversity in the Health Care Workforce’ and 

4 other related reports by the Institute of Medicine. 

5 This plan shall be publicly disclosed for review and 

6 comment and the final plan shall address any com7 ments or concerns that are received by the Office. 

8 ‘‘(2) Investigative and enforcement actions 

9 against intentional discrimination and policies and 

10 practices that have a disparate impact on minorities. 

11 ‘‘(3) The review of racial, ethnic, and primary 

12 language health data collected by Federal health 

13 agencies to assess health care disparities related to 

14 intentional discrimination and policies and practices 

15 that have a disparate impact on minorities. 

16 ‘‘(4) Outreach and education activities relating 

17 to compliance with title VI of the Civil Rights Act. 

18 ‘‘(5) The provision of technical assistance for 

19 health entities to facilitate compliance with title VI 

20 of the Civil Rights Act. 

21 ‘‘(6) Coordination and oversight of activities of 

22 the civil rights compliance offices established under 

23 section 3142. 

24 ‘‘(7) Ensuring compliance with the 1997 Office 

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1 ing, Collecting, and Presenting Federal Data on 

2 Race, Ethnicity and the available language stand3 ards. 

4 ‘‘(c) FUNDING AND STAFF.—The Secretary shall en5 sure the effectiveness of the Office of Health Disparities 

6 by ensuring that the Office is provided with— 

7 ‘‘(1) adequate funding to enable the Office to 

8 carry out its duties under this section; and 

9 ‘‘(2) staff with expertise in— 

10 ‘‘(A) epidemiology; 

11 ‘‘(B) statistics; 

12 ‘‘(C) health quality assurance; 

13 ‘‘(D) minority health and health dispari14 ties; 

15 ‘‘(E) cultural and linguistic competency; 

16 and 

17 ‘‘(F) civil rights. 

18 ‘‘(d) REPORT.—Not later than December 31, 2010, 

19 and annually thereafter, the Secretary, in collaboration 

20 with the Director of the Office for Civil Rights and the 

21 Director of the Office of Minority Health, shall submit a 

22 report to the Committee on Health, Education, Labor, and 

23 Pensions of the Senate and the Committee on Energy and 

24 Commerce of the House of Representatives that in25 cludes— 


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1 ‘‘(1) the number of cases filed, broken down by 

2 category; 

3 ‘‘(2) the number of cases investigated and 

4 closed by the office; 

5 ‘‘(3) the outcomes of cases investigated; 

6 ‘‘(4) the staffing levels of the office including 

7 staff credentials; 

8 ‘‘(5) the number of other lingering and emerg9 ing cases in which civil rights inequities can be dem10 onstrated; and 

11 ‘‘(6) the number of cases remaining open and 

12 an explanation for their open status. 

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

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

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

16 2010 through 2015. 

17 ‘‘SEC. 3142. ESTABLISHMENT OF HEALTH PROGRAM OF18 FICES FOR CIVIL RIGHTS WITHIN FEDERAL 

19 HEALTH AND HUMAN SERVICES AGENCIES. 

20 ‘‘(a) IN GENERAL.—The Secretary shall establish 

21 civil rights compliance offices in each agency within the 

22 Department of Health and Human Services that admin23 isters health programs. 

24 ‘‘(b) PURPOSE OF OFFICES.—Each office established 

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1 eral financial assistance under Federal health programs 

2 administer their programs, services, and activities in a 

3 manner that— 

4 ‘‘(1) does not discriminate, either intentionally 

5 or in effect, on the basis of race, national origin, lan6 guage, ethnicity, sex, age, or disability; and 

7 ‘‘(2) promotes the reduction and elimination of 

8 disparities in health and health care based on race, 

9 national origin, language, ethnicity, sex, age, and 

10 disability. 

11 ‘‘(c) POWERS AND DUTIES.—The offices established 

12 in subsection (a) shall have the following powers and du13 ties: 

14 ‘‘(1) The establishment of compliance and pro15 gram participation standards for recipients of Fed16 eral financial assistance under each program admin17 istered by an agency within the Department of 

18 Health and Human Services including the establish19 ment of disparity reduction standards to encompass 

20 disparities in health and health care related to race, 

21 national origin, language, ethnicity, sex, age, and 

22 disability. 

23 ‘‘(2) The development and implementation of 

24 program-specific guidelines that interpret and apply 

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1 ance under title VI of the Civil Rights Act of 1964 

2 to each Federal health program administered by the 

3 agency. 

4 ‘‘(3) The development of a disparity-reduction 

5 impact analysis methodology that shall be applied to 

6 every rule issued by the agency and published as 

7 part of the formal rulemaking process under sections 

8 555, 556, and 557 of title 5, United States Code. 

9 ‘‘(4) Oversight of data collection, analysis, and 

10 publication requirements for all recipients of Federal 

11 financial assistance under each Federal health pro12 gram administered by the agency, and compliance 

13 with the 1997 Office of Management and Budget 

14 Standards for Maintaining, Collecting, and Pre15 senting Federal Data on Race and Ethnicity and the 

16 available language standards. 

17 ‘‘(5) The conduct of publicly available studies 

18 regarding discrimination within Federal health pro19 grams administered by the agency as well as dis20 parity reduction initiatives by recipients of Federal 

21 financial assistance under Federal health programs. 

22 ‘‘(6) Annual reports to the Committee on 

23 Health, Education, Labor, and Pensions and the 

24 Committee on Finance of the Senate and the Com25 mittee on Energy and Commerce and the Committee 


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1 on Ways and Means of the House of Representatives 

2 on the progress in reducing disparities in health and 

3 health care through the Federal programs adminis4 tered by the agency. 

5 ‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS

6 IN THE DEPARTMENT OF JUSTICE.— 

7 ‘‘(1) DEPARTMENT OF HEALTH AND HUMAN

8 SERVICES.—The Office for Civil Rights in the De9 partment of Health and Human Services shall pro10 vide standard-setting and compliance review inves11 tigation support services to the Civil Rights Compli12 ance Office for each agency. 

13 ‘‘(2) DEPARTMENT OF JUSTICE.—The Office 

14 for Civil Rights in the Department of Justice shall 

15 continue to maintain the power to institute formal 

16 proceedings when an agency Office for Civil Rights 

17 determines that a recipient of Federal financial as18 sistance is not in compliance with the disparity re19 duction standards of the agency. 

20 ‘‘(e) DEFINITION.—In this section, the term ‘Federal 

21 health programs’ mean programs— 

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

23 301 et seq.) that pay for health care and services; 

24 and 


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1 ‘‘(2) under this Act that provide Federal finan2 cial assistance for health care, biomedical research, 

3 health services research, and programs designed to 

4 improve the public’s health.’’. 

5 SEC. 404. OFFICE OF MINORITY HEALTH. 

6 Section 1707 of the Public Health Service Act (42 

7 U.S.C. 300u–6) is amended— 

8 (1) by striking subsection (b) and inserting the 

9 following: 

10 ‘‘(b) DUTIES.—With respect to improving the health 

11 of racial and ethnic minority groups, the Secretary, acting 

12 through the Deputy Assistant Secretary for Minority 

13 Health (in this section referred to as the ‘Deputy Assist14 ant Secretary’), shall carry out the following: 

15 ‘‘(1) Establish, implement, monitor, and evalu16 ate short-range and long-range goals and objectives 

17 and oversee all other activities within the Public 

18 Health Service that relate to disease prevention, 

19 health promotion, service delivery, and research con20 cerning minority groups. The heads of each of the 

21 agencies of the Service shall consult with the Deputy 

22 Assistant Secretary to ensure the coordination of 

23 such activities. 

24 ‘‘(2) Oversee all activities within the Depart25 ment of Health and Human Services that relate to 


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1 reducing or eliminating disparities in health and 

2 health care in racial and ethnic minority populations 

3 and in rural and underserved communities, including 

4 coordinating— 

5 ‘‘(A) the design of programs, support for 

6 programs, and the evaluation of programs; 

7 ‘‘(B) the monitoring of trends in health 

8 and health care; 

9 ‘‘(C) research efforts; 

10 ‘‘(D) the training of health providers; and 

11 ‘‘(E) information and education programs 

12 and campaigns. 

13 ‘‘(3) Enter into interagency and intra-agency 

14 agreements with other agencies of the Public Health 

15 Service. 

16 ‘‘(4) Ensure that the Federal health agencies 

17 and the National Center for Health Statistics collect 

18 data on the health status and health care of each 

19 minority group, using at a minimum the categories 

20 specified in the 1997 OMB Standards for Maintain21 ing, Collecting, and Presenting Federal Data on 

22 Race and Ethnicity as required under subtitle B and 

23 available language standards. 

24 ‘‘(5) Provide technical assistance to States, 

25 local agencies, territories, Indian tribes, and entities 


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1 for activities relating to the elimination of racial and 

2 ethnic disparities in health and health care. 

3 ‘‘(6) Support a national minority health re4 source center to carry out the following: 

5 ‘‘(A) Facilitate the exchange of informa6 tion regarding matters relating to health infor7 mation, health promotion and wellness, preven8 tive health services, clinical trials, health infor9 mation technology, and education in the appro10 priate use of health services. 

11 ‘‘(B) Facilitate timely access to culturally 

12 and linguistically appropriate information. 

13 ‘‘(C) Assist in the analysis of such infor14 mation. 

15 ‘‘(D) Provide technical assistance with re16 spect to the exchange of such information (in17 cluding facilitating the development of materials 

18 for such technical assistance). 

19 ‘‘(7) Carry out programs to improve access to 

20 health care services for individuals with limited 

21 English proficiency, including developing and car22 rying out programs to provide bilingual or interpre23 tive services through the development and support of 

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1 guistic Competence in Health Care as provided for 

2 in section 3103. 

3 ‘‘(8) Carry out programs to improve access to 

4 health care services and to improve the quality of 

5 health care services for individuals with low func6 tional health literacy. As used in the preceding sen7 tence, the term ‘functional health literacy’ means the 

8 ability to obtain, process, and understand basic 

9 health information and services needed to make ap10 propriate health decisions. 

11 ‘‘(9) Advise in matters related to the develop12 ment, implementation, and evaluation of health pro13 fessions education on decreasing disparities in health 

14 care outcomes, with focus on cultural competency as 

15 a method of eliminating disparities in health and 

16 health care in racial and ethnic minority popu17 lations. 

18 ‘‘(10) Assist health care professionals, commu19 nity and advocacy organizations, academic centers 

20 and public health departments in the design and im21 plementation of programs that will improve the qual22 ity of health outcomes by strengthening the pro23 vider-patient relationship.’’; 

24 (2) by redesignating subsections (f) through (h) 

25 as subsections (g) through (i), respectively; 


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1 (3) by inserting after subsection (d) the fol2 lowing: 

3 ‘‘(f) PREPARATION OF HEALTH PROFESSIONALS TO

4 PROVIDE HEALTH CARE TO MINORITY POPULATIONS.— 

5 The Secretary, in collaboration with the Director of the 

6 Bureau of Health Professions and the Deputy Assistant 

7 Secretary for Minority Health, shall require that health 

8 professional schools that receive Federal funds train fu9 ture health professionals to provide culturally and linguis10 tically appropriate health care to diverse populations.’’; 

11 and 

12 (4) by striking subsection (i) (as so redesig13 nated) and inserting the following: 

14 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the 

15 purpose of carrying out this section, there are authorized 

16 to be appropriated $100,000,000 for fiscal year 2010, and 

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

18 2011 through 2015.’’. 

19 SEC. 405. ESTABLISHMENT OF THE INDIAN HEALTH SERV20 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

21 SERVICE. 

22 (a) ESTABLISHMENT.— 

23 (1) IN GENERAL.—In order to more effectively 

24 and efficiently carry out the responsibilities, authori25 ties, and functions of the United States to provide 


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1 health care services to Indians and Indian tribes, as 

2 are or may be hereafter provided by Federal statute 

3 or treaties, there is established within the Public 

4 Health Service of the Department of Health and 

5 Human Services the Indian Health Service. 

6 (2) ASSISTANT SECRETARY OF INDIAN

7 HEALTH.—The Service shall be administered by an 

8 Assistant Secretary of Indian Health, who shall be 

9 appointed by the President, by and with the advice 

10 and consent of the Senate. The Assistant Secretary 

11 shall report to the Secretary. Effective with respect 

12 to an individual appointed by the President, by and 

13 with the advice and consent of the Senate the term 

14 of service of the Assistant Secretary shall be 4 years. 

15 An Assistant Secretary may serve more than 1 term. 

16 (b) AGENCY.—The Service shall be an agency within 

17 the Public Health Service of the Department, and shall 

18 not be an office, component, or unit of any other agency 

19 of the Department. 

20 (c) FUNCTIONS AND DUTIES.—The Secretary shall 

21 carry out through the Assistant Secretary of the Service— 

22 (1) all functions which were, on the day before 

23 the date of enactment of the Indian Health Care 

24 Amendments of 1988, carried out by or under the 


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1 direction of the individual serving as Director of the 

2 Service on such day; 

3 (2) all functions of the Secretary relating to the 

4 maintenance and operation of hospital and health fa5 cilities for Indians and the planning for, and provi6 sion and utilization of, health services for Indians; 

7 (3) all health programs under which health care 

8 is provided to Indians based upon their status as In9 dians which are administered by the Secretary, in10 cluding programs under— 

11 (A) the Indian Health Care Improvement 

12 Act; 

13 (B) the Act of November 2, 1921 (25 

14 U.S.C. 13); 

15 (C) the Act of August 5, 1954 (42 U.S.C. 

16 2001 et seq.); 

17 (D) the Act of August 16, 1957 (42 

18 U.S.C. 2005 et seq.); 

19 (E) the Indian Self-Determination Act (25 

20 U.S.C. 450f et seq.); and 

21 (F) title XXXI of the Public Health Serv22 ice Act, as added by this Act; and 

23 (4) all scholarship and loan functions carried 

24 out under title I of the Indian Health Care Improve25 ment Act. 


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1 (d) AUTHORITY.— 

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

3 through the Assistant Secretary, shall have the au4 thority— 

5 (A) except to the extent provided for in 

6 paragraph (2), to appoint and compensate em7 ployees for the Service in accordance with title 

8 5, United States Code; 

9 (B) to enter into contracts for the procure10 ment of goods and services to carry out the 

11 functions of the Service; and 

12 (C) to manage, expend, and obligate all 

13 funds appropriated for the Service. 

14 (2) PERSONNEL ACTIONS.—Notwithstanding 

15 any other provision of law, the provisions of section 

16 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

17 U.S.C. 472), shall apply to all personnel actions 

18 taken with respect to new positions created within 

19 the Service as a result of its establishment under 

20 subsection (a). 

21 (e) RATE OF PAY.— 

22 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

23 title 5, United States Code, is amended by striking 

24 the following: ‘‘Assistant Secretaries of Health and 


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1 Human Services (6).’’ and inserting ‘‘Assistant Sec2 retaries of Health and Human Services (7).’’. 

3 (2) POSITIONS AT LEVEL V.—Section 5316 of 

4 such title is amended by striking the following: ‘‘Di5 rector, Indian Health Service, Department of Health 

6 and Human Services.’’. 

7 (f) DUTIES OF ASSISTANT SECRETARY FOR INDIAN

8 HEALTH.—Section 601 of the Indian Health Care Im9 provement Act (25 U.S.C. 1661) is amended in subsection 

10 (a)— 

11 (1) by inserting ‘‘(1)’’ after ‘‘(a)’’; 

12 (2) in the second sentence of paragraph (1), as 

13 so designated, by striking ‘‘a Director,’’ and insert14 ing ‘‘the Assistant Secretary for Indian Health,’’; 

15 (3) by striking the third sentence of paragraph 

16 (1), as so designated, and all that follows through 

17 the end of the subsection (a) of such section and in18 serting the following: ‘‘The Assistant Secretary for 

19 Indian Health shall carry out the duties specified in 

20 paragraph (2).’’; and 

21 (4) by adding after paragraph (1) the following: 

22 ‘‘(2) The Assistant Secretary for Indian Health 

23 shall— 


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1 ‘‘(A) report directly to the secretary con2 cerning all policy and budget-related matters 

3 affecting Indian health; 

4 ‘‘(B) collaborate with the Assistant Sec5 retary for Health concerning appropriate mat6 ters of Indian health that affect the agencies of 

7 the Public Health Service; 

8 ‘‘(C) advise each Assistant Secretary of the 

9 Department of Health and Human Services 

10 concerning matters of Indian health with re11 spect to which that Assistant Secretary has au12 thority and responsibility; 

13 ‘‘(D) advise the heads of other agencies 

14 and programs of the Department of Health and 

15 Human Services concerning matters of Indian 

16 health with respect to which those heads have 

17 authority and responsibility; and 

18 ‘‘(E) coordinate the activities of the De19 partment of Health and Human Services con20 cerning matters of Indian health.’’. 

21 (g) CONTINUED SERVICE BY INCUMBENT.—The indi22 vidual serving in the position of Director of the Indian 

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1 dian Health, at the pleasure of the President after the 

2 date of enactment of this Act. 

3 (h) CONFORMING AMENDMENTS.— 

4 (1) AMENDMENTS TO INDIAN HEALTH CARE IM5 PROVEMENT ACT.—The Indian Health Care Im6 provement Act (25 U.S.C. 1601 et seq.) is amend7 ed— 

8 (A) in section 601— 

9 (i) in subsection (c), by striking ‘‘Di10 rector of the Indian Health Service’’ both 

11 places it appears and inserting ‘‘Assistant 

12 Secretary for Indian Health’’; and 

13 (ii) in subsection (d), by striking ‘‘Di14 rector of the Indian Health Service’’ and 

15 inserting ‘‘Assistant Secretary for Indian 

16 Health’’; and 

17 (B) in section 816(c)(1), by striking ‘‘Di18 rector of the Indian Health Service’’ and insert19 ing ‘‘Assistant Secretary for Indian Health’’. 

20 (2) AMENDMENTS TO OTHER PROVISIONS OF

21 LAW.—The following provisions are each amended 

22 by striking ‘‘Director of the Indian Health Service’’ 

23 each place it appears and inserting ‘‘Assistant Sec24 retary for Indian Health’’: 


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1 (A) Section 203(a)(1) of the Rehabilitation 

2 Act of 1973 (29 U.S.C. 763(a)(1)). 

3 (B) Subsections (b) and (e) of section 518 

4 of the Federal Water Pollution Control Act (33 

5 U.S.C. 1377 (b) and (e)). 

6 (C) Section 803B(d)(1) of the Native 

7 American Programs Act of 1974 (42 U.S.C. 

8 2991b–2(d)(1)). 

9 (i) REFERENCES.—Reference in any other Federal 

10 law, Executive order, rule, regulation, or delegation of au11 thority, or any document of or relating to the Director 

12 of the Indian Health Service shall be deemed to refer to 

13 the Assistant Secretary for Indian Health. 

14 (j) DEFINITIONS.—For purposes of this section, the 

15 definitions contained in section 4 of the Indian Health 

16 Care Improvement Act shall apply. 

17 SEC. 406. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI18 NORITY HEALTH WITHIN AGENCIES OF THE 

19 PUBLIC HEALTH SERVICE. 

20 Title XVII of the Public Health Service Act (42 

21 U.S.C. 300u et seq.) is amended by inserting after section 

22 1707 the following section: 

23 ‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN

24 PUBLIC HEALTH SERVICE

25 ‘‘SEC. 1707A. 


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1 ‘‘(a) IN GENERAL.—The head of each agency speci2 fied in subsection (b)(1) shall establish within the agency 

3 an office to be known as the Office of Minority Health. 

4 Each such Office shall be headed by a director, who shall 

5 be appointed by the head of the agency within which the 

6 Office is established, and who shall report directly to the 

7 head of the agency. The head of such agency shall carry 

8 out this section (as this section relates to the agency) act9 ing through such Director. 

10 ‘‘(b) SPECIFIED AGENCIES.— 

11 ‘‘(1) IN GENERAL.—The agencies referred to in 

12 subsection (a) are the following: 

13 ‘‘(A) The Centers for Disease Control and 

14 Prevention. 

15 ‘‘(B) The Health Resources and Services 

16 Administration. 

17 ‘‘(C) The Substance Abuse and Mental 

18 Health Services Administration. 

19 ‘‘(D) The Administration on Aging. 

20 ‘‘(c) COMPOSITION.—The head of each specified 

21 agency shall ensure that the officers and employees of the 

22 minority health office of the agency are, collectively, expe23 rienced in carrying out community-based health programs 

24 for each of the various racial and ethnic minority groups 


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1 that are present in significant numbers in the United 

2 States. 

3 ‘‘(d) DUTIES.—Each Director of a minority health of4 fice shall establish and monitor the programs of the speci5 fied agency of such office in order to carry out the fol6 lowing: 

7 ‘‘(1) Determine the extent to which the pur8 poses of the programs are being carried out with re9 spect to racial and ethnic minority groups; 

10 ‘‘(2) Determine the extent to which members of 

11 such groups are represented among the Federal offi12 cers and employees who administer the programs; 

13 and 

14 ‘‘(3) Make recommendations to the head of 

15 such agency on carrying out the programs with re16 spect to such groups. In the case of programs that 

17 provide services, such recommendations shall include 

18 recommendations toward ensuring that— 

19 ‘‘(A) the services are equitably delivered 

20 with respect to racial and ethnic minority 

21 groups; 

22 ‘‘(B) the programs provide the services in 

23 the language and cultural context that is most 

24 appropriate for the individuals for whom the 

25 services are intended; and 


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1 ‘‘(C) the programs utilize racial and ethnic 

2 minority community-based organizations to de3 liver services. 

4 ‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head 

5 of each specified agency shall submit to the Secretary for 

6 inclusion in each biennial report describing— 

7 ‘‘(1) the extent to which the minority health of8 fice of the agency employs individuals who are mem9 bers of racial and ethnic minority groups, including 

10 a specification by minority group of the number of 

11 such individuals employed by such office. 

12 ‘‘(f) FUNDING.— 

13 ‘‘(1) ALLOCATIONS.—Of the amounts appro14 priated for a specified agency for a fiscal year, the 

15 Secretary must designate an appropriate amount of 

16 funds for the purpose of carrying out activities 

17 under this section through the minority health office 

18 of the agency. In reserving an amount under the 

19 preceding sentence for a minority health office for a 

20 fiscal year, the Secretary shall reduce, by substan21 tially the same percentage, the amount that other22 wise would be available for each of the programs of 

23 the designated agency involved. 

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1 able under paragraph may be expended by a minor2 ity health office include the costs of employing staff 

3 for such office.’’. 

4 SEC. 407. OFFICE OF MINORITY HEALTH AT THE CENTERS 

5 FOR MEDICARE & MEDICAID SERVICES. 

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

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

8 Human Services shall establish within the Centers for 

9 Medicare & Medicaid Services an Office of Minority 

10 Health (referred to in this section as the ‘‘Office’’). 

11 (b) DUTIES.—The Office shall be responsible for the 

12 coordination and facilitation of activities of the Centers 

13 for Medicare & Medicaid Services to improve minority 

14 health and health care and to reduce racial and ethnic dis15 parities in health and health care, which shall include— 

16 (1) creating a strategic plan, which shall be 

17 made available for public review, to improve the 

18 health and health care of Medicare, Medicaid, and 

19 SCHIP beneficiaries; 

20 (2) promoting agency-wide policies relating to 

21 health care delivery and financing that could have a 

22 beneficial impact on the health and health care of 

23 minority populations; 


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1 (3) assisting health plans, hospitals, and other 

2 health entities in providing culturally and linguis3 tically appropriate health care services; 

4 (4) increasing awareness and outreach activities 

5 for minority health care consumers and providers 

6 about the causes and remedies for health and health 

7 care disparities; 

8 (5) developing grant programs and demonstra9 tion projects to identify, implement and evaluate in10 novative approaches to improving the health and 

11 health care of minority beneficiaries in the Medicare, 

12 Medicaid, and SCHIP programs; 

13 (6) considering incentive programs relating to 

14 reimbursement that would reward health entities for 

15 providing quality health care for minority popu16 lations using established benchmarks for quality of 

17 care; 

18 (7) collaborating with the compliance office to 

19 ensure compliance with the anti-discrimination provi20 sions under title VI of the Civil Rights Act of 1964; 

21 (8) identifying barriers to enrollment in public 

22 programs under the jurisdiction of the Centers for 

23 Medicare & Medicaid Services; 


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1 (9) monitoring and evaluating on a regular 

2 basis the success of minority health programs and 

3 initiatives; 

4 (10) publishing an annual report about the ac5 tivities of the Centers for Medicare & Medicaid Serv6 ices relating to minority health improvement; and 

7 (11) other activities determined appropriate by 

8 the Secretary of Health and Human Services. 

9 (c) STAFF.—The staff at the Office shall include— 

10 (1) one or more individuals with expertise in 

11 minority health and racial and ethnic health dispari12 ties; and 

13 (2) one or more individuals with expertise in 

14 health care financing and delivery in underserved 

15 communities. 

16 (d) COORDINATION.—In carrying out its duties under 

17 this section, the Office shall coordinate with— 

18 (1) the Office of Minority Health in the Office 

19 of the Secretary of Health and Human Services; 

20 (2) the National Centers for Minority Health 

21 and Health Disparities in the National Institutes of 

22 Health; and 

23 (3) the Office of Minority Health in the Centers 

24 for Disease Control and Prevention. 


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1 (e) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there are authorized 

3 to be appropriated $10,000,000 for fiscal year 2010, and 

4 such sums may be necessary for each of fiscal years 2011 

5 through 2016. 

6 SEC. 408. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND 

7 DRUG ADMINISTRATION. 

8 Chapter IX of the Federal Food, Drug, and Cosmetic 

9 Act (21 U.S.C. 391 et seq.) is amended by adding at the 

10 end the following: 

11 ‘‘SEC. 911. OFFICE OF MINORITY AFFAIRS. 

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

13 date of enactment of this section, the Secretary shall es14 tablish within the Office of the Commissioner of Food and 

15 Drugs an Office of Minority Affairs (referred to in this 

16 section as the ‘Office’). 

17 ‘‘(b) DUTIES.—The Office shall be responsible for the 

18 coordination and facilitation of activities of the Food and 

19 Drug Administration to improve minority health and 

20 health care and to reduce racial and ethnic disparities in 

21 health and health care, which shall include— 

22 ‘‘(1) promoting policies in the development and 

23 review of medical products that reduce racial and 

24 ethnic disparities in health and health care; 


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1 ‘‘(2) encouraging appropriate data collection, 

2 analysis, and dissemination of racial and ethnic dif3 ferences using, at a minimum, the categories de4 scribed in the 1997 Office of Management and 

5 Budget standards, in response to different therapies 

6 in both adult and pediatric populations; 

7 ‘‘(3) providing, in coordination with other ap8 propriate government agencies, education, training, 

9 and support to increase participation of minority pa10 tients and physicians in clinical trials; 

11 ‘‘(4) collecting and analyzing data using, at a 

12 minimum, the categories described in the 1997 Of13 fice of Management and Budget standards, on the 

14 number of participants from minority racial and eth15 nic backgrounds in clinical trials used to support 

16 medical product approvals; 

17 ‘‘(5) the identification of methods to reduce lan18 guage and literacy barriers; and 

19 ‘‘(6) publishing an annual report about the ac20 tivities of the Food and Drug Administration per21 taining to minority health. 

22 ‘‘(c) STAFF.—The staff of the Office shall include— 

23 ‘‘(1) one or more individuals with expertise in 

24 the design and conduct of clinical trials of drugs, bi25 ological products, and medical devices; and 


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1 ‘‘(2) one or more individuals with expertise in 

2 therapeutic classes or disease states for which med3 ical evidence suggests a difference based on race or 

4 ethnicity. 

5 ‘‘(d) COORDINATION.—In carrying out its duties 

6 under this section, the Office shall coordinate with— 

7 ‘‘(1) the Office of Minority Health in the Office 

8 of the Secretary of Health and Human Services; 

9 ‘‘(2) the National Institute for Minority Health 

10 and Health Disparities in the National Institutes of 

11 Health; and 

12 ‘‘(3) the Office of Minority Health in the Cen13 ters for Disease Control and Prevention. 

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

15 purpose of carrying out this section, there are authorized 

16 to be appropriated such sums as may be necessary for 

17 each of the fiscal years 2010 through 2015.’’. 

18 SEC. 409. SAFETY AND EFFECTIVENESS OF DRUGS WITH 

19 RESPECT TO RACIAL AND ETHNIC BACK20 GROUND. 

21 (a) IN GENERAL.—Chapter V of the Federal Food, 

22 Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend23 ed by adding after section 505D the following: 


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

2 RESPECT TO RACIAL AND ETHNIC BACK3 GROUND. 

4 ‘‘(a) PRE-APPROVAL STUDIES.—If there is evidence 

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

6 ethnic background as to the safety or effectiveness of a 

7 drug, then— 

8 ‘‘(1)(A) the investigations required under sec9 tion 505(b)(1)(A) shall include adequate and well10 controlled investigations of the disparity; or 

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

12 of the Public Health Service Act for approval of a 

13 biologics license application for the drug shall in14 clude adequate and well-controlled investigations of 

15 the disparity; and 

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

17 a disparity, the labeling of the drug shall include ap18 propriate information about the disparity. 

19 ‘‘(b) POST-MARKET STUDIES.— 

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

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

22 ethnic background as to the safety or effectiveness 

23 of a drug for which there is an approved application 

24 under section 505 or a license under section 351 of 

25 the Public Health Service Act, the Secretary may by 

26 order require the holder of the approved application 


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1 or license to conduct, by a date specified by the Sec2 retary, post-marketing studies to investigate the dis3 parity. 

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

5 that the post-market studies confirm that there is a 

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

7 the drug shall include appropriate information about 

8 the disparity. 

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

10 specify all aspects of study design, including the 

11 number of studies and study participants, in the 

12 order requiring post-market studies of the drug. 

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

14 Secretary may by order modify any aspect of the 

15 study design as necessary after issuing an order 

16 under paragraph (1). 

17 ‘‘(5) STUDY RESULTS.—The results from stud18 ies required under paragraph (1) shall be submitted 

19 to the Secretary as supplements to the drug applica20 tion or biological license application. 

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

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

23 for adult and pediatric populations as to the safety or ef24 fectiveness of a drug’ includes— 


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

2 basis of racial or ethnic background as to safety or 

3 effectiveness of a drug in the same chemical class as 

4 the drug; 

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

6 basis of racial or ethnic background in the way the 

7 drug is metabolized; and 

8 ‘‘(3) other evidence as the Secretary may deter9 mine. 

10 ‘‘(d) APPLICATIONS UNDER SECTION 505(b)(2) AND

11 505(j).— 

12 ‘‘(1) IN GENERAL.—A drug for which an appli13 cation has been submitted or approved under section 

14 505(j) shall not be considered ineligible for approval 

15 under that section or misbranded under section 502 

16 on the basis that the labeling of the drug omits in17 formation relating to a disparity on the basis of ra18 cial or ethnic background as to the safety or effec19 tiveness of the drug, whether derived from investiga20 tions or studies required under this section or de21 rived from other sources, when the omitted informa22 tion is protected by patent or by exclusivity under 

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

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

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


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1 require that the labeling of a drug approved under 

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

3 disparity on the basis of racial or ethnic background 

4 as to the safety or effectiveness of the drug include 

5 a statement of any appropriate contraindications, 

6 warnings, or precautions related to the disparity 

7 that the Secretary considers necessary.’’. 

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

9 Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend10 ed by adding at the end the following: 

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

12 application under section 505 or license under section 351 

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

14 to complete the investigations or studies, or comply with 

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

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

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

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

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

20 SEC. 410. UNITED STATES COMMISSION ON CIVIL RIGHTS. 

21 (a) COORDINATION WITHIN DEPARTMENT OF JUS22 TICE OF ACTIVITIES REGARDING HEALTH DISPARI23 TIES.—Section 3 of the Civil Rights Commission Act of 

24 1983 (42 U.S.C. 1975a) is amended— 


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1 (1) in paragraph (1)(B), by striking ‘‘and’’ at 

2 the end; 

3 (2) in paragraph (2), in the matter after and 

4 below subparagraph (D), by striking the period and 

5 inserting ‘‘; and’’; and 

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

7 ‘‘(3) shall, with respect to activities carried out 

8 in health care and correctional facilities toward the 

9 goal of eliminating health disparities between the 

10 general population and members of racial or ethnic 

11 minority groups, coordinate such activities of— 

12 ‘‘(A) the Office for Civil Rights within the 

13 Department of Justice; 

14 ‘‘(B) the Office of Justice Programs within 

15 the Department of Justice; 

16 ‘‘(C) the Office for Civil Rights within the 

17 Department of Health and Human Services; 

18 and 

19 ‘‘(D) the Office of Minority Health within 

20 the Department of Health and Human Services 

21 (headed by the Deputy Assistant Secretary for 

22 Minority Health).’’. 

23 (b) AUTHORIZATION OF APPROPRIATIONS.—Section 

24 5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 

25 1975c) is amended by striking the first sentence and inVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00200 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 serting the following: ‘‘For the purpose of carrying out 

2 this Act, there are authorized to be appropriated 

3 $30,000,000 for fiscal year 2010, and such sums as may 

4 be necessary for each of the fiscal years 2011 through 

5 2015.’’. 

6 SEC. 411. SENSE OF CONGRESS CONCERNING FULL FUND7 ING OF ACTIVITIES TO ELIMINATE RACIAL 

8 AND ETHNIC HEALTH DISPARITIES. 

9 (a) FINDINGS.—Congress makes the following find10 ings: 

11 (1) The health status of the American populace 

12 is declining and the United States currently ranks 

13 below most industrialized nations in health status 

14 measured by longevity, sickness, and mortality. 

15 (2) Racial and ethnic minority populations tend 

16 have the poorest health status and face substantial 

17 cultural, social, and economic barriers to obtaining 

18 quality health care. 

19 (3) Efforts to improve minority health have 

20 been limited by inadequate resources (funding, staff21 ing, and stewardship) and accountability. 

22 (b) SENSE OF CONGRESS.—It is the sense of Con23 gress that— 

24 (1) funding should be doubled by fiscal year 

25 2010 for the National Institute for Minority Health 


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1 Disparities, the Office of Civil Rights in the Depart2 ment of Health and Human Services, the National 

3 Institute of Nursing Research, and the Office of Mi4 nority Health; 

5 (2) adequate funding by fiscal year 2010, and 

6 subsequent funding increases, should be provided for 

7 health professions training programs, the Racial and 

8 Ethnic Approaches to Community Health (REACH) 

9 at the Center for Disease Control and Prevention, 

10 the Minority HIV/AIDS Initiative, and the Excel11 lence Centers to Eliminate Ethnic/Racial Disparities 

12 (EXCEED) Program at the Agency for Healthcare 

13 Research and Quality; 

14 (3) current and newly created health disparity 

15 elimination incentives, programs, agencies, and de16 partments under this Act (and the amendments 

17 made by this Act) should receive adequate staffing 

18 and funding by fiscal year 2010; and 

19 (4) stewardship and accountability should be 

20 provided to Congress and the President for measur21 able and sustainable progress toward health dis22 parity elimination. 


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1 SEC. 412. GUIDELINES FOR DISEASE SCREENING FOR MI2 NORITY PATIENTS. 

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

4 Director of the Agency for Healthcare Research and Qual5 ity, shall convene a series of meetings to develop guidelines 

6 for disease screening for minority patient populations 

7 which have a higher than average risk for many chronic 

8 diseases and cancers. 

9 (b) PARTICIPANTS.—In convening meetings under 

10 subsection (a), the Secretary shall ensure that meeting 

11 participants include representatives of— 

12 (1) professional societies and associations; 

13 (2) minority health organizations; 

14 (3) health care researchers and providers, in15 cluding those with expertise in minority health; 

16 (4) Federal health agencies, including the Of17 fice of Minority Health, the National Center on Mi18 nority Health and Health Disparities, and the Na19 tional Institutes of Health; and 

20 (5) other experts determined appropriate by the 

21 Secretary. 

22 (c) DISEASES.—Screening guidelines for minority 

23 populations shall be developed under subsection (a) for— 

24 (1) hypertension; 

25 (2) hypercholesterolemia; 

26 (3) diabetes; 


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1 (4) cardiovascular disease; 

2 (5) cancers, including breast, prostate, colon, 

3 cervical, and lung cancer; 

4 (6) asthma; 

5 (7) diabetes; 

6 (8) kidney diseases; 

7 (9) eye diseases and disorders, including glau8 coma; 

9 (10) HIV/AIDS and sexually transmitted dis10 eases; 

11 (11) uterine fibroids; 

12 (12) autoimmune disease; 

13 (13) mental health conditions; 

14 (14) dental health conditions and oral diseases; 

15 (15) environmental and related health illnesses 

16 and conditions; 

17 (16) Sickle cell disease; 

18 (17) violence and injury prevention and control; 

19 (18) genetic and related conditions; 

20 (19) heart disease and stroke; 

21 (20) tuberculosis; 

22 (21) chronic obstructive pulmonary disease; and 

23 (22) other diseases determined appropriate by 

24 the Secretary. 


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1 (d) DISSEMINATION.—Not later than 24 months 

2 after the date of enactment of this title, the Secretary 

3 shall publish and disseminate to health care provider orga4 nizations the guidelines developed under subsection (a). 

5 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

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

7 sums as may be necessary for each of fiscal years 2010 

8 through 2015. 

9 SEC. 413. NATIONAL INSTITUTE FOR MINORITY HEALTH 

10 AND HEALTH DISPARITIES. 

11 (a) REDESIGNATION.— 

12 (1) IN GENERAL.—Title IV of the Public 

13 Health Service Act (42 U.S.C. 281 et seq.) is 

14 amended— 

15 (A) in section 401(b)(24), by striking ‘‘Na16 tional Center on Minority Health and Health 

17 Disparities’’ and inserting ‘‘National Institute 

18 for Minority Health and Health Disparities’’; 

19 and 

20 (B) in subpart 6 of part E— 

21 (i) in the subpart heading, by striking 

22 ‘‘Center’’ and inserting ‘‘Institute’’; 

23 (ii) in the headings of sections 485E 

24 and 485H, by striking ‘‘CENTER’’ and in25 serting ‘‘INSTITUTE’’; and 


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1 (iii) by striking (other than in section 

2 485E(i)(1)) the term ‘‘Center’’ each place 

3 it appears and inserting ‘‘Institute’’. 

4 (2) REFERENCES.—Any reference in any law, 

5 map, regulation, document, paper, or other record of 

6 the United States to the National Center on Minor7 ity Health and Health Disparities shall be deemed to 

8 be a reference to the National Institute for Minority 

9 Health and Health Disparities. 

10 (b) DUTIES; AUTHORITIES; FUNDING.—Section 

11 485E of the Public Health Service Act (42 U.S.C. 287c– 

12 31) is amended— 

13 (1) by amending subsection (e) to read as fol14 lows: 

15 ‘‘(e) DUTIES OF THE DIRECTOR.— 

16 ‘‘(1) INTERAGENCY COORDINATION OF MINOR17 ITY HEALTH AND HEALTH DISPARITY ACTIVITIES.— 

18 With respect to minority health and health dispari19 ties, the Director of the Institute shall plan, coordi20 nate, and evaluate research and other activities con21 ducted or supported by the institutes and centers of 

22 the National Institutes of Health. In carrying out 

23 the preceding sentence, the Director of the Institute 

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1 ters and shall provide for the periodic reevaluation 

2 of such activities. Such institutes and centers shall 

3 be responsible for providing information to the Insti4 tute, including data on clinical trials funded or con5 ducted by these institutes and centers. 

6 ‘‘(2) CONSULTATIONS.—The Director of the In7 stitute shall carry out this subpart (including devel8 oping and revising the plan and budget required by 

9 subsection (f) in consultation with the heads of the 

10 institutes and centers of the National Institutes of 

11 Health, the advisory councils of such institutes and 

12 centers, and the advisory council established pursu13 ant to subsection (j). 

14 ‘‘(3) COORDINATION OF ACTIVITIES.—The Di15 rector of the Institute— 

16 ‘‘(A) shall act as the primary Federal offi17 cial with responsibility for coordinating all re18 search and activities conducted or supported by 

19 the National Institutes of Health on minority or 

20 other health disparities; 

21 ‘‘(B) shall represent the health disparities 

22 research program of the National Institutes of 

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1 evant executive branch task forces, committees, 

2 and planning activities; and 

3 ‘‘(C) shall maintain communications with 

4 all relevant agencies of the Public Health Serv5 ice, including the Indian Health Service, and 

6 various other departments and agencies of the 

7 Federal Government to ensure the timely trans8 mission of information concerning advances in 

9 minority health disparities research and other 

10 health disparities research among these various 

11 agencies for dissemination to affected commu12 nities and health care providers.’’; 

13 (2) by amending subsection (f) to read as fol14 lows: 

15 ‘‘(f) STRATEGIC PLAN.— 

16 ‘‘(1) IN GENERAL.—Subject to the provisions of 

17 this section and other applicable law, the Director of 

18 the Institute, in consultation with the Director of 

19 NIH, the Directors of the other institutes and cen20 ters of the National Institutes of Health, and the 

21 advisory council established pursuant to subsection 

22 (j), shall— 

23 ‘‘(A) annually review and revise a strategic 

24 plan (referred to in this section as ‘the plan’) 

25 and budget for the conduct and support of all 


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1 minority health disparity research and other 

2 health disparity research activities of the insti3 tutes and centers of the National Institutes of 

4 Health that include time-based targeted objec5 tives with measurable outcomes and assure that 

6 the annual review and revision of the plan uses 

7 an established trans-National Institutes of 

8 Health process subject to timely review, ap9 proval, and dissemination; 

10 ‘‘(B) ensure that the plan and budget es11 tablish priorities among the health disparities 

12 research activities that such agencies are au13 thorized to carry out; 

14 ‘‘(C) ensure that the plan and budget es15 tablish objectives regarding such activities, de16 scribe the means for achieving the objectives, 

17 and designate the date by which the objectives 

18 are expected to be achieved; 

19 ‘‘(D) ensure that all amounts appropriated 

20 for such activities are expended in accordance 

21 with the plan and budget; 

22 ‘‘(E) annually submit to Congress a report 

23 on the progress made with respect to the plan; 

24 and 


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1 ‘‘(F) create and implement a plan for the 

2 systemic review of research activities supported 

3 by the National Institutes of Health that are 

4 within the mission of both the Institute and 

5 other institutes and centers of the National In6 stitutes of Health, including by establishing 

7 mechanisms for— 

8 ‘‘(i) tracking minority health and 

9 health disparity research conducted within 

10 the institutes and centers assessing the ap11 propriateness of this research with regard 

12 to the overall goals and objectives of the 

13 plan; 

14 ‘‘(ii) the early identification of appli15 cations and proposals for grants, contracts, 

16 and cooperative agreements supporting ex17 tramural training, research, and develop18 ment, that are submitted to the institutes 

19 and centers that are within the mission of 

20 the Institute; 

21 ‘‘(iii) providing the Institute with the 

22 written descriptions and scientific peer re23 view results of such applications and pro24 posals; 


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1 ‘‘(iv) enabling the institutes and cen2 ters to consult with the Director of the In3 stitute prior to final approval of such ap4 plications and proposals; and 

5 ‘‘(v) reporting to the Director of the 

6 Institute all such applications and pro7 posals that are approved for funding by 

8 the institutes and centers. 

9 ‘‘(2) CERTAIN COMPONENTS OF PLAN AND

10 BUDGET.—With respect to health disparities re11 search activities of the agencies of the National In12 stitutes of Health, the Director of the Institute shall 

13 ensure that the plan and budget under paragraph 

14 (1) provide for— 

15 ‘‘(A) basic research and applied research, 

16 including research and development with re17 spect to products; 

18 ‘‘(B) research that is conducted by the 

19 agencies; 

20 ‘‘(C) research that is supported by the 

21 agencies; 

22 ‘‘(D) proposals developed pursuant to so23 licitations by the agencies and for proposals de24 veloped independently of such solicitations; and 


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1 ‘‘(E) behavioral research and social 

2 sciences research, which may include cultural 

3 and linguistic research in each of the agencies. 

4 ‘‘(3) MINORITY HEALTH DISPARITIES RE5 SEARCH.—The plan and budget under paragraph (1) 

6 shall include a separate statement of the plan and 

7 budget for minority health disparities research.’’; 

8 (3) by amending subsection (h) to read as fol9 lows: 

10 ‘‘(h) RESEARCH ENDOWMENTS.— 

11 ‘‘(1) IN GENERAL.—The Director of the Insti12 tute shall carry out a program to facilitate minority 

13 health and health disparities research and other 

14 health disparities research by providing research en15 dowments at— 

16 ‘‘(A) centers of excellence under section 

17 736; and 

18 ‘‘(B) centers of excellence under section 

19 485F. 

20 ‘‘(2) ELIGIBILITY.—The Director of the Insti21 tute shall provide for a research endowment under 

22 paragraph (1) only if the institution involved meets 

23 the following conditions: 

24 ‘‘(A) The institution does not have an en25 dowment that is worth in excess of an amount 


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1 equal to 50 percent of the national average of 

2 endowment funds at institutions that conduct 

3 similar biomedical research or training of health 

4 professionals. 

5 ‘‘(B) The application of the institution 

6 under paragraph (1) regarding a research en7 dowment has been recommended pursuant to 

8 technical and scientific peer review and has 

9 been approved by the advisory council estab10 lished pursuant to subsection (j). 

11 ‘‘(C) The institution at any time was 

12 deemed to be eligible to receive a grant under 

13 section 736 and at any time received a research 

14 endowment under paragraph (1).’’; and 

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

16 ‘‘(k) FUNDING.— 

17 ‘‘(1) FULL FUNDING BUDGET.— 

18 ‘‘(A) IN GENERAL.—With respect to a fis19 cal year, the Director of the Institute shall pre20 pare and submit directly to the President, for 

21 review and transmittal to Congress, a budget 

22 estimate for carrying out the plan for the fiscal 

23 year, after reasonable opportunity for comment 

24 (but without change) by the Secretary, the Di25 rector of the National Institutes of Health, the 


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1 directors of the other institutes and centers of 

2 the National Institutes of Health, and the advi3 sory council established pursuant to subsection 

4 (j). The budget estimate shall include an esti5 mate of the number and type of personnel 

6 needs for the Institute. 

7 ‘‘(B) AMOUNTS NECESSARY.—The budget 

8 estimate submitted under subparagraph (A) 

9 shall estimate the amounts necessary for the in10 stitutes and centers of the National Institutes 

11 of Health to carry out all minority health and 

12 health disparities activities determined by the 

13 Director of the Institute to be appropriate, 

14 without regard to the probability that such 

15 amounts will be appropriated. 

16 ‘‘(2) ALTERNATE BUDGETS.— 

17 ‘‘(A) IN GENERAL.—With respect to a fis18 cal year, the Director of the Institute shall pre19 pare and submit to the Secretary and the Di20 rector of the National Institutes of Health the 

21 budget estimates described in subparagraph (B) 

22 for carrying out the plan for the fiscal year. 

23 The Secretary and such Director shall consider 

24 each of such estimates in making recommendaVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00214 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 tions to the President regarding a budget for 

2 the plan for such year. 

3 ‘‘(B) DESCRIPTION.—With respect to the 

4 fiscal year involved, the budget estimates re5 ferred to in subparagraph (A) for the plan are 

6 as follows: 

7 ‘‘(i) The budget estimate submitted 

8 under paragraph (1). 

9 ‘‘(ii) A budget estimate developed on 

10 the assumption that the amounts appro11 priated will be sufficient only for— 

12 ‘‘(I) continuing the conduct by 

13 the institutes and centers of the Na14 tional Institutes of Health of existing 

15 minority health and health disparity 

16 activities (if approved for continu17 ation), and continuing the support of 

18 such activities by the institutes and 

19 centers in the case of projects or pro20 grams for which the institutes or cen21 ters have made a commitment of con22 tinued support; and 

23 ‘‘(II) carrying out activities that 

24 are in addition to activities specified 

25 in subclause (I), only for which the 


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1 Director determines there is the most 

2 substantial need. 

3 ‘‘(iii) Such other budget estimates as 

4 the Director of the Institute determines to 

5 be appropriate.’’. 

6 SEC. 414. IOM REPORT ON LGBT HEALTH DISPARITIES. 

7 The Secretary of Health and Human Services shall 

8 enter into an agreement with the Institute of Medicine to 

9 prepare and submit to the Congress a report on— 

10 (1) health and health care disparities experi11 enced by the lesbian, gay, bisexual, and transgender 

12 communities; and 

13 (2) the unique health and health care chal14 lenges experienced by such communities. 

15 Subtitle B—Improving 

16 Environmental Justice 

17 SEC. 421. CODIFICATION OF EXECUTIVE ORDER 12898. 

18 (a) IN GENERAL.—The President of the United 

19 States is authorized and directed to execute, administer, 

20 and enforce as a matter of Federal law the provisions of 

21 Executive Order 12898, dated February 11, 1994 (‘‘Fed22 eral Actions To Address Environmental Justice In Minor23 ity Populations and Low-Income Populations’’), with such 

24 modifications as are provided in this section. 


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1 (b) DEFINITION OF ENVIRONMENTAL JUSTICE.—For 

2 purposes of carrying out the provisions of Executive Order 

3 12898, the following definitions shall apply: 

4 (1) The term ‘‘environmental justice’’ means 

5 the fair treatment and meaningful involvement of all 

6 people regardless of race, color, national origin, edu7 cational level, or income with respect to the develop8 ment, implementation, and enforcement of environ9 mental laws and regulations in order to ensure 

10 that— 

11 (A) minority and low-income communities 

12 have access to public information relating to 

13 human health and environmental planning, reg14 ulations, and enforcement; and 

15 (B) no minority or low-income population 

16 is forced to shoulder a disproportionate burden 

17 of the negative human health and environ18 mental impacts of pollution or other environ19 mental hazard. 

20 (2) The term ‘‘fair treatment’’ means policies 

21 and practices that ensure that no group of people, 

22 including racial, ethnic, or socioeconomic groups 

23 bear disproportionately high and adverse human 

24 health or environmental effects resulting from Fed25 eral agency programs, policies, and activities. 


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1 (c) JUDICIAL REVIEW AND RIGHTS OF ACTION.— 

2 The provisions of section 6–609 of Executive Order 12898 

3 shall not apply for purposes of this Act. 

4 SEC. 422. IMPLEMENTATION OF RECOMMENDATIONS BY 

5 ENVIRONMENTAL PROTECTION AGENCY. 

6 (a) INSPECTOR GENERAL RECOMMENDATIONS.—The 

7 Administrator of the Environmental Protection Agency 

8 shall, as promptly as practicable, carry out each of the 

9 following recommendations of the Inspector General of the 

10 agency as set forth in Report No. 2006–P–00034 entitled 

11 ‘‘EPA needs to conduct environmental justice reviews of 

12 its programs, policies and activities’’: 

13 (1) The recommendation that the Agency’s pro14 gram and regional offices identify which programs, 

15 policies, and activities need environmental justice re16 views and require these offices to establish a plan to 

17 complete the necessary reviews. 

18 (2) The recommendation that the Administrator 

19 of the Agency ensure that these reviews determine 

20 whether the programs, policies, and activities may 

21 have a disproportionately high and adverse health or 

22 environmental impact on minority and low-income 

23 populations. 

24 (3) The recommendation that each program 

25 and regional office develop specific environmental 


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1 justice review guidance for conducting environmental 

2 justice reviews. 

3 (4) The recommendation that the Administrator 

4 designate a responsible office to compile results of 

5 environmental justice reviews and recommend appro6 priate actions. 

7 (b) GAO RECOMMENDATIONS.—In developing rules 

8 under laws administered by the Environmental Protection 

9 Agency, the Administrator of the Agency shall, as prompt10 ly as practicable, carry out each of the following rec11 ommendations of the Comptroller General of the United 

12 States as set forth in GAO Report numbered GAO–05– 

13 289 entitled ‘‘EPA Should Devote More Attention to En14 vironmental Justice when Developing Clean Air Rules’’: 

15 (1) The recommendation that the Administrator 

16 ensure that workgroups involved in developing a rule 

17 devote attention to environmental justice while draft18 ing and finalizing the rule. 

19 (2) The recommendation that the Administrator 

20 enhance the ability of such workgroups to identify 

21 potential environmental justice issues through such 

22 steps as providing workgroup members with guid23 ance and training to helping them identify potential 

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1 ronmental justice coordinators in the workgroups 

2 when appropriate. 

3 (3) The recommendation that the Administrator 

4 improve assessments of potential environmental jus5 tice impacts in economic reviews by identifying the 

6 data and developing the modeling techniques needed 

7 to assess such impacts. 

8 (4) The recommendation that the Administrator 

9 direct appropriate Agency officers and employees to 

10 respond fully when feasible to public comments on 

11 environmental justice, including improving the Agen12 cy’s explanation of the basis for its conclusions, to13 gether with supporting data. 

14 (c) 2004 INSPECTOR GENERAL REPORT.—The Ad15 ministrator of the Environmental Protection Agency shall, 

16 as promptly as practicable, carry out each of the following 

17 recommendations of the Inspector General of the Agency 

18 as set forth in the report entitled ‘‘EPA Needs to Consist19 ently Implement the Intent of the Executive Order on En20 vironmental Justice’’ (Report No. 2004–P–00007): 

21 (1) The recommendation that the Agency clear22 ly define the mission of the Office of Environmental 

23 Justice (OEJ) and provide Agency staff with an un24 derstanding of the roles and responsibilities of the 

25 Office. 


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1 (2) The recommendation that the Agency estab2 lish (through issuing guidance or a policy statement 

3 from the Administrator) specific time frames for the 

4 development of definitions, goals, and measurements 

5 regarding environmental justice and provide the re6 gions and program offices a standard and consistent 

7 definition for a minority and low-income community, 

8 with instructions on how the Agency will implement 

9 and operationalize environmental justice into the 

10 Agency’s daily activities. 

11 (3) The recommendation that the Agency en12 sure the comprehensive training program currently 

13 under development includes standard and consistent 

14 definitions of the key environmental justice concepts 

15 (such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor16 tionately impacted’’) and instructions for implemen17 tation of those concepts. 

18 (d) REPORT.—The Administrator shall submit an ini19 tial report to Congress within 6 months after the enact20 ment of this Act regarding the Administrator’s strategy 

21 for implementing the recommendations referred to in sub22 sections (a), (b), and (c). Thereafter, the Administrator 

23 shall provide semi-annual reports to Congress regarding 

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1 gency management procedures to incorporate environ2 mental justice in the Agency’s Incident Command Struc3 ture (in accordance with the December 18, 2006, letter 

4 from the Deputy Administrator to the Acting Inspector 

5 General of the agency). 

6 SEC. 423. GRANT PROGRAM. 

7 (a) DEFINITIONS.—In this section: 

8 (1) DIRECTOR.—The term ‘‘Director’’ means 

9 the Director of the Centers for Disease Control and 

10 Prevention, acting in collaboration with the Adminis11 trator of the Environmental Protection Agency and 

12 the Director of the National Institute of Environ13 mental Health Sciences. 

14 (2) ELIGIBLE ENTITY.—The term ‘‘eligible enti15 ty’’ means a State or local community that— 

16 (A) bears a disproportionate burden of ex17 posure to environmental health hazards; 

18 (B) has established a coalition— 

19 (i) with not less than 1 community20 based organization; and 

21 (ii) with not less than 1— 

22 (I) public health entity; 

23 (II) health care provider organi24 zation; or 


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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.— 


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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 


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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 decision-making proc8 esses. 

9 (iii) DUTIES.—A PPC shall— 

10 (I) identify key stakeholders and 

11 engage and coordinate potential part12 ners in the planning process; 

13 (II) establish a formal advisory 

14 group to plan for the establishment of 

15 services; 

16 (III) conduct an in-depth review 

17 of the nature and extent of the need 

18 for an environmental health assess19 ment, including a local epidemiological 

20 profile, an evaluation of the service 

21 provider capacity of the community, 

22 and a profile of any target popu23 lations; and 

24 (IV) define the components of 

25 care and form essential programmatic 


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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. 


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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 


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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) healthcare 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, and related co-morbidities; 


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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 2010; and 


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1 (2) such sums as may be necessary for fiscal 

2 years 2011 through 2014. 

3 SEC. 424. 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; 

25 (F) accessibility to healthcare services; and 


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1 (G) other indicators as determined appro2 priate by the Secretary. 

3 (2) GRANTS.—The Secretary, in collaboration 

4 with the Administrator, shall provide grants to eligi5 ble institutions to conduct and coordinate research 

6 on the built environment and its influence on indi7 vidual and population-based health. 

8 (3) RESEARCH.—The Secretary shall support 

9 research that— 

10 (A) investigates and defines the causal 

11 links between all aspects of the built environ12 ment and the health of residents; 

13 (B) examines— 

14 (i) the extent of the impact of the 

15 built environment (including the various 

16 characteristics of the built environment) on 

17 the health of residents; 

18 (ii) the variance in the health of resi19 dents by— 

20 (I) location (such as inner cities, 

21 inner suburbs, and outer suburbs); 

22 and 

23 (II) population subgroup (such as 

24 children, the elderly, the disadvan25 taged); or 


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1 (iii) the importance of the built envi2 ronment to the total health of residents, 

3 which is the primary variable of interest 

4 from a public health perspective; 

5 (C) is used to develop— 

6 (i) measures to address health and the 

7 connection of health to the built environ8 ment; and 

9 (ii) efforts to link the measures to 

10 travel and health databases; and 

11 (D) distinguishes carefully between per12 sonal attitudes and choices and external influ13 ences on observed behavior to determine how 

14 much an observed association between the built 

15 environment and the health of residents, versus 

16 the lifestyle preferences of the people that 

17 choose to live in the neighborhood, reflects the 

18 physical characteristics of the neighborhood; 

19 and 

20 (E)(i) identifies or develops effective inter21 vention strategies to promote better health 

22 among residents with a focus on behavioral 

23 interventions and enhancements of the built en24 vironment that promote increased use by resi25 dents; and 


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1 (ii) in developing the intervention strate2 gies under clause (i), ensures that the interven3 tion strategies will reach out to high-risk popu4 lations, including racial and ethnic minorities 

5 and low-income urban and rural communities. 

6 (4) PRIORITY.—In providing assistance under 

7 the grant program authorized under paragraph (2), 

8 the Secretary and the Administrator shall give pri9 ority to research that incorporates— 

10 (A) minority-serving institutions as grant11 ees; 

12 (B) interdisciplinary approaches; or 

13 (C) the expertise of the public health, 

14 physical activity, urban planning, and transpor15 tation research communities in the United 

16 States and abroad. 

17 TITLE V—IMPROVEMENT OF 

18 HEALTH CARE SERVICES 

19 Subtitle A—Health Empowerment 

20 Zones 

21 SEC. 501. SHORT TITLE. 

22 This subtitle may be cited as the ‘‘Health Empower23 ment Zone Act of 2009’’. 

24 SEC. 502. FINDINGS. 

25 The Congress finds the following: 


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1 (1) Numerous studies and reports, including 

2 the National Healthcare Disparities Report and Un3 equal Treatment, the 2002 Institute of Medicine Re4 port, document the extensiveness to which health 

5 disparities exist across the country. 

6 (2) These studies have found that, on average, 

7 racial and ethnic minorities are disproportionately 

8 afflicted with chronic and acute conditions—such as 

9 cancer, diabetes, and hypertension—and suffer 

10 worse health outcomes, worse health status, and 

11 higher mortality rates than their White counter12 parts. 

13 (3) Several recent studies also show that health 

14 disparities are a function of not only access to health 

15 care, but also the social determinants of health—in16 cluding the environment, the physical structure of 

17 communities, nutrition and food options, educational 

18 attainment, employment, race, ethnicity, geography, 

19 and language preference—that directly and indi20 rectly affect the health, health care, and wellness of 

21 individuals and communities. 

22 (4) Integrally involving and fully supporting the 

23 communities most affected by health inequities in 

24 the assessment, planning, launch, and evaluation of 

25 health disparity elimination efforts is among the 


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1 leading recommendations made to adequately ad2 dress and ultimately reduce health disparities. 

3 (5) Recommendations also include supporting 

4 the efforts of community stakeholders from a broad 

5 cross-section—including, but not limited to local 

6 businesses, local departments of commerce, edu7 cation, labor, urban planning, and transportation, 

8 and community-based and other nonprofit organiza9 tions—to find areas of common ground around 

10 health disparity elimination and collaborate to im11 prove the overall health and wellness of a community 

12 and its residents. 

13 SEC. 503. DESIGNATION OF HEALTH EMPOWERMENT 

14 ZONES. 

15 (a) IN GENERAL.—At the request of an eligible com16 munity partnership, the Secretary may designate an eligi17 ble area as a health empowerment zone. 

18 (b) ELIGIBILITY CRITERIA.— 

19 (1) ELIGIBLE COMMUNITY PARTNERSHIP.—A 

20 community partnership is eligible to submit a re21 quest under this section if the partnership— 

22 (A) demonstrates widespread public sup23 port from key individuals and entities in the eli24 gible area, including State and local govern25 ments, nonprofit organizations, and community 


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1 and industry leaders, for designation of the eli2 gible area as a health empowerment zone; and 

3 (B) includes representatives of— 

4 (i) a broad cross section of stake5 holders and residents from communities in 

6 the eligible area experiencing dispropor7 tionate disparities in health status and 

8 health care; and 

9 (ii) organizations, facilities, and insti10 tutions that have a history of working 

11 within and serving such communities. 

12 (2) ELIGIBLE AREA.—An area is eligible to be 

13 designated as a health empowerment zone under this 

14 section if one or more communities in the area expe15 rience disproportionate disparities in health status 

16 and health care. In determining whether a commu17 nity experiences such disparities, the Secretary shall 

18 consider the data collected by the Department of 

19 Health and Human Services focusing on the fol20 lowing areas: 

21 (A) Access to high-quality health services. 

22 (B) Arthritis, osteoporosis, and chronic 

23 back conditions. 

24 (C) Cancer. 

25 (D) Chronic kidney disease. 


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1 (E) Diabetes. 

2 (F) Injury and violence prevention. 

3 (G) Maternal, infant, and child health. 

4 (H) Medical product safety. 

5 (I) Mental health and mental disorders. 

6 (J) Nutrition and overweight. 

7 (K) Disability and secondary conditions. 

8 (L) Educational and community-based 

9 health programs. 

10 (M) Environmental health. 

11 (N) Family planning. 

12 (O) Food safety. 

13 (P) Health communication. 

14 (Q) Health disease and stroke. 

15 (R) HIV/AIDS. 

16 (S) Immunization and infectious diseases. 

17 (T) Occupational safety and health. 

18 (U) Oral health. 

19 (V) Physical activity and fitness. 

20 (W) Public health infrastructure. 

21 (X) Respiratory diseases. 

22 (Y) Sexually transmitted diseases. 

23 (Z) Substance abuse. 

24 (AA) Tobacco use. 

25 (BB) Vision and hearing. 


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1 (c) PROCEDURE.— 

2 (1) REQUEST.—A request under subsection (a) 

3 shall— 

4 (A) describe the bounds of the area to be 

5 designated as a health empowerment zone and 

6 the process used to select those bounds; 

7 (B) demonstrate that the partnership sub8 mitting the request is an eligible community 

9 partnership described in subsection (b)(1); 

10 (C) demonstrate that the area is an eligible 

11 area described in subsection (b)(2); 

12 (D) include a comprehensive assessment of 

13 disparities in health status and health care ex14 perience by one or more communities in the 

15 area; 

16 (E) set forth— 

17 (i) a vision and a set of values for the 

18 area; and 

19 (ii) a comprehensive and holistic set of 

20 goals to be achieved in the area through 

21 designation as a health empowerment zone; 

22 and 

23 (F) include a strategic plan for achieving 

24 the goals described in subparagraph (E)(ii). 


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1 (2) APPROVAL.—Not later than 60 days after 

2 the receipt of a request for designation of an area 

3 as a health empowerment zone under this section, 

4 the Secretary shall approve or disapprove the re5 quest. 

6 (d) MINIMUM NUMBER.—The Secretary— 

7 (1) shall designate not more than 110 health 

8 empowerment zones under this section; and 

9 (2) shall designate at least one health empower10 ment zone in each of the several States, the District 

11 of Columbia, and each territory or possession of the 

12 United States. 

13 SEC. 504. ASSISTANCE TO THOSE SEEKING DESIGNATION. 

14 At the request of any organization or entity seeking 

15 to submit a request under section 503(a), the Secretary 

16 shall provide technical assistance, and may award a grant, 

17 to assist such organization or entity— 

18 (1) to form an eligible community partnership 

19 described in section 503(b)(1); 

20 (2) to complete a health assessment, including 

21 an assessment of health disparities under section 

22 503(c)(1)(D); or 

23 (3) to prepare and submit a request, including 

24 a strategic plan, in accordance with section 503. 


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1 SEC. 505. 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 503. 

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 


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1 grant because the Secretary rendered technical as2 sistance or made a grant to the same applicant 

3 under section 504. 

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. 506. 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 Director of the Office of Minority 

14 Health, and in cooperation with the Director of the Office 

15 of Community Services and the Director of the National 

16 Institute for Minority Health and Health Disparities. 

17 SEC. 507. AUTHORIZATION OF APPROPRIATIONS. 

18 To carry out this subtitle, there is authorized to be 

19 appropriated $100,000,000 for fiscal year 2010. 


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1 Subtitle B—Other Improvements of 

2 Health Care Services 

3 CHAPTER 1—IN GENERAL 

4 SEC. 511. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

5 ACT. 

6 Title XXXI of the Public Health Service Act, as 

7 amended by titles II, III, and IV of this Act, is further 

8 amended by adding at the end 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. 3151. 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— 


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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 


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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; 


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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. 


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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. 3152. 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 3151(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 

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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. 3153. 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. 


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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, or the Commonwealth of the 

5 Northern Mariana Islands, the United States Virgin Is6 lands, Puerto Rico, and Hawaii that— 

7 ‘‘(1) is owned or operated by— 

8 ‘‘(A) the government of American Samoa, 

9 Guam, or the Commonwealth of the Northern 

10 Mariana Islands, the United States Virgin Is11 lands, Puerto Rico, and Hawaii or a unit of 

12 local 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 


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1 a report that includes an assessment of health resources 

2 and facilities serving populations in American Samoa, 

3 Guam, and the Commonwealth of the Northern Mariana 

4 Islands, the United States Virgin Islands, Puerto Rico, 

5 and Hawaii. In preparing such report, the Secretary 

6 shall— 

7 ‘‘(1) consult with and obtain information on all 

8 health care facilities needs from the entities de9 scribed in subsection (b); 

10 ‘‘(2) include all amounts of Federal assistance 

11 received by each entity in the preceding fiscal year; 

12 ‘‘(3) review the total unmet needs of each juris13 diction for health care facilities, including needs for 

14 renovation and expansion of existing facilities; and 

15 ‘‘(4) include a strategic plan for addressing the 

16 needs of each jurisdiction identified in the report. 

17 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

18 are authorized to be appropriated such sums as necessary 

19 to carry out this section.’’. 

20 SEC. 512. MEDICAID PAYMENT FOR CERTAIN ALIENS. 

21 (a) MEDICAID.—Section 1903(v) of the Social Secu22 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

23 paragraph (4) and inserting the following: 

24 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 

25 403, and 421 of Public Law 104–193, payment shall be 


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1 made under this section for care and services that are fur2 nished to individuals, if they who otherwise meet the eligi3 bility requirements for medical assistance under the State 

4 plan approved under this title (other than the requirement 

5 of the receipt of aid or assistance under title IV, supple6 mental security income benefits under title XVI, or a State 

7 supplementary payment), and are— 

8 ‘‘(i) lawfully present in the United States; 

9 ‘‘(ii) children under age 21, including optional 

10 targeted low-income children described in section 

11 1905(u)(2)(B); or 

12 ‘‘(iii) pregnant women during pregnancy (and 

13 during the 60-day period beginning on the last day 

14 of the pregnancy). 

15 ‘‘(B) No debt shall accrue under an affidavit of sup16 port against any sponsor of such individual on the basis 

17 of provision of medical assistance and the cost of such as18 sistance shall not be considered as an unreimbursed 

19 cost.’’. 

20 (b) SCHIP.—Section 2107(e)(1) of the Social Secu21 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by striking 

22 subparagraph (H) and inserting the following: 

23 ‘‘(H) Paragraph (4) of section 1903(v) (re24 lating to individuals who, but for sections 

25 401(a), 403, and 421 of Public Law 104–193 


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1 would be eligible for medical assistance under 

2 title XXI).’’. 

3 (c) CONFORMING AMENDMENT.—Section 1137(f) of 

4 such Act (42 U.S.C. 1320b–7(f)) is amended by inserting 

5 ‘‘and for medical assistance provided to children and preg6 nant women’’ before the period at the end. 

7 SEC. 513. MEDICAID PAYMENT PARITY FOR THE TERRI8 TORIES. 

9 (a) ELIMINATION OF FUNDING LIMITATIONS FOR

10 PUERTO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTH11 ERN MARIANA ISLANDS, AND AMERICAN SAMOA.— 

12 (1) IN GENERAL.—Section 1108 of the Social 

13 Security Act (42 U.S.C. 1308) is amended— 

14 (A) in subsection (f), in the matter before 

15 paragraph (1), by striking ‘‘subsection (g)’’ and 

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

17 (B) in subsection (g)(2), in the matter be18 fore subparagraph (A), by inserting ‘‘and sub19 section (h)’’ after ‘‘paragraph (3)’’; and 

20 (C) by adding at the end the following new 

21 subsection: 

22 ‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER23 TO RICO, THE VIRGIN ISLANDS, GUAM, THE NORTHERN

24 MARIANA ISLANDS, AND AMERICAN SAMOA.—Subsections 

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1 lands, Guam, the Northern Mariana Islands, and Amer2 ican Samoa for any fiscal year after fiscal year 2009.’’. 

3 (2) CONFORMING AMENDMENT.—Section 

4 1903(u) of such Act (42 U.S.C. 1396c(u)) is amend5 ed by striking paragraph (4). 

6 (3) EFFECTIVE DATE.—The amendments made 

7 by this subsection shall apply beginning with fiscal 

8 year 2010. 

9 (b) PARITY IN FMAP.— 

10 (1) IN GENERAL.—Section 1905(b)(2) of such 

11 Act (42 U.S.C. 1396d(b)(2)) is amended by insert12 ing after ‘‘50 per centum’’ the following: ‘‘(except 

13 that, beginning with fiscal year 2012, the Federal 

14 medical assistance percentage for Puerto Rico, the 

15 Virgin Islands, Guam, the Northern Mariana Is16 lands, and American Samoa shall be the Federal 

17 medical assistance percentage determined by the 

18 Secretary in consultation (for the Virgin Islands, 

19 Guam, the Northern Mariana Islands, and American 

20 Samoa) with the Secretary of the Interior)’’. 

21 (2) 2-FISCAL-YEAR TRANSITION.—Notwith22 standing any other provision of law, during fiscal 

23 years 2010 and 2011, the Federal medical assist24 ance percentage established under section 1905(b) of 

25 the Social Security Act (42 U.S.C. 1396d(b)) for 


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1 Puerto Rico, the Virgin Islands, Guam, the North2 ern Mariana Islands, and American Samoa shall be 

3 the highest such Federal medical assistance percent4 age applicable to any of the 50 States or the District 

5 of Columbia for the fiscal year involved, taking into 

6 account the application of subsections (a) and (b)(1) 

7 of 5001 of division B of the American Recovery and 

8 Reinvestment Act of 2009 (Public Law 111–5) to 

9 such States and District for calendar quarters dur10 ing such fiscal years for which such subsections 

11 apply respectively. 

12 (3) PER CAPITA INCOME DATA.— 

13 (A) REPORT TO CONGRESS.—Not later 

14 than October 1, 2010, the Secretary of Health 

15 and Human Services shall submit to Congress 

16 a report that describes the per capita income 

17 data used to promulgate the Federal medical 

18 assistance percentage in the territories and how 

19 such data differ from the per capita income 

20 data used to promulgate Federal medical assist21 ance percentages for the 50 States and the Dis22 trict of Columbia. The report should include 

23 recommendations on how the Federal medical 

24 assistance percentages can be calculated for the 


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1 territories to ensure parity with the 50 States 

2 and the District of Columbia. 

3 (B) APPLICATION.—Section 1101(a)(8)(B) 

4 of the Social Security Act (42 U.S.C. 

5 1308(a)(8)(B)) is amended— 

6 (i) by striking ‘‘(other than Puerto 

7 Rico, the Virgin Islands, and Guam)’’ and 

8 inserting ‘‘(including Puerto Rico, the Vir9 gin Islands, Guam, the Northern Mariana 

10 Islands, and American Samoa)’’; and 

11 (ii) by inserting ‘‘(or, if such satisfac12 tory data are not available in the case of 

13 the Virgin Islands, Guam, the Northern 

14 Mariana Islands, or American Samoa, sat15 isfactory data available from the Depart16 ment of the Interior for the same period, 

17 or if such satisfactory data are not avail18 able in the case of Puerto Rico, satisfac19 tory data available from the government of 

20 the Commonwealth of Puerto Rico for the 

21 same period)’’ after ‘‘Department of Com22 merce’’. 

23 (4) RELATION TO AMERICAN RECOVERY AND

24 REINVESTMENT ACT OF 2009.—For any period and 

25 territory in which the provisions of this subsection 


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1 apply to a territory, the provisions of section 

2 5001(b)(2) of division B of the American Recovery 

3 and Reinvestment Act of 2009 (Public Law 111–5) 

4 shall not apply (except as otherwise specifically pro5 vided in paragraph (2)). 

6 SEC. 514. EXTENSION OF MEDICARE SECONDARY PAYER. 

7 (a) IN GENERAL.—Section 1862(b)(1)(C) of the So8 cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend9 ed— 

10 (1) in the last sentence, by inserting ‘‘, and be11 fore January 1, 2010’’ after ‘‘prior to such date)’’; 

12 and 

13 (2) by adding at the end the following new sen14 tence: ‘‘Effective for items and services furnished on 

15 or after January 1, 2010 (with respect to periods 

16 beginning on or after the date that is 42 months 

17 prior to such date), clauses (i) and (ii) shall be ap18 plied by substituting ‘42-month’ for ‘12-month’ each 

19 place it appears in the first sentence.’’. 

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

21 this subsection shall take effect on the date of enactment 

22 of this Act. For purposes of determining an individual’s 

23 status under section 1862(b)(1)(C) of the Social Security 

24 Act (42 U.S.C. 1395y(b)(1)(C)), as amended by para25 graph (1), an individual who is within the coordinating 


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1 period as of the date of enactment of this Act shall have 

2 that period extended to the full 42 months described in 

3 the last sentence of such section, as added by the amend4 ment made by paragraph (1)(B). 

5 SEC. 515. BORDER HEALTH GRANTS. 

6 (a) ELIGIBLE ENTITY DEFINED.—In this section, 

7 the term ‘‘eligible entity’’ means a State, public institution 

8 of higher education, local government, tribal government, 

9 nonprofit health organization, community health center, or 

10 community clinic receiving assistance under section 330 

11 of the Public Health Service Act (42 U.S.C. 254b), that 

12 is located in the border area. 

13 (b) AUTHORIZATION.—From funds appropriated 

14 under subsection (f), the Secretary of Health and Human 

15 Services (in this section referred to as the ‘‘Secretary’’), 

16 acting through the United States members of the United 

17 States-Mexico Border Health Commission, shall award 

18 grants to eligible entities to address priorities and rec19 ommendations to improve the health of border area resi20 dents that are established by— 

21 (1) the United States members of the United 

22 States-Mexico Border Health Commission; 

23 (2) the State border health offices; and 

24 (3) the Secretary. 


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1 (c) APPLICATION.—An eligible entity that desires a 

2 grant under subsection (b) shall submit an application to 

3 the Secretary at such time, in such manner, and con4 taining such information as the Secretary may require. 

5 (d) USE OF FUNDS.—An eligible entity that receives 

6 a grant under subsection (b) shall use the grant funds 

7 for— 

8 (1) programs relating to— 

9 (A) maternal and child health; 

10 (B) primary care and preventative health; 

11 (C) public health and public health infra12 structure; 

13 (D) health education and promotion; 

14 (E) oral health; 

15 (F) mental and behavioral health; 

16 (G) substance abuse; 

17 (H) health conditions that have a high 

18 prevalence in the border area; 

19 (I) medical and health services research; 

20 (J) workforce training and development; 

21 (K) community health workers or 

22 promotoras; 

23 (L) health care infrastructure problems in 

24 the border area (including planning and con25 struction grants); 


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1 (M) health disparities in the border area; 

2 (N) environmental health; and 

3 (O) outreach and enrollment services with 

4 respect to Federal programs (including pro5 grams authorized under titles XIX and XXI of 

6 the Social Security Act (42 U.S.C. 1396 and 

7 1397aa)); and 

8 (2) other programs determined appropriate by 

9 the Secretary. 

10 (e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro11 vided to an eligible entity awarded a grant under sub12 section (b) shall be used to supplement and not supplant 

13 other funds available to the eligible entity to carry out the 

14 activities described in subsection (d). 

15 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

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

17 $200,000,000 for fiscal year 2010, and such sums as may 

18 be necessary for each succeeding fiscal year. 

19 SEC. 516. CANCER PREVENTION AND TREATMENT DEM20 ONSTRATION FOR ETHNIC AND RACIAL MI21 NORITIES. 

22 (a) DEMONSTRATION.— 

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

24 Human Services (in this section referred to as the 

25 ‘‘Secretary’’) shall conduct demonstration projects 


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1 (in this section referred to as ‘‘demonstration 

2 projects’’) for the purpose of developing models and 

3 evaluating methods that— 

4 (A) improve the quality of items and serv5 ices provided to target individuals in order to 

6 facilitate reduced disparities in early detection 

7 and treatment of cancer; 

8 (B) improve clinical outcomes, satisfaction, 

9 quality of life, and appropriate use of Medicare10 covered services and referral patterns among 

11 those target individuals with cancer; 

12 (C) eliminate disparities in the rate of pre13 ventive cancer screening measures, such as pap 

14 smears, prostate cancer screenings, and CT 

15 scans for lung cancer among target individuals; 

16 and 

17 (D) promote collaboration with community18 based organizations to ensure cultural com19 petency of health care professionals and lin20 guistic access for persons with limited English 

21 proficiency. 

22 (2) TARGET INDIVIDUAL DEFINED.—In this 

23 section, the term ‘‘target individual’’ means an indi24 vidual of a racial and ethnic minority group, as de25 fined by section 1707 of the Public Health Service 


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1 Act (42 U.S.C. 300u–6) who is entitled to benefits 

2 under part A, and enrolled under part B, of title 

3 XVIII of the Social Security Act. 

4 (b) PROGRAM DESIGN.— 

5 (1) INITIAL DESIGN.—Not later than 1 year 

6 after the date of the enactment of this Act, the Sec7 retary shall evaluate best practices in the private 

8 sector, community programs, and academic research 

9 of methods that reduce disparities among individuals 

10 of racial and ethnic minority groups in the preven11 tion and treatment of cancer and shall design the 

12 demonstration projects based on such evaluation. 

13 (2) NUMBER AND PROJECT AREAS.—Not later 

14 than 2 years after the date of the enactment of this 

15 Act, the Secretary shall implement at least nine 

16 demonstration projects, including the following: 

17 (A) Two projects for each of the four fol18 lowing major racial and ethnic minority groups: 

19 (i) American Indians and Alaska Na20 tives, Eskimos and Aleuts. 

21 (ii) Asian Americans. 

22 (iii) Blacks/African Americans. 

23 (iv) Hispanic/Latino Americans. 

24 (v) Native Hawaiians and other Pa25 cific Islanders. 


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1 The two projects must target different ethnic 

2 subpopulations. 

3 (B) One project within the Pacific Islands 

4 or United States insular areas. 

5 (C) At least one project each in a rural 

6 area and inner-city area. 

7 (3) EXPANSION OF PROJECTS; IMPLEMENTA8 TION OF DEMONSTRATION PROJECT RESULTS.—If 

9 the initial report under subsection (c) contains an 

10 evaluation that demonstration projects— 

11 (A) reduce expenditures under the Medi12 care program under title XVIII of the Social 

13 Security Act; or 

14 (B) do not increase expenditures under the 

15 Medicare program and reduce racial and ethnic 

16 health disparities in the quality of health care 

17 services provided to target individuals and in18 crease satisfaction of beneficiaries and health 

19 care providers; 

20 the Secretary shall continue the existing demonstra21 tion projects and may expand the number of dem22 onstration projects. 

23 (c) REPORT TO CONGRESS.— 

24 (1) IN GENERAL.—Not later than 2 years after 

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1 onstration projects, and biannually thereafter, the 

2 Secretary shall submit to Congress a report regard3 ing the demonstration projects. 

4 (2) CONTENTS OF REPORT.—Each report under 

5 paragraph (1) shall include the following: 

6 (A) A description of the demonstration 

7 projects. 

8 (B) An evaluation of— 

9 (i) the cost-effectiveness of the dem10 onstration projects; 

11 (ii) the quality of the health care serv12 ices provided to target individuals under 

13 the demonstration projects; and 

14 (iii) beneficiary and health care pro15 vider satisfaction under the demonstration 

16 projects. 

17 (C) Any other information regarding the 

18 demonstration projects that the Secretary de19 termines to be appropriate. 

20 (d) WAIVER AUTHORITY.—The Secretary shall waive 

21 compliance with the requirements of title XVIII of the So22 cial Security Act to such extent and for such period as 

23 the Secretary determines is necessary to conduct dem24 onstration projects. 


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1 SEC. 517. GRANTS TO PROMOTE POSITIVE HEALTH BEHAV2 IORS IN WOMEN AND CHILDREN. 

3 Part P of title III of the Public Health Service Act 

4 (42 U.S.C. 280g et seq.) is amended— 

5 (1) by redesignating the second and third sec6 tions 399R (added by Public Laws 110–373 and 

7 110–374) as sections 399S and 399T, respectively; 

8 and 

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

10 ‘‘SEC. 399U. GRANTS TO PROMOTE POSITIVE HEALTH BE11 HAVIORS IN WOMEN AND CHILDREN. 

12 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col13 laboration with the Director of the Centers for Disease 

14 Control and Prevention and other Federal officials deter15 mined appropriate by the Secretary, is authorized to 

16 award grants to eligible entities to promote positive health 

17 behaviors for women and children in target populations, 

18 especially racial and ethnic minority women and children 

19 in medically underserved communities. 

20 ‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 

21 subsection (a) may be used to support community health 

22 workers— 

23 ‘‘(1) to educate and provide outreach regarding 

24 enrollment in health insurance including the State 

25 Children’s Health Insurance Program under title 

26 XXI of the Social Security Act, Medicare under title 


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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) dental and oral health problems; and 

20 ‘‘(J) understanding informed consent; 

21 ‘‘(4) to educate and guide regarding effective 

22 strategies to promote positive health behaviors with23 in the family; 

24 ‘‘(5) to promote community wellness and aware25 ness; and 


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1 ‘‘(6) to educate and refer target populations to 

2 appropriate health care agencies and community3 based programs and organizations in order to in4 crease access to quality health care services, includ5 ing preventive health services. 

6 ‘‘(c) APPLICATION.— 

7 ‘‘(1) IN GENERAL.—Each eligible entity that 

8 desires to receive a grant under subsection (a) shall 

9 submit an application to the Secretary, at such time, 

10 in such manner, and accompanied by such additional 

11 information as the Secretary may require. 

12 ‘‘(2) CONTENTS.—Each application submitted 

13 pursuant to paragraph (1) shall— 

14 ‘‘(A) describe the activities for which as15 sistance under this section is sought; 

16 ‘‘(B) contain an assurance that with re17 spect to each community health worker pro18 gram receiving funds under the grant awarded, 

19 such program provides training and supervision 

20 to community health workers to enable such 

21 workers to provide authorized program services; 

22 ‘‘(C) contain an assurance that the appli23 cant will evaluate the effectiveness of commu24 nity health worker programs receiving funds 

25 under the grant; 


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1 ‘‘(D) contain an assurance that each com2 munity health worker program receiving funds 

3 under the grant will provide services in the cul4 tural context most appropriate for the individ5 uals served by the program; 

6 ‘‘(E) contain a plan to document and dis7 seminate project description and results to 

8 other States and organizations as identified by 

9 the Secretary; and 

10 ‘‘(F) describe plans to enhance the capac11 ity of individuals to utilize health services and 

12 health-related social services under Federal, 

13 State, and local programs by— 

14 ‘‘(i) assisting individuals in estab15 lishing eligibility under the programs and 

16 in receiving the services or other benefits 

17 of the programs; and 

18 ‘‘(ii) providing other services as the 

19 Secretary determines to be appropriate, 

20 that may include transportation and trans21 lation services. 

22 ‘‘(d) PRIORITY.—In awarding grants under sub23 section (a), the Secretary shall give priority to those appli24 cants— 

25 ‘‘(1) who propose to target geographic areas— 


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1 ‘‘(A) with a high percentage of residents 

2 who are eligible for health insurance but are 

3 uninsured or underinsured; and 

4 ‘‘(B) with a high percentage of families for 

5 whom English is not their primary language. 

6 ‘‘(2) with experience in providing health or 

7 health-related social services to individuals who are 

8 underserved with respect to such services; and 

9 ‘‘(3) with documented community activity and 

10 experience with community health workers. 

11 ‘‘(e) COLLABORATION WITH ACADEMIC INSTITU12 TIONS.—The Secretary shall encourage community health 

13 worker programs receiving funds under this section to col14 laborate with academic institutions, including minority15 serving institutions. Nothing in this section shall be con16 strued to require such collaboration. 

17 ‘‘(f) QUALITY ASSURANCE AND COST-EFFECTIVE18 NESS.—The Secretary shall establish guidelines for assur19 ing the quality of the training and supervision of commu20 nity health workers under the programs funded under this 

21 section and for assuring the cost-effectiveness of such pro22 grams. 

23 ‘‘(g) MONITORING.—The Secretary shall monitor 

24 community health worker programs identified in approved 

25 applications and shall determine whether such programs 


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1 are in compliance with the guidelines established under 

2 subsection (f). 

3 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 

4 provide technical assistance to community health worker 

5 programs identified in approved applications with respect 

6 to planning, developing, and operating programs under the 

7 grant. 

8 ‘‘(i) REPORT TO CONGRESS.— 

9 ‘‘(1) IN GENERAL.—Not later than 4 years 

10 after the date on which the Secretary first awards 

11 grants under subsection (a), the Secretary shall sub12 mit to Congress a report regarding the grant 

13 project. 

14 ‘‘(2) CONTENTS.—The report required under 

15 paragraph (1) shall include the following: 

16 ‘‘(A) A description of the programs for 

17 which grant funds were used. 

18 ‘‘(B) The number of individuals served. 

19 ‘‘(C) An evaluation of— 

20 ‘‘(i) the effectiveness of these pro21 grams; 

22 ‘‘(ii) the cost of these programs; and 

23 ‘‘(iii) the impact of the project on the 

24 health outcomes of the community resi25 dents. 


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1 ‘‘(D) Recommendations for sustaining the 

2 community health worker programs developed 

3 or assisted under this section. 

4 ‘‘(E) Recommendations regarding training 

5 to enhance career opportunities for community 

6 health workers. 

7 ‘‘(j) DEFINITIONS.—In this section: 

8 ‘‘(1) COMMUNITY HEALTH WORKER.—The term 

9 ‘community health worker’ means an individual who 

10 promotes health or nutrition within the community 

11 in which the individual resides— 

12 ‘‘(A) by serving as a liaison between com13 munities and health care agencies; 

14 ‘‘(B) by providing guidance and social as15 sistance to community residents; 

16 ‘‘(C) by enhancing community residents’ 

17 ability to effectively communicate with health 

18 care providers; 

19 ‘‘(D) by providing culturally and linguis20 tically appropriate health or nutrition edu21 cation; 

22 ‘‘(E) by advocating for individual and com23 munity health, including dental, oral, mental, 

24 and environmental health, or nutrition needs; 

25 and 


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1 ‘‘(F) by providing referral and followup 

2 services. 

3 ‘‘(2) COMMUNITY SETTING.—The term ‘commu4 nity setting’ means a home or a community organi5 zation located in the neighborhood in which a partic6 ipant resides. 

7 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en8 tity’ means— 

9 ‘‘(A) a unit of State, territorial, local, or 

10 tribal government (including a federally recog11 nized tribe or Alaska native villages); or 

12 ‘‘(B) a community-based organization. 

13 ‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 

14 The term ‘medically underserved community’ means 

15 a community— 

16 ‘‘(A) that has a substantial number of in17 dividuals who are members of a medically un18 derserved population, as defined by section 

19 330(b)(3); and 

20 ‘‘(B) a significant portion of which is a 

21 health professional shortage area as designated 

22 under section 332. 

23 ‘‘(5) SUPPORT.—The term ‘support’ means the 

24 provision of training, supervision, and materials 

25 needed to effectively deliver the services described in 


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1 subsection (b), reimbursement for services, and 

2 other benefits. 

3 ‘‘(6) TARGET POPULATION.—The term ‘target 

4 population’ means women of reproductive age, re5 gardless of their current childbearing status and 

6 children under 21 years of age. 

7 ‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated to carry out this section 

9 $15,000,000 for each of fiscal years 2010, 2011, 2012, 

10 2013, and 2014.’’. 

11 SEC. 518. EXCEPTION FOR CITIZENS OF FREELY ASSOCI12 ATED STATES. 

13 (a) IN GENERAL.—Section 402(a)(2) of the Personal 

14 Responsibility and Work Opportunity Reconciliation Act 

15 of 1996 (8 U.S.C. 1612(a)(2)) is amended by adding at 

16 the end the following: 

17 ‘‘(N) EXCEPTION FOR CITIZENS OF FREE18 LY ASSOCIATED STATES.—With respect to eligi19 bility for benefits for the specified Federal pro20 grams described in paragraph (3), paragraph 

21 (1) shall not apply to any individual who law22 fully resides in the United States (including ter23 ritories and possessions of the United States) in 

24 accordance with— 


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1 ‘‘(i) section 141 of the Compact of 

2 Free Association between the Government 

3 of the United States and the Government 

4 of the Federated States of Micronesia, ap5 proved by Congress in the Compact of 

6 Free Association Amendments Act of 

7 2003; 

8 ‘‘(ii) section 141 of the Compact of 

9 Free Association between the Government 

10 of the United States and the Government 

11 of the Republic of the Marshall Islands, 

12 approved by Congress in the Compact of 

13 Free Association Amendments Act of 

14 2003; or 

15 ‘‘(iii) section 141 of the Compact of 

16 Free Association between the Government 

17 of the United States and the Government 

18 of Palau, approved by Congress in Public 

19 Law 99–658 (100 Stat. 3672).’’. 

20 (b) MEDICAID EXCEPTION.—Section 402(b)(2) of the 

21 Personal Responsibility and Work Opportunity Reconcili22 ation Act of 1996 (8 U.S.C. 1612(b)(2)) is amended by 

23 adding at the end the following: 

24 ‘‘(G) MEDICAID EXCEPTIONS FOR CITI25 ZENS OF FREELY ASSOCIATED STATES.—With 


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1 respect to eligibility for benefits for the pro2 grams defined in subparagraphs (A) and (C) of 

3 paragraph (3) (relating to Medicaid), paragraph 

4 (1) shall not apply to any individual who law5 fully resides in the United States (including ter6 ritories and possessions of the United States) in 

7 accordance with a Compact of Free Association 

8 referred to in subsection (a)(2)(N).’’. 

9 (c) QUALIFIED ALIEN.—Section 431(b) of the Per10 sonal Responsibility and Work Opportunity Reconciliation 

11 Act of 1996 (8 U.S.C. 1641(b)) is amended— 

12 (1) in paragraph (6), by striking ‘‘or’’ at the 

13 end; 

14 (2) in paragraph (7), by striking the period at 

15 the end and inserting ‘‘; or’’; and 

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

17 ‘‘(8) an individual who lawfully resides in the 

18 United States (including territories and possessions 

19 of the United States) in accordance with a Compact 

20 of Free Association referred to in section 

21 402(a)(2)(N).’’. 

22 (d) INCREASED FMAP.—The third sentence of sec23 tion 1905(b) of the Social Security Act (42 U.S.C. 

24 1396d(b)) is amended by inserting before the period at 

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1 viduals described in section 431(b)(8) of the Personal Re2 sponsibility and Work Opportunity Reconciliation Act of 

3 1996’’. 

4 SEC. 519. MEDICARE GRADUATE MEDICAL EDUCATION. 

5 (a) CLARIFICATION OF CONGRESSIONAL INTENT RE6 GARDING THE COUNTING OF RESIDENTS IN A NONHOS7 PITAL SETTING.— 

8 (1) D–GME.—Section 1886(h)(4)(E) of the So9 cial Security Act (42 U.S.C. 1395ww(h)(4)(E)) is 

10 amended by adding at the end the following new 

11 sentences: ‘‘For purposes of the preceding sentence, 

12 the term ‘all, or substantially all, of the costs for the 

13 training program’ means the stipends and benefits 

14 provided to the resident and other amounts, if any, 

15 as determined by the hospital and the entity oper16 ating the nonhospital setting. The hospital is not re17 quired to pay the entity any amounts other than 

18 those determined by the hospital and the entity in 

19 order for the hospital to be considered to have in20 curred all, or substantially all, of the costs for the 

21 training program in that setting.’’. 

22 (2) IME.—Section 1886(d)(5)(B)(iv) of the So23 cial Security Act (42 U.S.C. 1395ww(d)(5)(B)(iv)) is 

24 amended by adding at the end the following new 

25 sentences: ‘‘For purposes of the preceding sentence, 


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1 the term ‘all, or substantially all, of the costs for the 

2 training program’ means the stipends and benefits 

3 provided to the resident and other amounts, if any, 

4 as determined by the hospital and the entity oper5 ating the nonhospital setting. The hospital is not re6 quired to pay the entity any amounts other than 

7 those determined by the hospital and the entity in 

8 order for the hospital to be considered to have in9 curred all, or substantially all, of the costs for the 

10 training program in that setting.’’. 

11 (3) EFFECTIVE DATE.—The amendments made 

12 by this subsection shall take effect on January 1, 

13 2010. 

14 (b) CLARIFICATION OF ELIGIBILITY OF A NONRURAL

15 HOSPITAL THAT HAS A TRAINING PROGRAM WITH AN

16 INTEGRATED RURAL TRACK.— 

17 (1) IN GENERAL.—Section 1886(h)(4)(H) of 

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

19 1395ww(h)(4)(H)) is amended— 

20 (A) in clause (iv), by inserting ‘‘(as defined 

21 in clause (vi))’’ after ‘‘an integrated rural 

22 track’’; and 

23 (B) by adding at the end the following new 

24 clause: 


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1 ‘‘(vi) DEFINITION OF ACCREDITED

2 TRAINING PROGRAM WITH AN INTEGRATED

3 RURAL TRACK.—For purposes of clause 

4 (iv), the term ‘accredited training program 

5 with an integrated rural track’ means an 

6 accredited medical residency training pro7 gram located in an urban area which offers 

8 a curriculum for all residents in the pro9 gram that includes the following character10 istics: 

11 ‘‘(I) A minimum of 3 block 

12 months of rural rotations. During 

13 such 3 block months, the resident is 

14 in a rural area for 4 weeks or a 

15 month. 

16 ‘‘(II) A stated mission for train17 ing rural physicians. 

18 ‘‘(III) A minimum of 3 months of 

19 obstetrical training, or an equivalent 

20 longitudinal experience. 

21 ‘‘(IV) A minimum of 4 months of 

22 pediatric training that includes neo23 natal, ambulatory, inpatient, and 

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1 tions, or an equivalent longitudinal ex2 perience. 

3 ‘‘(V) A minimum of 2 months of 

4 emergency medicine rotations, or an 

5 equivalent longitudinal experience.’’. 

6 (2) EFFECTIVE DATE.—The amendments made 

7 by this subsection apply with respect to— 

8 (A) payments to hospitals under section 

9 1886(h) of the Social Security Act (42 U.S.C. 

10 1395ww(h)) for cost reporting periods begin11 ning on or after January 1, 2010; and 

12 (B) payments to hospitals under section 

13 1886(d)(5)(B)(v) of such Act (42 U.S.C. 

14 1395ww(d)(5)(B)(v)) for discharges occurring 

15 on or after January 1, 2010. 

16 SEC. 520. HIV/AIDS REDUCTION IN RACIAL AND ETHNIC MI17 NORITY COMMUNITIES. 

18 (a) EXPANDED FUNDING.—The Secretary, in col19 laboration with the Director of the Office of Minority 

20 Health, the Director of the Centers for Disease Control 

21 and Prevention, the Administrator of the Health Re22 sources and Services Administration, and the Adminis23 trator of the Substance Abuse and Mental Health Services 

24 Administration, shall provide funds and carry out activi25 ties to expand the Minority HIV/AIDS Initiative. 


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1 (b) USE OF FUNDS.—The additional funds made 

2 available under this section may be used, through the Mi3 nority AIDS Initiative, to support the following activities: 

4 (1) Providing technical assistance and infra5 structure support to reduce HIV/AIDS in minority 

6 populations. 

7 (2) Increasing minority populations’ access to 

8 HIV/AIDS prevention and care services. 

9 (3) Building strong community programs and 

10 partnerships to address HIV prevention and the 

11 health care needs of specific racial and ethnic minor12 ity populations. 

13 (c) PRIORITY INTERVENTIONS.—Within the racial 

14 and ethnic minority populations referred to in subsection 

15 (b), priority in conducting intervention services shall be 

16 given to— 

17 (1) women; 

18 (2) youth; 

19 (3) men who engage in homosexual activity; 

20 (4) persons who engage in intravenous drug 

21 abuse; 

22 (5) homeless individuals; and 

23 (6) individuals incarcerated or in the penal sys24 tem. 


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1 (d) AUTHORIZATION OF APPROPRIATIONS.—For car2 rying out this section, there are authorized to be appro3 priated $610,000,0000 for fiscal year 2010 and such sums 

4 as may be necessary for each of fiscal years 2011 through 

5 2014. 

6 SEC. 521. GRANTS FOR RACIAL AND ETHNIC APPROACHES 

7 TO COMMUNITY HEALTH. 

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

9 provide for the awarding of grants to assist communities 

10 in mobilizing and organizing resources in support of effec11 tive and sustainable programs that will reduce or eliminate 

12 disparities in health and healthcare experienced by racial 

13 and ethnic minority individuals. 

14 (b) AUTHORITY TO AWARD GRANTS.—The Sec15 retary, acting through the Centers for Disease Control and 

16 Prevention, shall award grants to eligible entities to assist 

17 in designing, implementing, and evaluating culturally and 

18 linguistically appropriate, science-based and community19 driven sustainable strategies to eliminate racial and ethnic 

20 health and healthcare disparities. 

21 (c) ELIGIBLE ENTITIES.—To be eligible to receive a 

22 grant under this section, an entity shall— 

23 (1) represent a coalition— 

24 (A) whose principal purpose is to develop 

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1 nate a health or healthcare disparity in a tar2 geted racial or ethnic minority group in the 

3 community served by the coalition; and 

4 (B) that includes— 

5 (i) members selected from among— 

6 (I) public health departments; 

7 (II) community-based organiza8 tions; 

9 (III) university and research or10 ganizations; 

11 (IV) American Indian tribal or12 ganizations, national American Indian 

13 organizations, Indian Health Service, 

14 or organizations serving Alaska Na15 tives; and 

16 (V) interested public or private 

17 healthcare providers or organizations 

18 as deemed appropriate by the Sec19 retary; and 

20 (ii) at least 1 member from a commu21 nity-based organization that represents the 

22 targeted racial or ethnic minority group; 

23 and 

24 (2) submit to the Secretary an application at 

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1 formation as the Secretary may require, which shall 

2 include— 

3 (A) a description of the targeted racial or 

4 ethnic populations in the community to be 

5 served under the grant; 

6 (B) a description of at least 1 health dis7 parity that exists in the racial or ethnic tar8 geted populations, including health issues such 

9 as infant mortality, breast and cervical cancer 

10 screening and management, cardiovascular dis11 ease, diabetes, child and adult immunization 

12 levels, or other health priority area(s) as des13 ignated by the Secretary; and 

14 (C) a demonstration of a proven record of 

15 accomplishment of the coalition members in 

16 serving and working with the targeted commu17 nity. 

18 (d) SUSTAINABILITY.—The Secretary shall give pri19 ority to an eligible entity under this section if the entity 

20 agrees that, with respect to the costs to be incurred by 

21 the entity in carrying out the activities for which the grant 

22 was awarded, the entity (and each of the participating 

23 partners in the coalition represented by the entity) will 

24 maintain its expenditures of non-Federal funds for such 

25 activities at a level that is not less than the level of such 


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1 expenditures during the fiscal year immediately preceding 

2 the first fiscal year for which the grant is awarded. 

3 (e) NONDUPLICATION.—Funds provided through this 

4 grant program should supplement, not supplant, existing 

5 Federal funding, and the funds should not be used to du6 plicate the activities of the other health disparity grant 

7 programs in this Act. 

8 (f) TECHNICAL ASSISTANCE.—The Secretary may, 

9 either directly or by grant or contract, provide any entity 

10 that receives a grant under this section with technical and 

11 other nonfinancial assistance necessary to meet the re12 quirements of this section. 

13 (g) DISSEMINATION.—The Secretary shall encourage 

14 and enable grantees to share best practices, evaluation re15 sults, and reports with communities not affiliated with 

16 grantees using the Internet, conferences, and other perti17 nent information regarding the projects funded by this 

18 section, including the outreach efforts of the Office of Mi19 nority Health and Health Disparity Elimination and the 

20 Centers for Disease Control and Prevention. 

21 (h) ADMINISTRATIVE BURDENS.—The Secretary 

22 shall make every effort to minimize duplicative or unneces23 sary administrative burdens on grantees. 


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1 (i) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated such sums as may be 

3 necessary to carry out the Public Health Service Act. 

4 SEC. 522. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 

5 (a) ELIMINATION OF ISOLATION TEST FOR COST6 BASED AMBULANCE REIMBURSEMENT.— 

7 (1) IN GENERAL.—Section 1834(l)(8) of the 

8 Social Security Act (42 U.S.C. 1395m(l)(8)) is 

9 amended— 

10 (A) in subparagraph (B)— 

11 (i) by striking ‘‘owned and’’; and 

12 (ii) by inserting ‘‘(including when 

13 such services are provided by the entity 

14 under an arrangement with the hospital)’’ 

15 after ‘‘hospital’’; and 

16 (B) by striking the comma at the end of 

17 subparagraph (B) and all that follows and in18 serting a period. 

19 (2) EFFECTIVE DATE.—The amendments made 

20 by this subsection shall apply to services furnished 

21 on or after January 1, 2010. 

22 (b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE

23 TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT

24 REQUIREMENT.— 


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1 (1) IN GENERAL.—Section 1820(c)(2) of the 

2 Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 

3 amended— 

4 (A) in subparagraph (B)(iii), by striking 

5 ‘‘provides not more than’’ and inserting ‘‘sub6 ject to subparagraph (F), provides not more 

7 than’’; and 

8 (B) by adding at the end the following new 

9 subparagraph: 

10 ‘‘(F) ALTERNATIVE TO 25 INPATIENT BED

11 LIMIT REQUIREMENT.— 

12 ‘‘(i) IN GENERAL.—A State may elect 

13 to treat a facility, with respect to the des14 ignation of the facility for a cost reporting 

15 period, as satisfying the requirement of 

16 subparagraph (B)(iii) relating to a max17 imum number of acute care inpatient beds 

18 if the facility elects, in accordance with a 

19 method specified by the Secretary and be20 fore the beginning of the cost reporting pe21 riod, to meet the requirement under clause 

22 (ii). 

23 ‘‘(ii) ALTERNATE REQUIREMENT.— 

24 The requirement under this clause, with 

25 respect to a facility and a cost reporting 


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1 period, is that the total number of inpa2 tient bed days described in subparagraph 

3 (B)(iii) during such period will not exceed 

4 7,300. For purposes of this subparagraph, 

5 an individual who is an inpatient in a bed 

6 in the facility for a single day shall be 

7 counted as one inpatient bed day. 

8 ‘‘(iii) WITHDRAWAL OF ELECTION.— 

9 The option described in clause (i) shall not 

10 apply to a facility for a cost reporting pe11 riod if the facility (for any two consecutive 

12 cost reporting periods during the previous 

13 5 cost reporting periods) was treated under 

14 such option and had a total number of in15 patient bed days for each of such two cost 

16 reporting periods that exceeded the num17 ber specified in such clause.’’. 

18 (2) EFFECTIVE DATE.—The amendments made 

19 by paragraph (1) shall apply to cost reporting peri20 ods beginning on or after the date of the enactment 

21 of this Act. 


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1 SEC. 523. COVERAGE OF MARRIAGE AND FAMILY THERA2 PIST SERVICES AND MENTAL HEALTH COUN3 SELOR SERVICES UNDER PART B OF THE 

4 MEDICARE PROGRAM. 

5 (a) COVERAGE OF SERVICES.— 

6 (1) IN GENERAL.—Section 1861(s)(2) of the 

7 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

8 amended— 

9 (A) in subparagraph (DD), by striking 

10 ‘‘and’’ at the end; 

11 (B) in subparagraph (EE), by inserting 

12 ‘‘and’’ at the end; and 

13 (C) by adding at the end the following new 

14 subparagraph: 

15 ‘‘(FF) marriage and family therapist services 

16 (as defined in subsection (ccc)(1)) and mental health 

17 counselor services (as defined in subsection 

18 (hhh)(3));’’. 

19 (2) DEFINITIONS.—Section 1861 of such Act 

20 (42 U.S.C. 1395x) is amended by adding at the end 

21 the following new subsection: 

22 ‘‘Marriage and Family Therapist Services; Marriage and 

23 Family Therapist; Mental Health Counselor Serv24 ices; Mental Health Counselor 

25 ‘‘(hhh)(1) The term ‘marriage and family therapist 

26 services’ means services performed by a marriage and 


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1 family therapist (as defined in paragraph (2)) for the diag2 nosis and treatment of mental illnesses, which the mar3 riage and family therapist is legally authorized to perform 

4 under State law (or the State regulatory mechanism pro5 vided by State law) of the State in which such services 

6 are performed, as would otherwise be covered if furnished 

7 by a physician or as an incident to a physician’s profes8 sional service, but only if no facility or other provider 

9 charges or is paid any amounts with respect to the fur10 nishing of such services. 

11 ‘‘(2) The term ‘marriage and family therapist’ means 

12 an individual who— 

13 ‘‘(A) possesses a master’s or doctoral degree 

14 which qualifies for licensure or certification as a 

15 marriage and family therapist pursuant to State 

16 law; 

17 ‘‘(B) after obtaining such degree has performed 

18 at least 2 years of clinical supervised experience in 

19 marriage and family therapy; and 

20 ‘‘(C) in the case of an individual performing 

21 services in a State that provides for licensure or cer22 tification of marriage and family therapists, is li23 censed or certified as a marriage and family thera24 pist in such State. 


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1 ‘‘(3) The term ‘mental health counselor services’ 

2 means services performed by a mental health counselor (as 

3 defined in paragraph (4)) for the diagnosis and treatment 

4 of mental illnesses which the mental health counselor is 

5 legally authorized to perform under State law (or the 

6 State regulatory mechanism provided by the State law) of 

7 the State in which such services are performed, as would 

8 otherwise be covered if furnished by a physician or as inci9 dent to a physician’s professional service, but only if no 

10 facility or other provider charges or is paid any amounts 

11 with respect to the furnishing of such services. 

12 ‘‘(4) The term ‘mental health counselor’ means an 

13 individual who— 

14 ‘‘(A) possesses a master’s or doctor’s degree in 

15 mental health counseling or a related field; 

16 ‘‘(B) after obtaining such a degree has per17 formed at least 2 years of supervised mental health 

18 counselor practice; and 

19 ‘‘(C) in the case of an individual performing 

20 services in a State that provides for licensure or cer21 tification of mental health counselors or professional 

22 counselors, is licensed or certified as a mental health 

23 counselor or professional counselor in such State.’’. 

24 (3) PROVISION FOR PAYMENT UNDER PART

25 B.—Section 1832(a)(2)(B) of such Act (42 U.S.C. 


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1 1395k(a)(2)(B)) is amended by adding at the end 

2 the following new clause: 

3 ‘‘(v) marriage and family therapist 

4 services and mental health counselor serv5 ices;’’. 

6 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

7 of such Act (42 U.S.C. 1395l(a)(1)) is amended— 

8 (A) by striking ‘‘and (W)’’ and inserting 

9 ‘‘(W)’’; and 

10 (B) by inserting before the semicolon at 

11 the end the following: ‘‘, and (X) with respect 

12 to marriage and family therapist services and 

13 mental health counselor services under section 

14 1861(s)(2)(FF), the amounts paid shall be 80 

15 percent of the lesser of the actual charge for 

16 the services or 75 percent of the amount deter17 mined for payment of a psychologist under sub18 paragraph (L)’’. 

19 (5) EXCLUSION OF MARRIAGE AND FAMILY

20 THERAPIST SERVICES AND MENTAL HEALTH COUN21 SELOR SERVICES FROM SKILLED NURSING FACILITY

22 PROSPECTIVE PAYMENT SYSTEM.—Section 

23 1888(e)(2)(A)(ii) of such Act (42 U.S.C. 

24 1395yy(e)(2)(A)(ii)) is amended by inserting ‘‘mar25 riage and family therapist services (as defined in 


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1 section 1861(hhh)(1)), mental health counselor serv2 ices (as defined in section 1861(hhh)(3)),’’ after 

3 ‘‘qualified psychologist services,’’. 

4 (6) INCLUSION OF MARRIAGE AND FAMILY

5 THERAPISTS AND MENTAL HEALTH COUNSELORS AS

6 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec7 tion 1842(b)(18)(C) of such Act (42 U.S.C. 

8 1395u(b)(18)(C)) is amended by adding at the end 

9 the following new clauses: 

10 ‘‘(vii) A marriage and family therapist (as de11 fined in section 1861(hhh)(2)). 

12 ‘‘(viii) A mental health counselor (as defined in 

13 section 1861(hhh)(4)).’’. 

14 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV15 ICES PROVIDED IN CERTAIN SETTINGS.— 

16 (1) RURAL HEALTH CLINICS AND FEDERALLY

17 QUALIFIED HEALTH CENTERS.—Section 

18 1861(aa)(1)(B) of the Social Security Act (42 

19 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

20 by a clinical social worker (as defined in subsection 

21 (hh)(1)),’’ and inserting ‘‘, by a clinical social worker 

22 (as defined in subsection (hh)(1)), by a marriage 

23 and family therapist (as defined in subsection 

24 (hhh)(2)), or by a mental health counselor (as de25 fined in subsection (hhh)(4)),’’. 


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1 (2) HOSPICE PROGRAMS.—Section 

2 1861(dd)(2)(B)(i)(III) of such Act (42 U.S.C. 

3 1395x(dd)(2)(B)(i)(III)) is amended by inserting ‘‘or 

4 one marriage and family therapist (as defined in 

5 subsection (hhh)(2))’’ after ‘‘social worker’’. 

6 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

7 THERAPISTS TO DEVELOP DISCHARGE PLANS FOR POST8 HOSPITAL SERVICES.—Section 1861(ee)(2)(G) of the So9 cial Security Act (42 U.S.C. 1395x(ee)(2)(G)) is amended 

10 by inserting ‘‘marriage and family therapist (as defined 

11 in subsection (hhh)(2)),’’ after ‘‘social worker,’’. 

12 (d) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply with respect to services furnished 

14 on or after January 1, 2010. 

15 SEC. 524. ESTABLISHMENT OF RURAL COMMUNITY HOS16 PITAL (RCH) PROGRAM. 

17 (a) IN GENERAL.—Section 1861 of the Social Secu18 rity Act (42 U.S.C. 1395x), as amended by section 523, 

19 is amended by adding at the end of the following new sub20 section: 

21 ‘‘Rural Community Hospital; Rural Community Hospital 

22 Services 

23 ‘‘(iii)(1) The term ‘rural community hospital’ means 

24 a hospital (as defined in subsection (e)) that— 


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1 ‘‘(A) is located in a rural area (as defined in 

2 section 1886(d)(2)(D)) or treated as being so lo3 cated pursuant to section 1886(d)(8)(E); 

4 ‘‘(B) subject to paragraph (2), has less than 51 

5 acute care inpatient beds, as reported in its most re6 cent cost report; 

7 ‘‘(C) makes available 24-hour emergency care 

8 services; 

9 ‘‘(D) subject to paragraph (3), has a provider 

10 agreement in effect with the Secretary and is open 

11 to the public as of January 1, 2010; and 

12 ‘‘(E) applies to the Secretary for such designa13 tion. 

14 ‘‘(2) For purposes of paragraph (1)(B), beds in a 

15 psychiatric or rehabilitation unit of the hospital which is 

16 a distinct part of the hospital shall not be counted. 

17 ‘‘(3) Subparagraph (1)(D) shall not be construed to 

18 prohibit any of the following from qualifying as a rural 

19 community hospital: 

20 ‘‘(A) A replacement facility (as defined by the 

21 Secretary in regulations in effect on January 1, 

22 2010) with the same service area (as defined by the 

23 Secretary in regulations in effect on such date). 

24 ‘‘(B) A facility obtaining a new provider num25 ber pursuant to a change of ownership. 


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1 ‘‘(C) A facility which has a binding written 

2 agreement with an outside, unrelated party for the 

3 construction, reconstruction, lease, rental, or financ4 ing of a building as of January 1, 2010. 

5 ‘‘(4) Nothing in this subsection shall be construed as 

6 prohibiting a critical access hospital from qualifying as a 

7 rural community hospital if the critical access hospital 

8 meets the conditions otherwise applicable to hospitals 

9 under subsection (e) and section 1866. 

10 ‘‘(5) Nothing in this subsection shall be construed as 

11 prohibiting a rural community hospital participating in 

12 the demonstration program under Section 410A of the 

13 Medicare Prescription Drug, Improvement, and Mod14 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

15 2313) from qualifying as a rural community hospital if 

16 the rural community hospital meets the conditions other17 wise applicable to hospitals under subsection (e) and sec18 tion 1866.’’. 

19 (b) PAYMENT.— 

20 (1) INPATIENT HOSPITAL SERVICES.—Section 

21 1814 of the Social Security Act (42 U.S.C. 1395f) 

22 is amended by adding at the end the following new 

23 subsection: 


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1 ‘‘Payment for Inpatient Services Furnished in Rural 

2 Community Hospitals 

3 ‘‘(m) The amount of payment under this part for in4 patient hospital services furnished in a rural community 

5 hospital, other than such services furnished in a psy6 chiatric or rehabilitation unit of the hospital which is a 

7 distinct part, is, at the election of the hospital in the appli8 cation referred to in section 1861(iii)(1)(E)— 

9 ‘‘(1) 101 percent of the reasonable costs of pro10 viding such services, without regard to the amount 

11 of the customary or other charge, or 

12 ‘‘(2) the amount of payment provided for under 

13 the prospective payment system for inpatient hos14 pital services under section 1886(d).’’. 

15 (2) OUTPATIENT SERVICES.—Section 1834 of 

16 such Act (42 U.S.C. 1395m) is amended by adding 

17 at the end the following new subsection: 

18 ‘‘(n) PAYMENT FOR OUTPATIENT SERVICES FUR19 NISHED IN RURAL COMMUNITY HOSPITALS.—The 

20 amount of payment under this part for outpatient services 

21 furnished in a rural community hospital is, at the election 

22 of the hospital in the application referred to in section 

23 1861(iii)(1)(E)— 

24 ‘‘(1) 101 percent of the reasonable costs of pro25 viding such services, without regard to the amount 


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1 of the customary or other charge and any limitation 

2 under section 1861(v)(1)(U), or 

3 ‘‘(2) the amount of payment provided for under 

4 the prospective payment system for covered OPD 

5 services under section 1833(t).’’. 

6 (3) EXEMPTION FROM 30-PERCENT REDUCTION

7 IN REIMBURSEMENT FOR BAD DEBT.—Section 

8 1861(v)(1)(T) of such Act (42 U.S.C. 

9 1395x(v)(1)(T)) is amended by inserting ‘‘(other 

10 than for a rural community hospital)’’ after ‘‘In de11 termining such reasonable costs for hospitals’’. 

12 (c) BENEFICIARY COST-SHARING FOR OUTPATIENT

13 SERVICES.—Section 1834(n) of such Act (as added by 

14 subsection (b)(2)) is amended— 

15 (1) by redesignating paragraphs (1) and (2) as 

16 subparagraphs (A) and (B), respectively; 

17 (2) by inserting ‘‘(1)’’ after ‘‘(n)’’; and 

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

19 ‘‘(2) The amounts of beneficiary cost-sharing for out20 patient services furnished in a rural community hospital 

21 under this part shall be as follows: 

22 ‘‘(A) For items and services that would have 

23 been paid under section 1833(t) if provided by a 

24 hospital, the amount of cost-sharing determined 

25 under paragraph (8) of such section. 


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1 ‘‘(B) For items and services that would have 

2 been paid under section 1833(h) if furnished by a 

3 provider or supplier, no cost-sharing shall apply. 

4 ‘‘(C) For all other items and services, the 

5 amount of cost-sharing that would apply to the item 

6 or service under the methodology that would be used 

7 to determine payment for such item or service if pro8 vided by a physician, provider, or supplier, as the 

9 case may be.’’. 

10 (d) CONFORMING AMENDMENTS.— 

11 (1) PART A PAYMENT.—Section 1814(b) of 

12 such Act (42 U.S.C. 1395f(b)) is amended in the 

13 matter preceding paragraph (1) by inserting ‘‘other 

14 than inpatient hospital services furnished by a rural 

15 community hospital,’’ after ‘‘critical access hospital 

16 services,’’. 

17 (2) PART B PAYMENT.—Section 1833(a) of 

18 such Act (42 U.S.C. 1395l(a)) is amended— 

19 (A) in paragraph (2), in the matter before 

20 subparagraph (A), by striking ‘‘and (I)’’ and in21 serting ‘‘(I), and (K)’’; 

22 (B) by striking ‘‘and’’ at the end of para23 graph (8); 

24 (C) by striking the period at the end of 

25 paragraph (9) and inserting ‘‘; and’’; and 


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

2 ‘‘(10) in the case of outpatient services fur3 nished by a rural community hospital, the amounts 

4 described in section 1834(n).’’. 

5 (3) TECHNICAL AMENDMENTS.— 

6 (A) CONSULTATION WITH STATE AGEN7 CIES.—Section 1863 of such Act (42 U.S.C. 

8 1395z) is amended by striking ‘‘and (dd)(2)’’ 

9 and inserting ‘‘(dd)(2), (mm)(1), and (iii)(1)’’. 

10 (B) PROVIDER AGREEMENTS.—Section 

11 1866(a)(2)(A) of such Act (42 U.S.C. 

12 1395cc(a)(2)(A)) is amended by inserting ‘‘sec13 tion 1834(n)(2),’’ after ‘‘section 1833(b),’’. 

14 (e) EFFECTIVE DATE.—The amendments made by 

15 this section shall apply to items and services furnished on 

16 or after October 1, 2009. 

17 SEC. 525. MEDICARE REMOTE MONITORING PILOT 

18 PROJECTS. 

19 (a) PILOT PROJECTS.— 

20 (1) IN GENERAL.—Not later than 9 months 

21 after the date of enactment of this Act, the Sec22 retary of Health and Human Services (in this sec23 tion referred to as the ‘‘Secretary’’) shall conduct 

24 pilot projects under title XVIII of the Social Secu25 rity Act for the purpose of providing incentives to 


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1 home health agencies to utilize home monitoring and 

2 communications technologies that— 

3 (A) enhance health outcomes for Medicare 

4 beneficiaries; and 

5 (B) reduce expenditures under such title. 

6 (2) SITE REQUIREMENTS.— 

7 (A) URBAN AND RURAL.—The Secretary 

8 shall conduct the pilot projects under this sec9 tion in both urban and rural areas. 

10 (B) SITE IN A SMALL STATE.—The Sec11 retary shall conduct at least 3 of the pilot 

12 projects in a State with a population of less 

13 than 1,000,000. 

14 (3) DEFINITION OF HOME HEALTH AGENCY.— 

15 In this section, the term ‘‘home health agency’’ has 

16 the meaning given that term in section 1861(o) of 

17 the Social Security Act (42 U.S.C. 1395x(o)). 

18 (b) MEDICARE BENEFICIARIES WITHIN THE SCOPE

19 OF PROJECTS.—The Secretary shall specify the criteria 

20 for identifying those Medicare beneficiaries who shall be 

21 considered within the scope of the pilot projects under this 

22 section for purposes of the application of subsection (c) 

23 and for the assessment of the effectiveness of the home 

24 health agency in achieving the objectives of this section. 

25 Such criteria may provide for the inclusion in the projects 


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1 of Medicare beneficiaries who begin receiving home health 

2 services under title XVIII of the Social Security Act after 

3 the date of the implementation of the projects. 

4 (c) INCENTIVES.— 

5 (1) PERFORMANCE TARGETS.—The Secretary 

6 shall establish for each home health agency partici7 pating in a pilot project under this section a per8 formance target using one of the following meth9 odologies, as determined appropriate by the Sec10 retary: 

11 (A) ADJUSTED HISTORICAL PERFORMANCE

12 TARGET.—The Secretary shall establish for the 

13 agency— 

14 (i) a base expenditure amount equal 

15 to the average total payments made to the 

16 agency under parts A and B of title XVIII 

17 of the Social Security Act for Medicare 

18 beneficiaries determined to be within the 

19 scope of the pilot project in a base period 

20 determined by the Secretary; and 

21 (ii) an annual per capita expenditure 

22 target for such beneficiaries, reflecting the 

23 base expenditure amount adjusted for risk 

24 and adjusted growth rates. 


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1 (B) COMPARATIVE PERFORMANCE TAR2 GET.—The Secretary shall establish for the 

3 agency a comparative performance target equal 

4 to the average total payments under such parts 

5 A and B during the pilot project for comparable 

6 individuals in the same geographic area that 

7 are not determined to be within the scope of the 

8 pilot project. 

9 (2) INCENTIVE.—Subject to paragraph (3), the 

10 Secretary shall pay to each participating home care 

11 agency an incentive payment for each year under the 

12 pilot project equal to a portion of the Medicare sav13 ings realized for such year relative to the perform14 ance target under paragraph (1). 

15 (3) LIMITATION ON EXPENDITURES.—The Sec16 retary shall limit incentive payments under this sec17 tion in order to ensure that the aggregate expendi18 tures under title XVIII of the Social Security Act 

19 (including incentive payments under this subsection) 

20 do not exceed the amount that the Secretary esti21 mates would have been expended if the pilot projects 

22 under this section had not been implemented. 

23 (d) WAIVER AUTHORITY.—The Secretary may waive 

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1 rity Act as the Secretary determines to be appropriate for 

2 the conduct of the pilot projects under this section. 

3 (e) REPORT TO CONGRESS.—Not later than 5 years 

4 after the date that the first pilot project under this section 

5 is implemented, the Secretary shall submit to Congress a 

6 report on the pilot projects. Such report shall contain a 

7 detailed description of issues related to the expansion of 

8 the projects under subsection (f) and recommendations for 

9 such legislation and administrative actions as the Sec10 retary considers appropriate. 

11 (f) EXPANSION.—If the Secretary determines that 

12 any of the pilot projects under this section enhance health 

13 outcomes for Medicare beneficiaries and reduce expendi14 tures under title XVIII of the Social Security Act, the Sec15 retary may initiate comparable projects in additional 

16 areas. 

17 (g) INCENTIVE PAYMENTS HAVE NO EFFECT ON

18 OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen19 tive payment under this section— 

20 (1) shall be in addition to the payments that a 

21 home health agency would otherwise receive under 

22 title XVIII of the Social Security Act for the provi23 sion of home health services; and 

24 (2) shall have no effect on the amount of such 

25 payments. 


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1 SEC. 526. RURAL HEALTH QUALITY ADVISORY COMMISSION 

2 AND DEMONSTRATION PROJECTS. 

3 (a) RURAL HEALTH QUALITY ADVISORY COMMIS4 SION.— 

5 (1) ESTABLISHMENT.—Not later than 6 

6 months after the date of the enactment of this sec7 tion, the Secretary of Health and Human Services 

8 (in this section referred to as the ‘‘Secretary’’) shall 

9 establish a commission to be known as the Rural 

10 Health Quality Advisory Commission (in this section 

11 referred to as the ‘‘Commission’’). 

12 (2) DUTIES OF COMMISSION.— 

13 (A) NATIONAL PLAN.—The Commission 

14 shall develop, coordinate, and facilitate imple15 mentation of a national plan for rural health 

16 quality improvement. The national plan shall— 

17 (i) identify objectives for rural health 

18 quality improvement; 

19 (ii) identify strategies to eliminate 

20 known gaps in rural health system capacity 

21 and improve rural health quality; and 

22 (iii) provide for Federal programs to 

23 identify opportunities for strengthening 

24 and aligning policies and programs to im25 prove rural health quality. 


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1 (B) DEMONSTRATION PROJECTS.—The 

2 Commission shall design demonstration projects 

3 to test alternative models for rural health qual4 ity improvement, including with respect to both 

5 personal and population health. 

6 (C) MONITORING.—The Commission shall 

7 monitor progress toward the objectives identi8 fied pursuant to paragraph (1)(A). 

9 (3) MEMBERSHIP.— 

10 (A) NUMBER.—The Commission shall be 

11 composed of 11 members appointed by the Sec12 retary. 

13 (B) SELECTION.—The Secretary shall se14 lect the members of the Commission from 

15 among individuals with significant rural health 

16 care and health care quality expertise, including 

17 expertise in clinical health care, health care 

18 quality research, population or public health, or 

19 purchaser organizations. 

20 (4) CONTRACTING AUTHORITY.—Subject to the 

21 availability of funds, the Commission may enter into 

22 contracts and make other arrangements, as may be 

23 necessary to carry out the duties described in para24 graph (2). 


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1 (5) STAFF.—Upon the request of the Commis2 sion, the Secretary may detail, on a reimbursable 

3 basis, any of the personnel of the Office of Rural 

4 Health Policy of the Health Resources and Services 

5 Administration, the Agency for Health Care Quality 

6 and Research, or the Centers for Medicare & Med7 icaid Services to the Commission to assist in car8 rying out this subsection. 

9 (6) REPORTS TO CONGRESS.—Not later than 1 

10 year after the establishment of the Commission, and 

11 annually thereafter, the Commission shall submit a 

12 report to the Congress on rural health quality. Each 

13 such report shall include the following: 

14 (A) An inventory of relevant programs and 

15 recommendations for improved coordination and 

16 integration of policy and programs. 

17 (B) An assessment of achievement of the 

18 objectives identified in the national plan devel19 oped under paragraph (2) and recommenda20 tions for realizing such objectives. 

21 (C) Recommendations on Federal legisla22 tion, regulations, or administrative policies to 

23 enhance rural health quality and outcomes. 

24 (b) RURAL HEALTH QUALITY DEMONSTRATION

25 PROJECTS.— 


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1 (1) IN GENERAL.—Not later than 270 days 

2 after the date of the enactment of this section, the 

3 Secretary, in consultation with the Rural Health 

4 Quality Advisory Commission, the Office of Rural 

5 Health Policy of the Health Resources and Services 

6 Administration, the Agency for Healthcare Research 

7 and Quality, and the Centers for Medicare & Med8 icaid Services, shall make grants to eligible entities 

9 for 5 demonstration projects to implement and 

10 evaluate methods for improving the quality of health 

11 care in rural communities. Each such demonstration 

12 project shall include— 

13 (A) alternative community models that— 

14 (i) will achieve greater integration of 

15 personal and population health services; 

16 and 

17 (ii) address safety, effectiveness, 

18 patient- or community-centeredness, timeli19 ness, efficiency, and equity (the six aims 

20 identified by the Institute of Medicine of 

21 the National Academies in its report enti22 tled ‘‘Crossing the Quality Chasm: A New 

23 Health System for the 21st Century’’ re24 leased on March 1, 2001); 


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1 (B) innovative approaches to the financing 

2 and delivery of health services to achieve rural 

3 health quality goals; and 

4 (C) development of quality improvement 

5 support structures to assist rural health sys6 tems and professionals (such as workforce sup7 port structures, quality monitoring and report8 ing, clinical care protocols, and information 

9 technology applications). 

10 (2) ELIGIBLE ENTITIES.—In this subsection, 

11 the term ‘‘eligible entity’’ means a consortium 

12 that— 

13 (A) shall include— 

14 (i) at least one health care provider or 

15 health care delivery system located in a 

16 rural area; and 

17 (ii) at least one organization rep18 resenting multiple community stakeholders; 

19 and 

20 (B) may include other partners such as 

21 rural research centers. 

22 (3) CONSULTATION.—In developing the pro23 gram for awarding grants under this subsection, the 

24 Secretary shall consult with the Administrator of the 

25 Agency for Healthcare Research and Quality, rural 


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1 health care providers, rural health care researchers, 

2 and private and non-profit groups (including na3 tional associations) which are undertaking similar 

4 efforts. 

5 (4) EXPEDITED WAIVERS.—The Secretary shall 

6 expedite the processing of any waiver that— 

7 (A) is authorized under title XVIII or XIX 

8 of the Social Security Act (42 U.S.C. 1395 et 

9 seq.); and 

10 (B) is necessary to carry out a demonstra11 tion project under this subsection. 

12 (5) DEMONSTRATION PROJECT SITES.—The 

13 Secretary shall ensure that the 5 demonstration 

14 projects funded under this subsection are conducted 

15 at a variety of sites representing the diversity of 

16 rural communities in the Nation. 

17 (6) DURATION.—Each demonstration project 

18 under this subsection shall be for a period of 4 

19 years. 

20 (7) INDEPENDENT EVALUATION.—The Sec21 retary shall enter into an arrangement with an enti22 ty that has experience working directly with rural 

23 health systems for the conduct of an independent 

24 evaluation of the program carried out under this 

25 subsection. 


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1 (8) REPORT.—Not later than one year after the 

2 conclusion of all of the demonstration projects fund3 ed under this subsection, the Secretary shall submit 

4 a report to the Congress on the results of such 

5 projects. The report shall include— 

6 (A) an evaluation of patient access to care, 

7 patient outcomes, and an analysis of the cost 

8 effectiveness of each such project; and 

9 (B) recommendations on Federal legisla10 tion, regulations, or administrative policies to 

11 enhance rural health quality and outcomes. 

12 (c) APPROPRIATION.— 

13 (1) IN GENERAL.—Out of funds in the Treas14 ury not otherwise appropriated, there are appro15 priated to the Secretary to carry out this section 

16 $30,000,000 for the period of fiscal years 2010 

17 through 2014. 

18 (2) AVAILABILITY.— 

19 (A) IN GENERAL.—Funds appropriated 

20 under paragraph (1) shall remain available for 

21 expenditure through fiscal year 2014. 

22 (B) REPORT.—For purposes of carrying 

23 out subsection (b)(8), funds appropriated under 

24 paragraph (1) shall remain available for ex25 penditure through fiscal year 2015. 


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1 (3) RESERVATION.—Of the amount appro2 priated under paragraph (1), the Secretary shall re3 serve— 

4 (A) $5,000,000 to carry out subsection (a); 

5 and 

6 (B) $25,000,000 to carry out subsection 

7 (b), of which— 

8 (i) 2 percent shall be for the provision 

9 of technical assistance to grant recipients; 

10 and 

11 (ii) 5 percent shall be for independent 

12 evaluation under subsection (b)(7). 

13 SEC. 527. RURAL HEALTH CARE SERVICES. 

14 Section 330A of the Public Health Service Act (42 

15 U.S.C. 254c) is amended to read as follows: 

16 ‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 

17 RURAL HEALTH NETWORK DEVELOPMENT, 

18 DELTA RURAL DISPARITIES AND HEALTH 

19 SYSTEMS DEVELOPMENT, AND SMALL RURAL 

20 HEALTH CARE PROVIDER QUALITY IMPROVE21 MENT GRANT PROGRAMS. 

22 ‘‘(a) PURPOSE.—The purpose of this section is to 

23 provide for grants— 

24 ‘‘(1) under subsection (b), to promote rural 

25 health care services outreach; 


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1 ‘‘(2) under subsection (c), to provide for the 

2 planning and implementation of integrated health 

3 care networks in rural areas; 

4 ‘‘(3) under subsection (d), to assist rural com5 munities in the Delta Region to reduce health dis6 parities and to promote and enhance health system 

7 development; and 

8 ‘‘(4) under subsection (e), to provide for the 

9 planning and implementation of small rural health 

10 care provider quality improvement activities. 

11 ‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH

12 GRANTS.— 

13 ‘‘(1) GRANTS.—The Director of the Office of 

14 Rural Health Policy of the Health Resources and 

15 Services Administration may award grants to eligible 

16 entities to promote rural health care services out17 reach by expanding the delivery of health care serv18 ices to include new and enhanced services in rural 

19 areas. The Director may award the grants for peri20 ods of not more than 3 years. 

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

22 grant under this subsection for a project, an enti23 ty— 

24 ‘‘(A) shall be a rural public or rural non25 profit private entity, a facility that qualifies as 


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1 a rural health clinic under title XVIII of the 

2 Social Security Act, a public or nonprofit entity 

3 existing exclusively to provide services to mi4 grant and seasonal farm workers in rural areas, 

5 or a tribal government whose grant-funded ac6 tivities will be conducted within federally recog7 nized tribal areas; 

8 ‘‘(B) shall represent a consortium com9 posed of members— 

10 ‘‘(i) that include 3 or more independ11 ently owned health care entities; and 

12 ‘‘(ii) that may be nonprofit or for13 profit entities; and 

14 ‘‘(C) shall not previously have received a 

15 grant under this subsection for the same or a 

16 similar project, unless the entity is proposing to 

17 expand the scope of the project or the area that 

18 will be served through the project. 

19 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

20 grant under this subsection, an eligible entity shall 

21 prepare and submit to the Director an application at 

22 such time, in such manner, and containing such in23 formation as the Director may require, including— 


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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) a description of the manner in which 

5 the project funded under the grant will meet 

6 the health care needs of rural populations in 

7 the local community or region to be served; 

8 ‘‘(C) a plan for quantifying how health 

9 care needs will be met through identification of 

10 the target population and benchmarks of service 

11 delivery or health status, such as— 

12 ‘‘(i) quantifiable measurements of 

13 health status improvement for projects fo14 cusing on health promotion; or 

15 ‘‘(ii) benchmarks of increased access 

16 to primary care, including tracking factors 

17 such as the number and type of primary 

18 care visits, identification of a medical 

19 home, or other general measures of such 

20 access; 

21 ‘‘(D) a description of how the local com22 munity or region to be served will be involved 

23 in the development and ongoing operations of 

24 the project; 


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1 ‘‘(E) a plan for sustaining the project after 

2 Federal support for the project has ended; 

3 ‘‘(F) a description of how the project will 

4 be evaluated; 

5 ‘‘(G) the administrative capacity to submit 

6 annual performance data electronically as speci7 fied by the Director; and 

8 ‘‘(H) other such information as the Direc9 tor determines to be appropriate. 

10 ‘‘(c) RURAL HEALTH NETWORK DEVELOPMENT

11 GRANTS.— 

12 ‘‘(1) GRANTS.— 

13 ‘‘(A) IN GENERAL.—The Director may 

14 award rural health network development grants 

15 to eligible entities to promote, through planning 

16 and implementation, the development of inte17 grated health care networks that have combined 

18 the functions of the entities participating in the 

19 networks in order to— 

20 ‘‘(i) achieve efficiencies and economies 

21 of scale; 

22 ‘‘(ii) expand access to, coordinate, and 

23 improve the quality of the health care de24 livery system through development of orga25 nizational efficiencies; 


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1 ‘‘(iii) implement health information 

2 technology to achieve efficiencies, reduce 

3 medical errors, and improve quality; 

4 ‘‘(iv) coordinate care and manage 

5 chronic illness; and 

6 ‘‘(v) strengthen the rural health care 

7 system as a whole in such a manner as to 

8 show a quantifiable return on investment 

9 to the participants in the network. 

10 ‘‘(B) GRANT PERIODS.—The Director may 

11 award such a rural health network development 

12 grant— 

13 ‘‘(i) for a period of 3 years for imple14 mentation activities; or 

15 ‘‘(ii) for a period of 1 year for plan16 ning activities to assist in the initial devel17 opment of an integrated health care net18 work, if the proposed participants in the 

19 network do not have a history of collabo20 rative efforts and a 3-year grant would be 

21 inappropriate. 

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

23 grant under this subsection, an entity— 

24 ‘‘(A) shall be a rural public or rural non25 profit private entity, a facility that qualifies as 


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1 a rural health clinic under title XVIII of the 

2 Social Security Act, a public or nonprofit entity 

3 existing exclusively to provide services to mi4 grant and seasonal farm workers in rural areas, 

5 or a tribal government whose grant-funded ac6 tivities will be conducted within federally recog7 nized tribal areas; 

8 ‘‘(B) shall represent a network composed 

9 of participants— 

10 ‘‘(i) that include 3 or more independ11 ently owned health care entities; and 

12 ‘‘(ii) that may be nonprofit or for13 profit entities; and 

14 ‘‘(C) shall not previously have received a 

15 grant under this subsection (other than a 1- 

16 year grant for planning activities) for the same 

17 or a similar project. 

18 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

19 grant under this subsection, an eligible entity, in 

20 consultation with the appropriate State office of 

21 rural health or another appropriate State entity, 

22 shall prepare and submit to the Director an applica23 tion at such time, in such manner, and containing 

24 such information as the Director may require, in25 cluding— 


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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— 

8 ‘‘(i) the history of collaborative activi9 ties carried out by the participants in the 

10 network; 

11 ‘‘(ii) the degree to which the partici12 pants are ready to integrate their func13 tions; and 

14 ‘‘(iii) how the local community or re15 gion to be served will benefit from and be 

16 involved in the activities carried out by the 

17 network; 

18 ‘‘(D) a description of how the local com19 munity or region to be served will experience in20 creased access to quality health care services 

21 across the continuum of care as a result of the 

22 integration activities carried out by the net23 work, including a description of— 

24 ‘‘(i) return on investment for the com25 munity and the network members; and 


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1 ‘‘(ii) other quantifiable performance 

2 measures that show the benefit of the net3 work activities; 

4 ‘‘(E) a plan for sustaining the project after 

5 Federal support for the project has ended; 

6 ‘‘(F) a description of how the project will 

7 be evaluated; 

8 ‘‘(G) the administrative capacity to submit 

9 annual performance data electronically as speci10 fied by the Director; and 

11 ‘‘(H) other such information as the Direc12 tor determines to be appropriate. 

13 ‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS14 TEMS DEVELOPMENT GRANTS.— 

15 ‘‘(1) GRANTS.—The Director may award grants 

16 to eligible entities to support reduction of health dis17 parities, improve access to health care, and enhance 

18 rural health system development in the Delta Re19 gion. 

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

21 grant under this subsection, an entity shall be a 

22 rural public or rural nonprofit private entity, a facil23 ity that qualifies as a rural health clinic under title 

24 XVIII of the Social Security Act, a public or non25 profit entity existing exclusively to provide services 


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1 to migrant and seasonal farm workers in rural 

2 areas, or a tribal government whose grant-funded 

3 activities will be conducted within federally recog4 nized tribal areas. 

5 ‘‘(3) APPLICATIONS.—To be eligible to receive a 

6 grant under this subsection, an eligible entity shall 

7 prepare and submit to the Director an application at 

8 such time, in such manner, and containing such in9 formation as the Director may require, including— 

10 ‘‘(A) a description of the project that the 

11 eligible entity will carry out using the funds 

12 provided under the grant; 

13 ‘‘(B) an explanation of the reasons why 

14 Federal assistance is required to carry out the 

15 project; 

16 ‘‘(C) a description of the manner in which 

17 the project funded under the grant will meet 

18 the health care needs of the Delta Region; 

19 ‘‘(D) a description of how the local com20 munity or region to be served will experience in21 creased access to quality health care services as 

22 a result of the activities carried out by the enti23 ty; 


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1 ‘‘(E) a description of how health dispari2 ties will be reduced or the health system will be 

3 improved; 

4 ‘‘(F) a plan for sustaining the project after 

5 Federal support for the project has ended; 

6 ‘‘(G) a description of how the project will 

7 be evaluated including process and outcome 

8 measures related to the quality of care provided 

9 or how the health care system improves its per10 formance; 

11 ‘‘(H) a description of how the grantee will 

12 develop an advisory group made up of rep13 resentatives of the communities to be served to 

14 provide guidance to the grantee to best meet 

15 community need; and 

16 ‘‘(I) other such information as the Director 

17 determines to be appropriate. 

18 ‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL19 ITY IMPROVEMENT GRANTS.— 

20 ‘‘(1) GRANTS.—The Director may award grants 

21 to provide for the planning and implementation of 

22 small rural health care provider quality improvement 

23 activities. The Director may award the grants for 

24 periods of 1 to 3 years. 


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1 ‘‘(2) ELIGIBILITY.—To be eligible for a grant 

2 under this subsection, an entity— 

3 ‘‘(A) shall be— 

4 ‘‘(i) a rural public or rural nonprofit 

5 private health care provider or provider of 

6 health care services, such as a rural health 

7 clinic; or 

8 ‘‘(ii) another rural provider or net9 work of small rural providers identified by 

10 the Director as a key source of local care; 

11 and 

12 ‘‘(B) shall not previously have received a 

13 grant under this subsection for the same or a 

14 similar project. 

15 ‘‘(3) PREFERENCE.—In awarding grants under 

16 this subsection, the Director shall give preference to 

17 facilities that qualify as rural health clinics under 

18 title XVIII of the Social Security Act. 

19 ‘‘(4) APPLICATIONS.—To be eligible to receive a 

20 grant under this subsection, an eligible entity shall 

21 prepare and submit to the Director an application at 

22 such time, in such manner, and containing such in23 formation as the Director may require, including— 


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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 assure 

9 continuous quality improvement in the provision 

10 of services by the entity; 

11 ‘‘(D) a description of how the local com12 munity or region to be served will experience in13 creased access to quality health care services as 

14 a result of the activities carried out by the enti15 ty; 

16 ‘‘(E) a plan for sustaining the project after 

17 Federal support for the project has ended; 

18 ‘‘(F) a description of how the project will 

19 be evaluated including process and outcome 

20 measures related to the quality of care pro21 vided; and 

22 ‘‘(G) other such information as the Direc23 tor determines to be appropriate. 

24 ‘‘(f) GENERAL REQUIREMENTS.— 


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1 ‘‘(1) PROHIBITED USES OF FUNDS.—An entity 

2 that receives a grant under this section may not use 

3 funds provided through the grant— 

4 ‘‘(A) to build or acquire real property; or 

5 ‘‘(B) for construction. 

6 ‘‘(2) COORDINATION WITH OTHER AGENCIES.— 

7 The Director shall coordinate activities carried out 

8 under grant programs described in this section, to 

9 the extent practicable, with Federal and State agen10 cies and nonprofit organizations that are operating 

11 similar grant programs, to maximize the effect of 

12 public dollars in funding meritorious proposals. 

13 ‘‘(g) REPORT.—Not later than September 30, 2012, 

14 the Secretary shall prepare and submit to the appropriate 

15 committees of Congress a report on the progress and ac16 complishments of the grant programs described in sub17 sections (b), (c), (d), and (e). 

18 ‘‘(h) DEFINITIONS.—In this section: 

19 ‘‘(1) The term ‘Delta Region’ has the meaning 

20 given to the term ‘region’ in section 382A of the 

21 Consolidated Farm and Rural Development Act (7 

22 U.S.C. 2009aa). 

23 ‘‘(2) The term ‘Director’ means the Director of 

24 the Office of Rural Health Policy of the Health Re25 sources and Services Administration. 


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1 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this section 

3 $40,000,000 for fiscal year 2010, and such sums as may 

4 be necessary for each of fiscal years 2011 through 2014.’’. 

5 SEC. 528. COMMUNITY HEALTH CENTER COLLABORATIVE 

6 ACCESS EXPANSION. 

7 Section 330 of the Public Health Service Act (42 

8 U.S.C. 254b) is amended by adding at the end the fol9 lowing: 

10 ‘‘(s) MISCELLANEOUS PROVISIONS.— 

11 ‘‘(1) RULE OF CONSTRUCTION WITH RESPECT

12 TO RURAL HEALTH CLINICS.— 

13 ‘‘(A) IN GENERAL.—Nothing in this sec14 tion shall be construed to prevent a community 

15 health center from contracting with a federally 

16 certified rural health clinic (as defined by sec17 tion 1861(aa)(2) of the Social Security Act) for 

18 the delivery of primary health care services that 

19 are available at the rural health clinic to indi20 viduals who would otherwise be eligible for free 

21 or reduced cost care if that individual were able 

22 to obtain that care at the community health 

23 center. Such services may be limited in scope to 

24 those primary health care services available in 

25 that rural health clinic. 


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1 ‘‘(B) ASSURANCES.—In order for a rural 

2 health clinic to receive funds under this section 

3 through a contract with a community health 

4 center under paragraph (1), such rural health 

5 clinic shall establish policies to ensure— 

6 ‘‘(i) nondiscrimination based upon the 

7 ability of a patient to pay; and 

8 ‘‘(ii) the establishment of a sliding fee 

9 scale for low-income patients.’’. 

10 SEC. 529. FACILITATING THE PROVISION OF TELEHEALTH 

11 SERVICES ACROSS STATE LINES. 

12 (a) IN GENERAL.—For purposes of expediting the 

13 provision of telehealth services, for which payment is made 

14 under the Medicare program, across State lines, the Sec15 retary of Health and Human Services shall, in consulta16 tion with representatives of States, physicians, health care 

17 practitioners, and patient advocates, encourage and facili18 tate the adoption of provisions allowing for multistate 

19 practitioner practice across State lines. 

20 (b) DEFINITIONS.—In subsection (a): 

21 (1) TELEHEALTH SERVICE.—The term ‘‘tele22 health service’’ has the meaning given that term in 

23 subparagraph (F) of section 1834(m)(4) of the So24 cial Security Act (42 U.S.C. 1395m(m)(4)). 


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1 (2) PHYSICIAN, PRACTITIONER.—The terms 

2 ‘‘physician’’ and ‘‘practitioner’’ have the meaning 

3 given those terms in subparagraphs (D) and (E), re4 spectively, of such section. 

5 (3) MEDICARE PROGRAM.—The term ‘‘Medicare 

6 program’’ means the program of health insurance 

7 administered by the Secretary of Health and Human 

8 Services under title XVIII of the Social Security Act 

9 (42 U.S.C. 1395 et seq.). 

10 SEC. 530. REMOVING BARRIERS TO HEALTH CARE AND NU11 TRITION ASSISTANCE HEALTH COVERAGE 

12 FOR CHILDREN, PREGNANT WOMEN, AND 

13 LAWFULLY RESIDING INDIVIDUALS. 

14 (a) MEDICAID.—Section 1903(v) of the Social Secu15 rity Act (42 U.S.C. 1396b(v)) is amended by striking 

16 paragraph (4) and inserting the following new paragraph: 

17 ‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 

18 403, and 421 of the Personal Responsibility and Work Op19 portunity Reconciliation Act of 1996, payment shall be 

20 made under this section for care and services that are fur21 nished to individuals, including those described in para22 graph (1), if they otherwise meet the eligibility require23 ments for medical assistance under the State plan ap24 proved under this title (other than the requirement of the 

25 receipt of aid or assistance under title IV, supplemental 


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1 security income benefits under title XVI, or a State sup2 plementary payment), and are— 

3 ‘‘(i) lawfully present in the United States; 

4 ‘‘(ii) children under age 21, including optional 

5 targeted low-income children described in section 

6 1905(u)(2)(B); or 

7 ‘‘(iii) pregnant women during pregnancy (and 

8 during the 60-day period beginning on the last day 

9 of the pregnancy). 

10 ‘‘(B) No debt shall accrue under an affidavit of sup11 port against any sponsor of such an alien on the basis 

12 of provision of assistance to such category and the cost 

13 of such assistance shall not be considered as an unreim14 bursed cost.’’. 

15 (b) SCHIP.—Section 2107(e)(1) of the Social Secu16 rity Act (42 U.S.C. 1397gg(e)(1)) is amended by striking 

17 subparagraph (H) and inserting the following new sub18 paragraph: 

19 ‘‘(H) Paragraph (4) of section 1903(v) (re20 lating to individuals who, but for sections 

21 401(a), 403, and 421 of the Personal Responsi22 bility and Work Opportunity Reconciliation Act 

23 of 1996, would be eligible for medical assistance 

24 under title XXI).’’. 

25 (c) NUTRITION ASSISTANCE.— 


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1 (1) SUPPLEMENTAL NUTRITION ASSISTANCE.— 

2 Notwithstanding sections 401(a), 402(a), and 403(a) 

3 of the Personal Responsibility and Work Oppor4 tunity Reconciliation Act of 1996 (8 U.S.C. 1611(a); 

5 1612(a), 1613(a)) and section 6(f) of the Food and 

6 Nutrition Act of 2008 (7 U.S.C 2015(f)), persons 

7 who are lawfully present in the United States shall 

8 be not be ineligible for benefits under the supple9 mental nutrition assistance program on the basis of 

10 their immigration status or date of entry into the 

11 United States. 

12 (2) ELIGIBILITY FOR FAMILIES WITH CHIL13 DREN.—Section of the 421(d)(3) of the Personal Re14 sponsibility and Work Opportunity Reconciliation 

15 Act of 1996 (8 U.S.C. 1631(d)(3)) is amended by 

16 striking ‘‘to the extent that a qualified alien is eligi17 ble under section 402(a)(2)(J)’’ and inserting, ‘‘to 

18 the extent that a child is a member of a household 

19 under the supplemental nutrition assistance pro20 gram’’. 

21 (3) ENSURING PROPER SCREENING.—Section 

22 11(e)(2)(B) of the Food and Nutrition Act of 2008 

23 (7 U.S.C. 2020(e)(2)(B)) is amended— 

24 (A) by redesignating clauses (vi) and (viii) 

25 as clauses (vii) and (viii); and 


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1 (B) by inserting after clause (v) the fol2 lowing: 

3 ‘‘(vi) shall provide a method for imple4 menting section 421 of the Personal Re5 sponsibility and Work Opportunity Rec6 onciliation Act of 1996 (8 U.S.C. 1631) 

7 that does not require any unnecessary in8 formation from persons who may be ex9 empt from that provision;’’. 

10 SEC. 531. REMOVING MEDICARE BARRIER TO HEALTH 

11 CARE. 

12 Section 1818(a)(3) of the Social Security Act (42 

13 U.S.C. 1395i–2(a)(3)) is amended by amending clause (B) 

14 to read as follows: ‘‘(B) an individual who is lawfully 

15 present in the United States’’. 

16 CHAPTER 2—LUNG CANCER MORTALITY 

17 REDUCTION 

18 SEC. 541. SHORT TITLE. 

19 This chapter may be cited as the ‘‘Lung Cancer Mor20 tality Reduction Act of 2009’’. 

21 SEC. 542. FINDINGS. 

22 Congress makes the following findings: 

23 (1) Lung cancer is the leading cause of cancer 

24 death for both men and women, accounting for 28 

25 percent of all cancer deaths. 


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1 (2) Lung cancer kills more people annually 

2 than breast cancer, prostate cancer, colon cancer, 

3 liver cancer, melanoma, and kidney cancer combined. 

4 (3) Since the National Cancer Act of 1971 

5 (Public Law 92–218; 85 Stat. 778), coordinated and 

6 comprehensive research has raised the 5-year sur7 vival rates for breast cancer to 88 percent, for pros8 tate cancer to 99 percent, and for colon cancer to 

9 64 percent. 

10 (4) However, the 5-year survival rate for lung 

11 cancer is still only 15 percent and a similar coordi12 nated and comprehensive research effort is required 

13 to achieve increases in lung cancer survivability 

14 rates. 

15 (5) Sixty percent of lung cancer cases are now 

16 diagnosed as nonsmokers or former smokers. 

17 (6) Two-thirds of nonsmokers diagnosed with 

18 lung cancer are women. 

19 (7) Certain minority populations, such as Afri20 can-American males, have disproportionately high 

21 rates of lung cancer incidence and mortality, not22 withstanding their similar smoking rate. 

23 (8) Members of the baby boomer generation are 

24 entering their sixties, the most common age at which 

25 people develop lung cancer. 


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1 (9) Tobacco addiction and exposure to other 

2 lung cancer carcinogens such as Agent Orange and 

3 other herbicides and battlefield emissions are serious 

4 problems among military personnel and war vet5 erans. 

6 (10) Significant and rapid improvements in 

7 lung cancer mortality can be expected through great8 er use and access to lung cancer screening tests for 

9 at-risk individuals. 

10 (11) Additional strategies are necessary to fur11 ther enhance the existing tests and therapies avail12 able to diagnose and treat lung cancer in the future. 

13 (12) The August 2001 Report of the Lung 

14 Cancer Progress Review Group of the National Can15 cer Institute stated that funding for lung cancer re16 search was ‘‘far below the levels characterized for 

17 other common malignancies and far out of propor18 tion to its massive health impact’’. 

19 (13) The Report of the Lung Cancer Progress 

20 Review Group identified as its ‘‘highest priority’’ the 

21 creation of integrated, multidisciplinary, multi-insti22 tutional research consortia organized around the 

23 problem of lung cancer rather than around specific 

24 research disciplines. 


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1 (14) The United States must enhance its re2 sponse to the issues raised in the Report of the 

3 Lung Cancer Progress Review Group, and this can 

4 be accomplished through the establishment of a co5 ordinated effort designed to reduce the lung cancer 

6 mortality rate by 50 percent by 2015 and targeted 

7 funding to support this coordinated effort. 

8 SEC. 543. SENSE OF CONGRESS CONCERNING INVESTMENT 

9 IN LUNG CANCER RESEARCH. 

10 It is the sense of the Congress that— 

11 (1) lung cancer mortality reduction should be 

12 made a national public health priority; and 

13 (2) a comprehensive mortality reduction pro14 gram coordinated by the Secretary of Health and 

15 Human Services is justified and necessary to ade16 quately address and reduce lung cancer mortality. 

17 SEC. 544. LUNG CANCER MORTALITY REDUCTION PRO18 GRAM. 

19 (a) IN GENERAL.—Subpart 1 of part C of title IV 

20 of the Public Health Service Act (42 U.S.C. 285 et seq.) 

21 is amended by adding at the end the following: 

22 ‘‘SEC. 417G. LUNG CANCER MORTALITY REDUCTION PRO23 GRAM. 

24 ‘‘(a) IN GENERAL.—Not later than 6 months after 

25 the date of the enactment of this section, the Secretary, 


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1 in consultation with the Secretary of Defense, the Sec2 retary of Veterans Affairs, the Director of the National 

3 Institutes of Health, the Director of the Centers for Dis4 ease Control and Prevention, the Commissioner of Food 

5 and Drugs, the Administrator of the Centers for Medicare 

6 & Medicaid Services, the Director of the National Center 

7 on Minority Health and Health Disparities, and other 

8 members of the Lung Cancer Advisory Board established 

9 under section 546 of the Lung Cancer Mortality Reduc10 tion Act of 2009, shall implement a comprehensive pro11 gram, to be known as the Lung Cancer Mortality Reduc12 tion Program, to achieve a reduction of at least 25 percent 

13 in the mortality rate of lung cancer by 2015. 

14 ‘‘(b) REQUIREMENTS.—The Program shall include at 

15 least the following: 

16 ‘‘(1) With respect to the National Institutes of 

17 Health— 

18 ‘‘(A) a strategic review and prioritization 

19 by the National Cancer Institute of research 

20 grants to achieve the goal of the Lung Cancer 

21 Mortality Reduction Program in reducing lung 

22 cancer mortality; 

23 ‘‘(B) the provision of funds to enable the 

24 Airway Biology and Disease Branch of the Na25 tional Heart, Lung, and Blood Institute to exVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00332 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 pand its research programs to include pre2 dispositions to lung cancer, the interrelationship 

3 between lung cancer and other pulmonary and 

4 cardiac disease, and the diagnosis and treat5 ment of these interrelationships; 

6 ‘‘(C) the provision of funds to enable the 

7 National Institute of Biomedical Imaging and 

8 Bioengineering to expedite the development of 

9 computer assisted diagnostic, surgical, treat10 ment, and drug testing innovations to reduce 

11 lung cancer mortality, such as through expan12 sion of the Institute’s Quantum Grant Program 

13 and Image-Guided Interventions programs; and 

14 ‘‘(D) the provision of funds to enable the 

15 National Institute of Environmental Health 

16 Sciences to implement research programs rel17 ative to the lung cancer incidence. 

18 ‘‘(2) With respect to the Food and Drug Ad19 ministration— 

20 ‘‘(A) activities under section 529 of the 

21 Federal Food, Drug, and Cosmetic Act; and 

22 ‘‘(B) activities under section 561 of the 

23 Federal Food, Drug, and Cosmetic Act to ex24 pand access to investigational drugs and devices 


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1 for the diagnosis, monitoring, or treatment of 

2 lung cancer. 

3 ‘‘(3) With respect to the Centers for Disease 

4 Control and Prevention, the establishment of an 

5 early disease research and management program 

6 under section 1511. 

7 ‘‘(4) With respect to the Agency for Healthcare 

8 Research and Quality, the conduct of a biannual re9 view of lung cancer screening, diagnostic, and treat10 ment protocols, and the issuance of updated guide11 lines. 

12 ‘‘(5) The cooperation and coordination of all 

13 minority and health disparity programs within the 

14 Department of Health and Human Services to en15 sure that all aspects of the Lung Cancer Mortality 

16 Reduction Program under this section adequately 

17 address the burden of lung cancer on minority and 

18 rural populations. 

19 ‘‘(6) The cooperation and coordination of all to20 bacco control and cessation programs within agen21 cies of the Department of Health and Human Serv22 ices to achieve the goals of the Lung Cancer Mor23 tality Reduction Program under this section with 

24 particular emphasis on the coordination of drug and 


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1 other cessation treatments with early detection pro2 tocols.’’. 

3 (b) FEDERAL FOOD, DRUG, AND COSMETIC ACT.— 

4 Subchapter B of chapter V of the Federal Food, Drug, 

5 and Cosmetic Act (21 U.S.C. 360aaa et seq.) is amended 

6 by adding at the end the following: 

7 ‘‘DRUGS RELATING TO LUNG CANCER

8 ‘‘SEC. 529. (a) IN GENERAL.—The provisions of this 

9 subchapter shall apply to a drug described in subsection 

10 (b) to the same extent and in the same manner as such 

11 provisions apply to a drug for a rare disease or condition. 

12 ‘‘(b) QUALIFIED DRUGS.—A drug described in this 

13 subsection is— 

14 ‘‘(1) a chemoprevention drug for precancerous 

15 conditions of the lung; 

16 ‘‘(2) a drug for a targeted therapeutic treat17 ments, including any vaccine for, lung cancer; and 

18 ‘‘(3) a drug to curtail or prevent nicotine addic19 tion. 

20 ‘‘(c) BOARD.—The Board established under section 

21 546 of the Lung Cancer Mortality Reduction Act of 2009 

22 shall monitor the program implemented under this sec23 tion.’’. 

24 (c) ACCESS TO UNAPPROVED THERAPIES.—Section 

25 561(e) of the Federal Food, Drug, and Cosmetic Act (21 

26 U.S.C. 360bbb(e)) is amended by inserting before the peVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00335 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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1 riod the following: ‘‘and shall include expanding access to 

2 drugs under section 529, with substantial consideration 

3 being given to whether the totality of information available 

4 to the Secretary regarding the safety and effectiveness of 

5 an investigational drug, as compared to the risk of mor6 bidity and death from the disease, indicates that a patient 

7 may obtain more benefit than risk if treated with the 

8 drug’’. 

9 (d) CDC.—Title XV of the Public Health Service Act 

10 (42 U.S.C. 300k et seq.) is amended by adding at the end 

11 the following: 

12 ‘‘SEC. 1511. EARLY DISEASE RESEARCH AND MANAGEMENT 

13 PROGRAM. 

14 ‘‘The Secretary shall establish and implement an 

15 early disease research and management program targeted 

16 at the high incidence and mortality rates of lung cancer 

17 among minority and low-income populations.’’. 

18 SEC. 545. DEPARTMENT OF DEFENSE AND THE DEPART19 MENT OF VETERANS AFFAIRS. 

20 The Secretary of Defense and the Secretary of Vet21 erans Affairs shall coordinate with the Secretary of Health 

22 and Human Services— 

23 (1) in the development of the Lung Cancer 

24 Mortality Reduction Program under section 417G; 


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1 (2) in the implementation within the Depart2 ment of Defense and the Department of Veterans 

3 Affairs of an early detection and disease manage4 ment research program for military personnel and 

5 veterans whose smoking history and exposure to car6 cinogens during active duty service has increased 

7 their risk for lung cancer; and 

8 (3) in the implementation of coordinated care 

9 programs for military personnel and veterans diag10 nosed with lung cancer. 

11 SEC. 546. LUNG CANCER ADVISORY BOARD. 

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

13 Human Services shall convene a Lung Cancer Advisory 

14 Board (referred to in this section as the ‘‘Board’’)— 

15 (1) to monitor the programs established under 

16 this chapter (and the amendments made by this 

17 chapter); and 

18 (2) to provide annual reports to the Congress 

19 concerning benchmarks, expenditures, lung cancer 

20 statistics, and the public health impact of such pro21 grams. 

22 (b) COMPOSITION.—The Board shall be composed 

23 of— 

24 (1) the Secretary of Health and Human Serv25 ices; 


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1 (2) the Secretary of Defense; 

2 (3) the Secretary of Veterans Affairs; and 

3 (4) two representatives each from the fields of 

4 clinical medicine focused on lung cancer, lung cancer 

5 research, imaging, drug development, and lung can6 cer advocacy, to be appointed by the Secretary of 

7 Health and Human Services. 

8 SEC. 547. AUTHORIZATION OF APPROPRIATIONS. 

9 (a) IN GENERAL.—To carry out this chapter (and the 

10 amendments made by this chapter), there are authorized 

11 to be appropriated such sums as may be necessary for 

12 each of fiscal years 2010 through 2014. 

13 (b) LUNG CANCER MORTALITY REDUCTION PRO14 GRAM.—Of the amounts authorized to be appropriated by 

15 subsection (a), there are authorized to be appropriated— 

16 (1) $25,000,000 for fiscal year 2010, and such 

17 sums as may be necessary for each of fiscal years 

18 2011 through 2014, for the activities described in 

19 section 417G(b)(1)(B) of the Public Health Service 

20 Act, as added by section 544(a); 

21 (2) $25,000,000 for fiscal year 2010, and such 

22 sums as may be necessary for each of fiscal years 

23 2011 through 2014, for the activities described in 

24 section 417G(b)(1)(C) of such Act; 


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1 (3) $10,000,000 for fiscal year 2010, and such 

2 sums as may be necessary for each of fiscal years 

3 2011 through 2014, for the activities described in 

4 section 417G(b)(1)(D) of such Act; and 

5 (4) $15,000,000 for fiscal year 2010, and such 

6 sums as may be necessary for each of fiscal years 

7 2011 through 2014, for the activities described in 

8 section 417G(b)(3) of such Act. 

9 TITLE VI—ELIMINATING DIS10 PARITIES IN DIABETES PRE11 VENTION ACCESS AND CARE 

12 ACT 

13 Subtitle A—NATIONAL 

14 INSTITUTES OF HEALTH 

15 SEC. 611. RESEARCH, TREATMENT, AND EDUCATION. 

16 (a) IN GENERAL.—Subpart 3 of part C of title IV 

17 of the Public Health Service Act (42 U.S.C. 285c et seq.) 

18 is amended by adding at the end the following new section: 

19 ‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 

20 ‘‘(a) IN GENERAL.—The Director of the National In21 stitutes of Health shall expand, intensify, and support on22 going research and other activities with respect to pre-dia23 betes and diabetes, particularly type 2, in minority popu24 lations, including research to identify clinical, socioVerDate Nov 24 2008 01:55 Jul 02, 2009 Jkt 079200 PO 00000 Frm 00339 Fmt 6652 Sfmt 6201 E:\BILLS\H3090.IH H3090

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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) Continue research on behavior and obesity, 

7 including research through the obesity research cen8 ter 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 


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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 Center 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 


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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. 

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 2010 and each subsequent fiscal year.’’. 

14 (b) DIABETES MELLITUS INTERAGENCY COORDI15 NATING COMMITTEE.—Section 429 of the Public Health 

16 Service Act (42 U.S.C. 285c–3) is amended by adding at 

17 the end the following new subsection: 

18 ‘‘(c)(1) In each annual report prepared by the Diabe19 tes Mellitus Interagency Coordinating Committee, the 

20 Committee shall include an assessment of the Federal ac21 tivities and programs related to diabetes in minority popu22 lations. Such assessment shall— 

23 ‘‘(A) compile the current activities of all 

24 current Federal health programs to allow for 

25 the assessment of their adequacy as a systemic 


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1 method of addressing the impact of diabetes 

2 mellitus on minority populations; 

3 ‘‘(B) develop strategic planning activities 

4 to develop an effective and comprehensive Fed5 eral plan to address diabetes mellitus within mi6 nority populations which will involve all appro7 priate Federal health programs and shall— 

8 ‘‘(i) include steps to address issues in9 cluding type 1 and type 2 diabetes in chil10 dren and the disproportionate impact of di11 abetes mellitus on minority populations; 

12 and 

13 ‘‘(ii) remain consistent with the pro14 grams and activities identified in section 

15 399O, as well as remaining consistent with 

16 the intent of the Eliminating Disparities in 

17 Diabetes Prevention Access and Care Act 

18 of 2009; and 

19 ‘‘(C) assess the implementation of such a 

20 plan throughout Federal health programs. 

21 ‘‘(2) For the purposes of this subsection, the 

22 term ‘minority population’ means a racial and ethnic 

23 minority group, as defined in section 1707. 

24 ‘‘(3) For the purpose of carrying out this sub25 section, there are authorized to be appropriated such 


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1 sums as are necessary for fiscal year 2010 and each 

2 subsequent fiscal year.’’. 

3 Subtitle B—CENTERS FOR DIS4 EASE CONTROL AND PREVEN5 TION 

6 SEC. 621. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

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

8 (42 U.S.C. 243 et seq.) is amended by inserting after sec9 tion 317T the following section: 

10 ‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 

11 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

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

13 through the Director of the Centers for Disease 

14 Control and Prevention, shall conduct and support 

15 research and other activities with respect to diabetes 

16 in minority populations. 

17 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

18 paragraph (1) regarding diabetes in minority popu19 lations shall include the following: 

20 ‘‘(A) Expanding the National Diabetes 

21 Laboratory capacity for translational research 

22 and the identification of genetic and 

23 immunological risk factors associated with dia24 betes. 


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1 ‘‘(B) Enhancing the National Health and 

2 Nutrition Examination Survey to include risk 

3 factors for type 2 diabetes and pre-diabetes 

4 with emphasis on eating and dietary habits, and 

5 focus, including cultural and socioeconomic fac6 tors, on Hispanic-American, African-American, 

7 American Indian and Alaskan Native, and 

8 Asian-American, Native Hawaiian and other 

9 Pacific Islander communities. 

10 ‘‘(C) Further enhancing the National 

11 Health and Nutrition Examination Survey by 

12 over-sampling Asian-American, Native Hawai13 ian, and Other Pacific Islanders in appropriate 

14 geographic areas to better determine the preva15 lence of diabetes in such populations as well as 

16 to improve the data collection of diabetes pene17 tration disaggregated into major ethnic groups 

18 within such populations. 

19 ‘‘(D) Within the Division of Diabetes 

20 Translation, providing for prevention research 

21 to better understand how to influence health 

22 care systems changes to improve quality of care 

23 being delivered to such populations, and within 

24 the Division of Diabetes Translation, carrying 

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1 plement, and evaluate effective diabetes preven2 tion and control intervention for such popu3 lations. 

4 ‘‘(E) Through the Division of Diabetes 

5 Translation, carrying out culturally appropriate 

6 community-based interventions designed to ad7 dress issues and problems experienced by such 

8 populations. 

9 ‘‘(F) Conducting applied research within 

10 the Division of Diabetes Translation to reduce 

11 health disparities within such populations with 

12 diabetes. 

13 ‘‘(G) Conducting applied research on pri14 mary prevention within the Division of Diabetes 

15 Translation to specifically focus on such popu16 lations with pre-diabetes. 

17 ‘‘(b) EDUCATION.— 

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

19 through the Director of the Centers for Disease 

20 Control and Prevention, shall direct the Division of 

21 Diabetes Translation to conduct and support pro22 grams to educate the public on the causes and ef23 fects of diabetes in minority populations. 

24 ‘‘(2) CERTAIN ACTIVITIES.—Programs under 

25 paragraph (1) regarding education on diabetes in 


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1 minority populations shall include carrying out pub2 lic awareness campaigns directed toward such popu3 lations to aggressively emphasize the importance and 

4 impact of physical activity and diet in regard to dia5 betes and diabetes-related complications through the 

6 National Diabetes Education Program. 

7 ‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION

8 ACTIVITIES, AND ACCESS.— 

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

10 through the Director of the Centers for Disease 

11 Control and Prevention, shall carry out culturally 

12 appropriate diabetes health promotion and preven13 tion programs for minority populations. 

14 ‘‘(2) CERTAIN ACTIVITIES.—Activities regard15 ing culturally appropriate diabetes health promotion 

16 and prevention programs for minority populations 

17 shall include the following: 

18 ‘‘(A) Expanding the Diabetes Prevention 

19 and Control Program (currently existing in all 

20 the States and territories) and providing funds 

21 for education and community outreach on dia22 betes. 

23 ‘‘(B) Providing funds for an expansion of 

24 the Diabetes Prevention Program Initiative that 

25 focuses on physical inactivity and diet and its 


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1 relation to type 2 diabetes within such popu2 lations. 

3 ‘‘(C) Providing funds to strengthen exist4 ing surveillance systems to improve the quality, 

5 accuracy, and timeliness of morbidity and mor6 tality diabetes data for such populations. 

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. 

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 2010 and each subsequent fiscal year.’’. 

14 Subtitle C—HEALTH RESOURCES 

15 AND SERVICES ADMINISTRA16 TION 

17 SEC. 631. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

18 Part P of title III of the Public Health Service Act, 

19 as amended, is amended by adding at the end the following 

20 new section: 

21 ‘‘SEC. 399V. PROGRAMS TO EDUCATE HEALTH PROVIDERS 

22 ON THE CAUSES AND EFFECTS OF DIABETES 

23 IN MINORITY POPULATIONS. 

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

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1 istration, shall conduct and support programs described 

2 in subsection (b) to educate health professionals on the 

3 causes and effects of diabetes in minority populations. 

4 ‘‘(b) PROGRAMS.—Programs described in this sub5 section, with respect to education on diabetes in minority 

6 populations, shall include the following: 

7 ‘‘(1) Making grants for diabetes-focused edu8 cation classes or training programs on cultural sen9 sitivity and patient care within such populations for 

10 health care providers. 

11 ‘‘(2) Providing funds to community health cen12 ters for programs that provide diabetes services and 

13 screenings. 

14 ‘‘(3) Providing additional funds for the Health 

15 Careers Opportunity Program, Centers for Excel16 lence, and the Minority Faculty Fellowship Program 

17 to partner with the Office of Minority Health under 

18 section 1707 and the National Institutes of Health 

19 to strengthen programs for career opportunities 

20 within minority populations focused on diabetes 

21 treatment and care. 

22 ‘‘(4) Developing a diabetes focus within, and 

23 providing additional funds for, the National Health 

24 Service Corps Scholarship program to place individ25 uals in areas that are disproportionately affected by 


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1 diabetes and to provide health care services to such 

2 areas. 

3 ‘‘(5) Establishing a diabetes ambassador pro4 gram for recruitment efforts to increase the number 

5 of underrepresented minorities currently serving in 

6 student, faculty, or administrative positions in insti7 tutions of higher learning, hospitals, and community 

8 health centers. 

9 ‘‘(6) Establishing a loan repayment program 

10 that focuses on diabetes care and prevention in mi11 nority populations.’’. 

12 Subtitle D—ADDITIONAL 

13 PROGRAMS 

14 SEC. 641. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 

15 Part P of title III of the Public Health Service Act 

16 (42 U.S.C. 280g et seq.), as amended, is further amended 

17 by adding at the end the following section: 

18 ‘‘SEC. 399W. RESEARCH, EDUCATION, AND OTHER ACTIVI19 TIES REGARDING DIABETES IN MINORITY 

20 POPULATIONS. 

21 ‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 

22 ‘‘(1) IN GENERAL.—In addition to activities 

23 under sections 317U and 434B, the Secretary shall 

24 conduct and support research and other activities 

25 with respect to diabetes within minority populations. 


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1 ‘‘(2) CERTAIN ACTIVITIES.—Activities under 

2 paragraph (1) regarding diabetes in minority popu3 lations shall include the following: 

4 ‘‘(A) Through the National Center on Mi5 nority Health and Health Disparities, the Office 

6 of Minority Health under section 1707, the 

7 Health Resources and Services Administration, 

8 the Centers for Disease Control and Prevention, 

9 and the Indian Health Service, establishing 

10 partnerships within minority populations to 

11 conduct studies on cultural, familial, and social 

12 factors that may influence health promotion, di13 abetes management, and prevention. 

14 ‘‘(B) Through the Indian Health Service, 

15 in collaboration with other appropriate Federal 

16 agencies, coordinating the collection of data on 

17 ethnic and culturally appropriate diabetes treat18 ment, care, prevention, and services by health 

19 care professionals to the American Indian popu20 lation. 

21 ‘‘(3) PROGRAMS RELATING TO CLINICAL RE22 SEARCH.— 

23 ‘‘(A) EDUCATION REGARDING CLINICAL

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1 crease participation of minority populations in 

2 clinical trials. 

3 ‘‘(B) MINORITY RESEARCHERS.—The Sec4 retary shall carry out mentorship programs for 

5 minority researchers who are conducting or in6 tend to conduct research on diabetes in minor7 ity populations. 

8 ‘‘(C) SUPPLEMENTING CLINICAL RE9 SEARCH REGARDING CHILDREN.—The Sec10 retary shall make grants to supplement clinical 

11 research programs to assist such programs in 

12 obtaining the services of health professionals 

13 and other resources to provide specialized care 

14 for children with type 1 and type 2 diabetes. 

15 ‘‘(4) ADDITIONAL PROGRAMS.—Activities under 

16 paragraph (1) regarding education on diabetes in 

17 minority populations shall include providing funds 

18 for new and existing diabetes-focused education 

19 grants and programs for present and future stu20 dents and clinicians in the medical field from minor21 ity populations, including for the following: 

22 ‘‘(A) For Federal and State loan repay23 ment programs for health profession students 

24 within communities of color. 


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1 ‘‘(B) For the Office of Minority Health 

2 under section 1707 for training health profes3 sion students to focus on diabetes within such 

4 populations. 

5 ‘‘(C) For State and local entities to estab6 lish diabetes awareness week or day every 

7 month in schools, nursing homes, and colleges 

8 through partnerships with the Office of Minor9 ity Health under section 1707 and the Health 

10 Resources and Services Administration. 

11 ‘‘(b) DEFINITION.—For purposes of this section, the 

12 term ‘minority population’ means a racial and ethnic mi13 nority group as defined in section 1707. 

14 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—For the 

15 purpose of carrying out this section, there are authorized 

16 to be appropriated such sums as are necessary for fiscal 

17 year 2010 and each subsequent fiscal year.’’. 

Æ 


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