180 
earnings 
of 
underemployed 
immigrants 
were 
$32,000, or 43 percent less than U.S.-born college 
graduates employed in the college labor market. 
(9) According to Upwardly Global and the Wel-
come Back Initiative, with proper guidance and sup-
port underemployed skilled immigrants typically in-
crease their income by 215 percent to 900 percent. 
(10) According to the Brookings Institution and 
the Partnership for a New American Economy, im-
migrants working in the health workforce are, on av-
erage, better-educated than U.S.-born workers in the 
health workforce. 
(b) GRANTS TO ELIGIBLE ENTITIES.— 
(1) AUTHORITY
TO
PROVIDE
GRANTS.—The 
Secretary of Health and Human Services, acting 
through the Bureau of Health Workforce within the 
Health Resources and Services Administration, the 
National Institute on Minority Health and Health 
Disparities, or the Office of Minority Health (in this 
section referred to as the ‘‘Secretary’’), may award 
grants to eligible entities to carry out activities de-
scribed in subsection (c). 
(2) ELIGIBILITY.—To be eligible to receive a 
grant under this section, an entity shall— 
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(A) be a clinical, public health, or health 
services organization, a community-based or 
nonprofit entity, an academic institution, a 
faith-based organization, a State, county, or 
local government, a National Area Health Edu-
cation Center, or another entity determined ap-
propriate by the Secretary; and 
(B) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require. 
(c) AUTHORIZED ACTIVITIES.—A grant awarded 
under this section shall be used— 
(1) to provide services to assist unemployed and 
underemployed skilled immigrants, residing in the 
United States, who have legal, permanent work au-
thorization and who are internationally educated 
health professions, enter into the American health 
workforce with employment matching their health 
professional skills and education, and advance in em-
ployment to positions that better match their health 
professional education and expertise; 
(2) to reduce disparities in incomes between 
skilled health professional immigrants and other 
workers in the health workforce; 
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(3) to reduce barriers to entry and advance-
ment in the health workforce for internationally edu-
cated skilled immigrants; and 
(4) to educate employers regarding the abilities 
and capacities of internationally educated health 
professionals. 
(d) DEFINITIONS.—In this section: 
(1) The term ‘‘health professional’’ means an 
individual trained for employment or intended em-
ployment in the field of public health, health man-
agement, dentistry, health administration, medicine, 
nursing, pharmacy, psychology, social work, psychi-
atry, other mental and behavioral health, allied 
health, community health, social work, or wellness 
work, including fitness and nutrition, or other fields 
as determined appropriate by the Secretary. 
(2) The term ‘‘underemployed’’ means being 
employed at less skilled tasks than an employee’s 
training or abilities would otherwise permit. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2015 through 2019. 
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TITLE IV—IMPROVEMENT OF 
HEALTH CARE SERVICES 
Subtitle A—Health Empowerment 
Zones 
SEC. 401. SHORT TITLE. 
This subtitle may be cited as the ‘‘Health Empower-
ment Zone Act of 2014’’. 
SEC. 402. FINDINGS. 
The Congress finds the following: 
(1) Numerous studies and reports, including 
the 2012 National Healthcare Disparities Report of 
the Administration on Healthcare Research and 
Quality and the 2002 Unequal Treatment Report of 
the Institute of Medicine, document the extensive-
ness to which health disparities exist across the 
country. 
(2) These studies have found that, on average, 
racial and ethnic minorities are disproportionately 
afflicted with chronic and acute conditions—such as 
cancer, diabetes, musculoskeletal disease, obesity, 
and hypertension—and suffer worse health out-
comes, worse health status, and higher mortality 
rates than their White counterparts. 
(3) Several recent studies also show that health 
disparities are a function of not only access to health 
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care, but also the social determinants of health—in-
cluding the environment, the physical structure of 
communities, nutrition and food options, educational 
attainment, employment, race, ethnicity, geography, 
and language preference—that directly and indi-
rectly affect the health, health care, and wellness of 
individuals and communities. 
(4) Integrally involving and fully supporting the 
communities most affected by health inequities in 
the assessment, planning, launch, and evaluation of 
health disparity elimination efforts are among the 
leading recommendations made to adequately ad-
dress and ultimately reduce health disparities. 
(5) Recommendations also include supporting 
the efforts of community stakeholders from a broad 
cross section—including, but not limited to local 
businesses, local departments of commerce, edu-
cation, labor, urban planning, and transportation, 
and community-based and other nonprofit organiza-
tions—to find areas of common ground around 
health disparity elimination and collaborate to im-
prove the overall health and wellness of a community 
and its residents. 
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SEC. 
403. 
DESIGNATION 
OF 
HEALTH 
EMPOWERMENT 
ZONES. 
(a) IN GENERAL.—At the request of an eligible com-
munity partnership, the Secretary may designate an eligi-
ble area as a health empowerment zone. 
(b) ELIGIBILITY CRITERIA.— 
(1) ELIGIBLE
COMMUNITY
PARTNERSHIP.—A 
community partnership is eligible to submit a re-
quest under this section if the partnership— 
(A) demonstrates widespread public sup-
port from key individuals and entities in the eli-
gible area, including members of the target 
community, State and local governments, non-
profit organizations, and community and indus-
try leaders, for designation of the eligible area 
as a health empowerment zone; and 
(B) includes representatives of— 
(i) a broad cross section of stake-
holders and residents from communities in 
the eligible area experiencing dispropor-
tionate disparities in health status and 
health care; and 
(ii) organizations, facilities, and insti-
tutions that have a history of working 
within and serving such communities. 
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(2) ELIGIBLE AREA.—An area is eligible to be 
designated as a health empowerment zone under this 
section if one or more communities in the area expe-
rience disproportionate disparities in health status 
and health care. In determining whether a commu-
nity experiences such disparities, the Secretary shall 
consider the data collected by the Department of 
Health and Human Services focusing on the fol-
lowing areas: 
(A) Access to affordable, high-quality 
health services. 
(B) The prevalence of disproportionate 
rates of certain illnesses or diseases including 
the following: 
(i) Arthritis, osteoporosis, chronic 
back conditions, and other musculoskeletal 
diseases. 
(ii) Cancer. 
(iii) Chronic kidney disease. 
(iv) Diabetes. 
(v) Injury (intentional and uninten-
tional). 
(vi) Violence (intimate and non-
intimate). 
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(vii) Maternal and paternal illnesses 
and diseases. 
(viii) Infant mortality. 
(ix) Mental illness and other disabil-
ities. 
(x) Substance abuse treatment and 
prevention, including underage drinking. 
(xi) Nutrition, obesity, and overweight 
conditions. 
(xii) Heart disease. 
(xiii) Hypertension. 
(xiv) 
Cerebrovascular 
disease 
or 
stroke. 
(xv) Tuberculosis. 
(xvi) HIV/AIDS and other sexually 
transmitted diseases. 
(xvii) Viral hepatitis. 
(xviii) Asthma. 
(xix) Tooth decay and other oral 
health issues. 
(C) Within the target community, the his-
torical and persistent presence of conditions 
that have been found to contribute to health 
disparities including any such conditions re-
specting the following: 
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(i) Poverty. 
(ii) Educational status and the quality 
of community schools. 
(iii) Income. 
(iv) Access to high-quality affordable 
health care. 
(v) Work and work environment. 
(vi) Environmental conditions in the 
community, including with respect to clean 
water, clean air, and the presence or ab-
sence of pollutants. 
(vii) Language and English pro-
ficiency. 
(viii) Access to affordable healthy 
food. 
(ix) Access to ethnically and culturally 
diverse health and human service providers 
and practitioners. 
(x) Access to culturally and linguis-
tically competent health and human serv-
ices and health and human service pro-
viders. 
(xi) Health-supporting infrastructure. 
(xii) Health insurance that is ade-
quate and affordable. 
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(xiii) Race, racism, and bigotry (con-
scious and unconscious). 
(xiv) Sexual orientation. 
(xv) Health literacy. 
(xvi) Place of residence (such as 
urban areas, rural areas, and tribal res-
ervations). 
(xvii) Stress. 
(c) PROCEDURE.— 
(1) REQUEST.—A request under subsection (a) 
shall— 
(A) describe the bounds of the area to be 
designated as a health empowerment zone and 
the process used to select those bounds; 
(B) demonstrate that the partnership sub-
mitting the request is an eligible community 
partnership described in subsection (b)(1); 
(C) demonstrate that the area is an eligible 
area described in subsection (b)(2); 
(D) include a comprehensive assessment of 
disparities in health status and health care ex-
perience by one or more communities in the 
area; 
(E) set forth— 
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(i) a vision and a set of values for the 
area; and 
(ii) a comprehensive and holistic set of 
goals to be achieved in the area through 
designation as a health empowerment zone; 
and 
(F) include a strategic plan and an action 
plan for achieving the goals described in sub-
paragraph (E)(ii). 
(2) APPROVAL.—Not later than 60 days after 
the receipt of a request for designation of an area 
as a health empowerment zone under this section, 
the Secretary shall approve or disapprove the re-
quest. 
(d) MINIMUM NUMBER.—The Secretary— 
(1) shall designate not more than 110 health 
empowerment zones under this section; and 
(2) shall designate at least one health empower-
ment zone in each of the several States, the District 
of Columbia, and each territory or possession of the 
United States. 
SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 
At the request of any organization or entity seeking 
to submit a request under section 403(a), the Secretary 
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shall provide technical assistance, and may award a grant, 
to assist such organization or entity— 
(1) to form an eligible community partnership 
described in section 403(b)(1); 
(2) to complete a health assessment, including 
an assessment of health disparities under section 
403(c)(1)(D); or 
(3) to prepare and submit a request, including 
a strategic plan, in accordance with section 403. 
SEC. 405. BENEFITS OF DESIGNATION. 
(a) PRIORITY.—In awarding any competitive grant, 
a Federal official shall give priority to any applicant 
that— 
(1) meets the eligibility criteria for the grant; 
(2) proposes to use the grant for activities in a 
health empowerment zone; and 
(3) demonstrates that such activities will di-
rectly and significantly further the goals of the stra-
tegic plan approved for such zone under section 403. 
(b) GRANTS
FOR INITIAL IMPLEMENTATION
OF 
STRATEGIC PLAN.— 
(1) IN GENERAL.—Upon designating an eligible 
area as a health empowerment zone at the request 
of an eligible community partnership, the Secretary 
shall, subject to the availability of appropriations, 
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make a grant to the community partnership for im-
plementation of the strategic plan for such zone. 
(2) GRANT PERIOD.—A grant under paragraph 
(1) for a health empowerment zone shall be for a pe-
riod of 2 years and may be renewed, except that the 
total period of grants under paragraph (1) for such 
zone may not exceed 10 years. 
(3) LIMITATION.—In awarding grants under 
this subsection, the Secretary shall not give less pri-
ority to an applicant or reduce the amount of a 
grant because the Secretary rendered technical as-
sistance or made a grant to the same applicant 
under section 404. 
(4) REPORTING.—The Secretary shall require 
each recipient of a grant under this subsection to re-
port to the Secretary not less than every 6 months 
on the progress in implementing the strategic plan 
for the health empowerment zone. 
SEC. 406. DEFINITION. 
In this subtitle, the term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services, acting through the 
Administrator of the Health Resources and Services Ad-
ministration and the Deputy Assistant Secretary for Mi-
nority Health, and in cooperation with the Director of the 
Office of Community Services and the Director of the Na-
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tional Institute for Minority Health and Health Dispari-
ties. 
SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 
To carry out this subtitle, there is authorized to be 
appropriated $100,000,000 for fiscal year 2015. 
Subtitle B—Other Improvements of 
Health Care Services 
CHAPTER 1—EXPANSION OF COVERAGE 
SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXIV of the Public Health Service Act, as 
amended by titles I, II, III, and IX of this Act, is further 
amended by inserting after subtitle C the following: 
‘‘Subtitle 
D—Reconstruction 
and 
Improvement Grants for Public 
Health Care Facilities Serving 
Pacific Islanders and the Insu-
lar Areas 
‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 
INITIATIVES. 
‘‘(a) IN GENERAL.—The Secretary, in collaboration 
with the Administrator of the Health Resources and Serv-
ices Administration, the Director of the Agency for 
Healthcare Research and Quality, and the Administrator 
of the Centers for Medicare & Medicaid Services, shall 
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award grants to eligible entities for the conduct of dem-
onstration projects to improve the quality of and access 
to health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a health center, hospital, health plan, 
health system, community clinic. or other health en-
tity determined appropriate by the Secretary— 
‘‘(A) that, by legal mandate or explicitly 
adopted mission, provides patients with access 
to services regardless of their ability to pay; 
‘‘(B) that provides care or treatment for a 
substantial number of patients who are unin-
sured, are receiving assistance under a State 
program under title XIX of the Social Security 
Act, or are members of vulnerable populations, 
as determined by the Secretary; and 
‘‘(C)(i) with respect to which, not less than 
50 percent of the entity’s patient population is 
made up of racial and ethnic minorities; or 
‘‘(ii) that— 
‘‘(I) serves a disproportionate percent-
age of local, minority racial and ethnic pa-
tients, or that has a patient population, at 
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least 50 percent of which is limited- 
English-proficient; and 
‘‘(II) provides an assurance that 
amounts received under the grant will be 
used only to support quality improvement 
activities in the racial and ethnic popu-
lation served; and 
‘‘(2) prepare and submit to the Secretary an 
application at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
‘‘(c) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to applicants 
under subsection (b)(2) that— 
‘‘(1) demonstrate an intent to operate as part 
of a health care partnership, network, collaborative, 
coalition, or alliance where each member entity con-
tributes to the design, implementation, and evalua-
tion of the proposed intervention; or 
‘‘(2) intend to use funds to carry out system-
wide changes with respect to health care quality im-
provement, including— 
‘‘(A) improved systems for data collection 
and reporting; 
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‘‘(B) innovative collaborative or similar 
processes; 
‘‘(C) group programs with behavioral or 
self-management interventions; 
‘‘(D) case management services; 
‘‘(E) physician or patient reminder sys-
tems; 
‘‘(F) educational interventions; or 
‘‘(G) other activities determined appro-
priate by the Secretary. 
‘‘(d) USE OF FUNDS.—An entity shall use amounts 
received under a grant under subsection (a) to support 
the implementation and evaluation of health care quality 
improvement activities or minority health and health care 
disparity reduction activities that include— 
‘‘(1) with respect to health care systems, activi-
ties relating to improving— 
‘‘(A) patient safety; 
‘‘(B) timeliness of care; 
‘‘(C) effectiveness of care; 
‘‘(D) efficiency of care; 
‘‘(E) patient centeredness; and 
‘‘(F) health information technology; and 
‘‘(2) with respect to patients, activities relating 
to— 
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‘‘(A) staying healthy; 
‘‘(B) getting well, mentally and physically; 
‘‘(C) living effectively with illness or dis-
ability; and 
‘‘(D) coping with end-of-life issues. 
‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 
provide financial and other technical assistance to grant-
ees under this section for the development of common data 
systems. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2015 through 2020. 
‘‘SEC. 3452. CENTERS OF EXCELLENCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall designate centers of excellence at 
public hospitals, and other health systems serving large 
numbers of minority patients, that— 
‘‘(1) 
meet 
the 
requirements 
of 
section 
3451(b)(1); 
‘‘(2) demonstrate excellence in providing care to 
minority populations; and 
‘‘(3) demonstrate excellence in reducing dispari-
ties in health and health care. 
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‘‘(b) REQUIREMENTS.—A hospital or health system 
that serves as a center of excellence under subsection (a) 
shall— 
‘‘(1) design, implement, and evaluate programs 
and policies relating to the delivery of care in ra-
cially, ethnically, and linguistically diverse popu-
lations; 
‘‘(2) provide training and technical assistance 
to other hospitals and health systems relating to the 
provision of quality health care to minority popu-
lations; and 
‘‘(3) develop activities for graduate or con-
tinuing medical education that institutionalize a 
focus on cultural competence training for health care 
providers. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2015 through 2020. 
‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 
FOR PUBLIC HEALTH CARE FACILITIES SERV-
ING PACIFIC ISLANDERS AND THE INSULAR 
AREAS. 
‘‘(a) IN GENERAL.—The Secretary shall provide di-
rect financial assistance to designated health care pro-
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viders and community health centers in American Samoa, 
Guam, the Commonwealth of the Northern Mariana Is-
lands, the United States Virgin Islands, Puerto Rico, and 
Hawaii for the purposes of reconstructing and improving 
health care facilities and services in a culturally competent 
and sustainable manner. 
‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi-
nancial assistance under subsection (a), an entity shall be 
a public health facility or community health center located 
in American Samoa, Guam, the Commonwealth of the 
Northern Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, or Hawaii that— 
‘‘(1) is owned or operated by— 
‘‘(A) the Government of American Samoa, 
Guam, the Commonwealth of the Northern 
Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, or Hawaii or a unit of local 
government; or 
‘‘(B) a nonprofit organization; and 
‘‘(2)(A) provides care or treatment for a sub-
stantial number of patients who are uninsured, re-
ceiving assistance under a State program under a 
title XVIII of the Social Security Act, or a State 
program under title XIX of such Act, or who are 
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members of a vulnerable population, as determined 
by the Secretary; or 
‘‘(B) serves a disproportionate percentage of 
local, minority racial and ethnic patients. 
‘‘(c) REPORT.—Not later than 180 days after the 
date of enactment of this title and annually thereafter, the 
Secretary shall submit to the Congress and the President 
a report that includes an assessment of health resources 
and facilities serving populations in American Samoa, 
Guam, the Commonwealth of the Northern Mariana Is-
lands, the United States Virgin Islands, Puerto Rico, and 
Hawaii. In preparing such report, the Secretary shall— 
‘‘(1) consult with and obtain information on all 
health care facilities needs from the entities de-
scribed in subsection (b); 
‘‘(2) include all amounts of Federal assistance 
received by each entity in the preceding fiscal year; 
‘‘(3) review the total unmet needs of each juris-
diction for health care facilities, including needs for 
renovation and expansion of existing facilities; 
‘‘(4) include a strategic plan for addressing the 
needs of each jurisdiction identified in the report; 
and 
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‘‘(5) evaluate the effectiveness of the care pro-
vided by measuring patient outcomes and cost meas-
ures. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as necessary 
to carry out this section.’’. 
SEC. 412. REMOVING CITIZENSHIP AND IMMIGRATION BAR-
RIERS TO ACCESS TO AFFORDABLE HEALTH 
CARE UNDER THE ACA. 
(a) IN GENERAL.— 
(1) PREMIUM TAX CREDITS.—Section 36B of 
the Internal Revenue Code of 1986 is amended— 
(A) in subsection (c)(1)(B)— 
(i) by amending the subparagraph 
heading to read as follows: ‘‘SPECIAL RULE 
FOR
CERTAIN
INDIVIDUALS
INELIGIBLE 
FOR MEDICAID DUE TO STATUS’’, and 
(ii) in clause (ii), by striking ‘‘lawfully 
present in the United States, but’’ and in-
serting ‘‘who’’, and 
(B) by striking subsection (e). 
(2) COST-SHARING REDUCTIONS.—Section 1402 
of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18071) is amended by striking sub-
section (e). 
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nating paragraphs (2), (3), and (4) as paragraphs 
(1), (2), and (3), respectively. 
(2) Section 1312(f) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18032(f)) is 
amended— 
(A) in the subsection heading, by striking 
‘‘employers;’’ and all that follows through ‘‘resi-
dents’’; and 
(B) by striking paragraph (3). 
SEC. 413. STUDY ON THE UNINSURED. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’) shall— 
(1) conduct a study, in accordance with the 
standards under section 3101 of the Public Health 
Service Act (42 U.S.C. 300kk), on the demographic 
characteristics of the population of individuals who 
do not have health insurance coverage; and 
(2) predict, based on such study, the demo-
graphic characteristics of the population of individ-
uals who would remain without health insurance cov-
erage after the end of open enrollment or any special 
enrollment period. 
(b) REPORTING REQUIREMENTS.— 
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(1) IN GENERAL.—Not later than 12 months 
after the date of the enactment of this Act, the Sec-
retary shall submit to the Congress the results of 
the study under subsection (a)(1) and the prediction 
made under subsection (a)(2). 
(2) REPORTING OF DEMOGRAPHIC CHARACTER-
ISTICS.—The Secretary shall report the demographic 
characteristics under paragraphs (1) and (2) of sub-
section (a) on the basis of racial and ethnic group, 
and shall stratify the reporting on each racial and 
ethnic group by other demographic characteristics 
that can impact access to health insurance coverage, 
such as sexual orientation, gender identity, primary 
language, disability status, sex, socioeconomic sta-
tus, age group, and citizenship and immigration sta-
tus, in a manner consistent with title I of this Act. 
SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI-
TORIES. 
(a) ELIMINATION OF FUNDING LIMITATIONS FOR 
PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 
GUAM, THE COMMONWEALTH OF THE NORTHERN MAR-
IANA ISLANDS, AND AMERICAN SAMOA.— 
(1) IN GENERAL.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
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(A) in subsection (f), in the matter pre-
ceding paragraph (1), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; 
(B) in subsection (g)(2), in the matter pre-
ceding subparagraph (A)— 
(i) by striking ‘‘Notwithstanding sub-
section (f) and subject to and’’ and insert-
ing ‘‘Notwithstanding subsection (f) and 
subject to’’; and 
(ii) by striking ‘‘paragraphs (3) and 
(5)’’ and inserting ‘‘, paragraphs (3) and 
(5) of this subsection, and subsection (h)’’. 
(C) by adding at the end the following new 
subsection: 
‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER-
TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 
THE COMMONWEALTH OF THE NORTHERN MARIANA IS-
LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 
shall not apply to Puerto Rico, the United States Virgin 
Islands, Guam, the Commonwealth of the Northern Mar-
iana Islands, and American Samoa for any fiscal year 
after fiscal year 2015.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1903(u) of such Act (42 U.S.C. 1396c(u)) is amend-
ed by striking paragraph (4). 
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(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply beginning with fiscal 
year 2016. 
(b) PARITY IN FMAP.— 
(1) IN GENERAL.—Section 1905(b) of such Act 
(42 U.S.C. 1396d(b)) is amended by inserting after 
‘‘and American Samoa shall be 55 percent,’’ the fol-
lowing: ‘‘(except that, beginning with fiscal year 
2018, the Federal medical assistance percentage for 
Puerto Rico, the United States Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana 
Islands, and American Samoa shall be the Federal 
medical assistance percentage determined by the 
Secretary in consultation (for the United States Vir-
gin Islands, Guam, the Commonwealth of the North-
ern Mariana Islands, and American Samoa) with the 
Secretary of the Interior)’’. 
(2) 
2-FISCAL-YEAR
TRANSITION.—Notwith-
standing any other provision of law, during fiscal 
years 2016 and 2017, the Federal medical assist-
ance percentage established under section 1905(b) of 
the Social Security Act (42 U.S.C. 1396d(b)) for 
Puerto Rico, the United States Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana 
Islands, and American Samoa shall be the highest 
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such Federal medical assistance percentage applica-
ble to any of the 50 States or the District of Colum-
bia for the fiscal year involved. 
(3) PER CAPITA INCOME DATA.— 
(A) REPORT
TO
CONGRESS.—Not later 
than October 1, 2016, the Secretary of Health 
and Human Services shall submit to Congress 
a report that describes the per capita income 
data used to promulgate the Federal medical 
assistance percentage in the territories and how 
such data differ from the per capita income 
data used to promulgate Federal medical assist-
ance percentages for the 50 States and the Dis-
trict of Columbia. The report should include 
recommendations on how the Federal medical 
assistance percentages can be calculated for the 
territories to ensure parity with the 50 States 
and the District of Columbia. 
(B) APPLICATION.—Section 1101(a)(8)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1308(a)(8)(B)) is amended— 
(i) by striking ‘‘(other than Puerto 
Rico, the United States Virgin Islands, and 
Guam)’’ and inserting ‘‘(including Puerto 
Rico, the United States Virgin Islands, 
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Guam, the Commonwealth of the Northern 
Mariana Islands, and American Samoa)’’; 
and 
(ii) by inserting ‘‘(or, if such satisfac-
tory data are not available in the case of 
the United States Virgin Islands, Guam, 
the Northern Mariana Islands, or Amer-
ican Samoa, satisfactory data available 
from the Department of the Interior for 
the same period, or if such satisfactory 
data are not available in the case of Puerto 
Rico, satisfactory data available from the 
government of the Commonwealth of Puer-
to Rico for the same period)’’ after ‘‘De-
partment of Commerce’’. 
SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘, and be-
fore January 1, 2015’’ after ‘‘prior to such date)’’; 
and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2015 (with respect to periods 
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beginning on or after the date that is 42 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears in the first sentence.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. For purposes of determining an individual’s sta-
tus under section 1862(b)(1)(C) of the Social Security Act 
(42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 
(a), an individual who is within the coordinating period 
as of the date of enactment of this Act shall have that 
period extended to the full 42 months described in the last 
sentence of such section, as added by the amendment 
made by subsection (a)(2). 
SEC. 416. BORDER HEALTH GRANTS. 
(a) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State, public institution 
of higher education, local government, tribal government, 
nonprofit health organization, community health center, or 
community clinic receiving assistance under section 330 
of the Public Health Service Act (42 U.S.C. 254b), that 
is located in the border area. 
(b) AUTHORIZATION.—From funds appropriated 
under subsection (f), the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’), 
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acting through the United States members of the United 
States-Mexico Border Health Commission, shall award 
grants to eligible entities to address priorities and rec-
ommendations to improve the health of border area resi-
dents that are established by— 
(1) the United States members of the United 
States-Mexico Border Health Commission; 
(2) the State border health offices; and 
(3) the Secretary. 
(c) APPLICATION.—An eligible entity that desires a 
grant under subsection (b) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require. 
(d) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (b) shall use the grant funds 
for— 
(1) programs relating to— 
(A) maternal and child health; 
(B) primary care and preventative health; 
(C) public health and public health infra-
structure; 
(D) musculoskeletal health and obesity; 
(E) health education and promotion; 
(F) oral health; 
(G) mental and behavioral health; 
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(H) substance abuse; 
(I) health conditions that have a high prev-
alence in the border area; 
(J) medical and health services research; 
(K) workforce training and development; 
(L) 
community 
health 
workers 
or 
promotoras; 
(M) health care infrastructure problems in 
the border area (including planning and con-
struction grants); 
(N) health disparities in the border area; 
(O) environmental health; and 
(P) outreach and enrollment services with 
respect to Federal programs (including pro-
grams authorized under titles XIX and XXI of 
the Social Security Act (42 U.S.C. 1396 and 
1397aa)); and 
(2) other programs determined appropriate by 
the Secretary. 
(e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro-
vided to an eligible entity awarded a grant under sub-
section (b) shall be used to supplement and not supplant 
other funds available to the eligible entity to carry out the 
activities described in subsection (d). 
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(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$200,000,000 for fiscal year 2015, and such sums as may 
be necessary for each succeeding fiscal year. 
SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH 
CARE. 
(a) PART A.—Section 1818(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 
‘‘(B)’’ and all that follows through ‘‘under this section’’ 
and inserting ‘‘(B) an individual who is lawfully present 
in the United States’’. 
(b) PART B.—Section 1836(2) of the Social Security 
Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘(B)’’ 
and all that follows through ‘‘under this part’’ and insert-
ing ‘‘(B) an individual who is lawfully present in the 
United States’’. 
SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED BY URBAN INDIAN HEALTH CEN-
TERS. 
(a) IN GENERAL.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396(b)), 
as amended by section 415(c), is further amended by in-
serting ‘‘or are received through a program operated by 
an urban Indian organization through a grant or contract 
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under title V of such Act’’ after ‘‘(as defined in section 
4 of the Indian Health Care Improvement Act)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to medical assistance provided on 
or after the date of enactment of this Act. 
SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED TO A NATIVE HAWAIIAN THROUGH 
A FEDERALLY QUALIFIED HEALTH CENTER 
OR A NATIVE HAWAIIAN HEALTH CARE SYS-
TEM UNDER THE MEDICAID PROGRAM. 
(a) IN GENERAL.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 
as amended by section 419, is amended by inserting ‘‘; 
and, with respect to medical assistance provided to a Na-
tive Hawaiian (as defined in section 12(2) of the Native 
Hawaiian Health Care Improvement Act) through a feder-
ally qualified health center or a Native Hawaiian health 
care system (as defined in section 12(6) of such Act), 
whether directly, by referral, or under contract or other 
arrangement between such federally qualified health cen-
ter or Native Hawaiian health care system and another 
health care provider’’ before the period. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to medical assistance provided on 
or after the date of enactment of this Act. 
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214 
CHAPTER 2—EXPANSION OF ACCESS 
SEC. 421. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the awarding of grants to assist communities 
in mobilizing and organizing resources in support of effec-
tive and sustainable programs that will reduce or eliminate 
disparities in health and health care experienced by racial 
and ethnic minority individuals. 
(b) AUTHORITY TO AWARD GRANTS.—The Secretary 
of Health and Human Services, acting through the Ad-
ministrator of the Health Resources and Services Admin-
istration, shall award grants to eligible entities to assist 
in designing, implementing, and evaluating culturally and 
linguistically appropriate, science-based, and community- 
driven sustainable strategies to eliminate racial and ethnic 
health and health care disparities. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall— 
(1) represent a coalition— 
(A) whose principal purpose is to develop 
and implement interventions to reduce or elimi-
nate a health or health care disparity in a tar-
geted racial or ethnic minority group in the 
community served by the coalition; and 
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(A) a description of the targeted racial or 
ethnic populations in the community to be 
served under the grant; 
(B) a description of at least 1 health dis-
parity that exists in the racial or ethnic tar-
geted populations, including health issues such 
as infant mortality, breast and cervical cancer 
screening and management, musculoskeletal 
diseases and obesity, prostate cancer screening 
and management, cardiovascular disease, diabe-
tes, child and adult immunization levels, or 
other health priority areas as designated by the 
Secretary; and 
(C) a demonstration of a proven record of 
accomplishment of the coalition members in 
serving and working with the targeted commu-
nity. 
(d) SUSTAINABILITY.—The Secretary shall give pri-
ority to an eligible entity under this section if the entity 
agrees that, with respect to the costs to be incurred by 
the entity in carrying out the activities for which the grant 
was awarded, the entity (and each of the participating 
partners in the coalition represented by the entity) will 
maintain its expenditures of non-Federal funds for such 
activities at a level that is not less than the level of such 
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expenditures during the fiscal year immediately preceding 
the first fiscal year for which the grant is awarded. 
(e) NONDUPLICATION.—Funds provided through this 
grant program should supplement, not supplant, existing 
Federal funding, and the funds should not be used to du-
plicate the activities of the other health disparity grant 
programs in this Act. 
(f) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide any entity 
that receives a grant under this section with technical and 
other nonfinancial assistance necessary to meet the re-
quirements of this section. 
(g) DISSEMINATION.—The Secretary shall encourage 
and enable grantees to share best practices, evaluation re-
sults, and reports with communities not affiliated with 
grantees using the Internet, conferences, and other perti-
nent information regarding the projects funded by this 
section, including the outreach efforts of the Office of Mi-
nority Health and Health Disparity Elimination and the 
Centers for Disease Control and Prevention. 
(h) ADMINISTRATIVE
BURDENS.—The Secretary 
shall make every effort to minimize duplicative or unneces-
sary administrative burdens on grantees. 
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(i) DEFINITION.—In this section, the term ‘‘Sec-
retary’’ means the Secretary of Health and Human Serv-
ices. 
(j) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
SEC. 422. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 
(a) ELIMINATION OF ISOLATION TEST FOR COST- 
BASED AMBULANCE REIMBURSEMENT.— 
(1) IN
GENERAL.—Section 1834(l)(8) of the 
Social Security Act (42 U.S.C. 1395m(l)(8)) is 
amended— 
(A) in subparagraph (B)— 
(i) by striking ‘‘owned and’’; and 
(ii) by inserting ‘‘(including when 
such services are provided by the entity 
under an arrangement with the hospital)’’ 
after ‘‘hospital’’; and 
(B) by striking the comma at the end of 
subparagraph (B) and all that follows and in-
serting a period. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after January 1, 2015. 
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(b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 
TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 
REQUIREMENT.— 
(1) IN
GENERAL.—Section 1820(c)(2) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 
amended— 
(A) in subparagraph (B)(iii), by striking 
‘‘provides not more than’’ and inserting ‘‘sub-
ject to subparagraph (F), provides not more 
than’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 
LIMIT REQUIREMENT.— 
‘‘(i) IN GENERAL.—A State may elect 
to treat a facility, with respect to the des-
ignation of the facility for a cost-reporting 
period, as satisfying the requirement of 
subparagraph (B)(iii) relating to a max-
imum number of acute care inpatient beds 
if the facility elects, in accordance with a 
method specified by the Secretary and be-
fore the beginning of the cost reporting pe-
riod, to meet the requirement under clause 
(ii). 
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‘‘(ii) ALTERNATE
REQUIREMENT.— 
The requirement under this clause, with 
respect to a facility and a cost-reporting 
period, is that the total number of inpa-
tient bed days described in subparagraph 
(B)(iii) during such period will not exceed 
7,300. For purposes of this subparagraph, 
an individual who is an inpatient in a bed 
in the facility for a single day shall be 
counted as one inpatient bed day. 
‘‘(iii) WITHDRAWAL OF ELECTION.— 
The option described in clause (i) shall not 
apply to a facility for a cost-reporting pe-
riod if the facility (for any two consecutive 
cost-reporting periods during the previous 
5 cost-reporting periods) was treated under 
such option and had a total number of in-
patient bed days for each of such two cost- 
reporting periods that exceeded the num-
ber specified in such clause.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost-reporting peri-
ods beginning on or after the date of the enactment 
of this Act. 
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SEC. 423. ESTABLISHMENT OF RURAL COMMUNITY HOS-
PITAL (RCH) PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by section 
203(b)(1), is amended by adding at the end of the fol-
lowing new subsection: 
‘‘Rural Community Hospital; Rural Community Hospital 
Services 
‘‘(jjj)(1) The term ‘rural community hospital’ means 
a hospital (as defined in subsection (e)) that— 
‘‘(A) is located in a rural area (as defined in 
section 1886(d)(2)(D)) or treated as being so lo-
cated pursuant to section 1886(d)(8)(E); 
‘‘(B) subject to paragraph (2), has less than 51 
acute care inpatient beds, as reported in its most re-
cent cost report; 
‘‘(C) makes available 24-hour emergency care 
services; 
‘‘(D) subject to paragraph (3), has a provider 
agreement in effect with the Secretary and is open 
to the public as of January 1, 2010; and 
‘‘(E) applies to the Secretary for such designa-
tion. 
‘‘(2) For purposes of paragraph (1)(B), beds in a 
psychiatric or rehabilitation unit of the hospital which is 
a distinct part of the hospital shall not be counted. 
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‘‘(3) Paragraph (1)(D) shall not be construed to pro-
hibit any of the following from qualifying as a rural com-
munity hospital: 
‘‘(A) A replacement facility (as defined by the 
Secretary in regulations in effect on January 1, 
2012) with the same service area (as defined by the 
Secretary in regulations in effect on such date). 
‘‘(B) A facility obtaining a new provider num-
ber pursuant to a change of ownership. 
‘‘(C) A facility which has a binding written 
agreement with an outside, unrelated party for the 
construction, reconstruction, lease, rental, or financ-
ing of a building as of January 1, 2012. 
‘‘(4) Nothing in this subsection shall be construed as 
prohibiting a critical access hospital from qualifying as a 
rural community hospital if the critical access hospital 
meets the conditions otherwise applicable to hospitals 
under subsection (e) and section 1866. 
‘‘(5) Nothing in this subsection shall be construed as 
prohibiting a rural community hospital participating in 
the demonstration program under section 410A of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2313) from qualifying as a rural community hospital if 
the rural community hospital meets the conditions other-
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wise applicable to hospitals under subsection (e) and sec-
tion 1866.’’. 
(b) PAYMENT.— 
(1) INPATIENT
HOSPITAL
SERVICES.—Section 
1814 of the Social Security Act (42 U.S.C. 1395f) 
is amended by adding at the end the following new 
subsection: 
‘‘Payment for Inpatient Services Furnished in Rural 
Community Hospitals 
‘‘(m) The amount of payment under this part for in-
patient hospital services furnished in a rural community 
hospital, other than such services furnished in a psy-
chiatric or rehabilitation unit of the hospital which is a 
distinct part, is, at the election of the hospital in the appli-
cation referred to in section 1861(jjj)(1)(E)— 
‘‘(1) 101 percent of the reasonable costs of pro-
viding such services, without regard to the amount 
of the customary or other charge, or 
‘‘(2) the amount of payment provided for under 
the prospective payment system for inpatient hos-
pital services under section 1886(d).’’. 
(2) OUTPATIENT SERVICES.—Section 1834 of 
such Act (42 U.S.C. 1395m) is amended by adding 
at the end the following new subsection: 
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‘‘(p) PAYMENT FOR OUTPATIENT SERVICES FUR-
NISHED
IN
RURAL
COMMUNITY
HOSPITALS.—The 
amount of payment under this part for outpatient services 
furnished in a rural community hospital is, at the election 
of the hospital in the application referred to in section 
1861(jjj)(1)(E)— 
‘‘(1) 101 percent of the reasonable costs of pro-
viding such services, without regard to the amount 
of the customary or other charge and any limitation 
under section 1861(v)(1)(U), or 
‘‘(2) the amount of payment provided for under 
the prospective payment system for covered OPD 
services under section 1833(t).’’. 
(3) EXEMPTION FROM 30-PERCENT REDUCTION 
IN
REIMBURSEMENT
FOR
BAD
DEBT.—Section 
1861(v)(1)(T) 
of 
such 
Act 
(42 
U.S.C. 
1395x(v)(1)(T)) is amended by inserting ‘‘(other 
than for a rural community hospital)’’ after ‘‘In de-
termining such reasonable costs for hospitals’’. 
(c) BENEFICIARY COST-SHARING FOR OUTPATIENT 
SERVICES.—Section 1834(p) of such Act (as added by 
subsection (b)(2)) is amended— 
(1) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively; 
(2) by inserting ‘‘(1)’’ after ‘‘(p)’’; and 
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(3) by adding at the end the following: 
‘‘(2) The amounts of beneficiary cost-sharing for out-
patient services furnished in a rural community hospital 
under this part shall be as follows: 
‘‘(A) For items and services that would have 
been paid under section 1833(t) if provided by a 
hospital, the amount of cost-sharing determined 
under paragraph (8) of such section. 
‘‘(B) For items and services that would have 
been paid under section 1833(h) if furnished by a 
provider or supplier, no cost-sharing shall apply. 
‘‘(C) For all other items and services, the 
amount of cost-sharing that would apply to the item 
or service under the methodology that would be used 
to determine payment for such item or service if pro-
vided by a physician, provider, or supplier, as the 
case may be.’’. 
(d) CONFORMING AMENDMENTS.— 
(1) PART
A
PAYMENT.—Section 1814(b) of 
such Act (42 U.S.C. 1395f(b)) is amended in the 
matter preceding paragraph (1) by inserting ‘‘other 
than inpatient hospital services furnished by a rural 
community hospital,’’ after ‘‘critical access hospital 
services,’’. 
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(2) PART
B
PAYMENT.—Section 1833(a) of 
such Act (42 U.S.C. 1395l(a)), as amended by sec-
tion 203(b)(2), is amended— 
(A) in paragraph (2), in the matter before 
subparagraph (A), by striking ‘‘and (I)’’ and in-
serting ‘‘(I), and (K)’’; 
(B) by striking ‘‘and’’ at the end of para-
graph (9); 
(C) by striking the period at the end of 
paragraph (10) and inserting ‘‘; and’’; and 
(D) by adding at the end the following: 
‘‘(11) in the case of outpatient services fur-
nished by a rural community hospital, the amounts 
described in section 1834(p).’’. 
(3) TECHNICAL AMENDMENTS.— 
(A) CONSULTATION
WITH
STATE
AGEN-
CIES.—Section 1863 of such Act (42 U.S.C. 
1395z) is amended by striking ‘‘and (dd)(2)’’ 
and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 
(B) 
PROVIDER
AGREEMENTS.—Section 
1866(a)(2)(A) 
of 
such 
Act 
(42 
U.S.C. 
1395cc(a)(2)(A)) is amended by inserting ‘‘sec-
tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 
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(A) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during pregnancy 
that may be associated with birth defects or 
other health risks, such as exposures to medica-
tions, chemicals, infections, foodborne patho-
gens, illnesses, nutrition, or lifestyle factors; 
(B) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during breast-
feeding that may be associated with health risks 
to a breast-fed infant, such as exposures to 
medications, chemicals, infections, foodborne 
pathogens, illnesses, nutrition, or lifestyle fac-
tors; 
(C) the provision of accurate, evidence- 
based information weighing risks of exposures 
during breastfeeding against the benefits of 
breastfeeding; and 
(D) the provision of information described 
in subparagraph (A), (B), or (C) through coun-
selors, Web sites, fact sheets, telephonic or elec-
tronic communication, community outreach ef-
forts, or other appropriate means. 
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‘‘(B) factors affecting the risk for youth of 
unintended teenage pregnancy or dating vio-
lence, including the physical and social environ-
ment, level of acculturation, access to health 
care, aspirations for the future, and history of 
physical or sexual violence or abuse; 
‘‘(C) the role that violence and abuse play 
in teenage sex, pregnancy, and childbearing; 
‘‘(D) strategies to address the dispropor-
tionate rates of unintended teenage pregnancies 
and dating violence in racial or ethnic minority 
or immigrant communities; 
‘‘(E) how effective interventions can be 
replicated or adapted in other settings to serve 
racial or ethnic minority or immigrant commu-
nities in a culturally appropriate manner; and 
‘‘(F) the effectiveness of media campaigns 
in addressing healthy relationship development, 
dating violence prevention, and unintended 
teenage pregnancy; and 
‘‘(3) tests research-based strategies for address-
ing high rates of unintended teenage pregnancy 
through programs that emphasize healthy relation-
ships and violence prevention. 
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grant funds to carry out demonstration projects de-
scribed in paragraph (1), including— 
‘‘(A) expanding community-based health 
promotion education, activities, and incentives 
focused on the prevention of gestational diabe-
tes and development of type 2 diabetes in 
women with a history of gestational diabetes; 
‘‘(B) aiding State- and tribal-based diabe-
tes prevention and control programs to collect, 
analyze, disseminate, and report surveillance 
data on women with, and at risk for, gesta-
tional diabetes, the recurrence of gestational di-
abetes in subsequent pregnancies, and, for 
women with a history of gestational diabetes, 
the development of type 2 diabetes; and 
‘‘(C) training and encouraging health care 
providers— 
‘‘(i) to promote risk assessment, high- 
quality care, and self-management for ges-
tational diabetes and the recurrence of ges-
tational diabetes in subsequent preg-
nancies; and 
‘‘(ii) to prevent the development of 
type 2 diabetes in women with a history of 
gestational diabetes, and its complications 
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‘‘(v) is provided without regard to the 
ability of the individual or her family to 
pay costs associated with the provision of 
such information to the individual. 
‘‘(B) Prompt offer to provide emergency 
contraception to the individual, and in the case 
that the individual accepts such offer, prompt 
provision of such contraception to such indi-
vidual without regard to the inability of the in-
dividual or her family to pay costs associated 
with the offer and provision of such contracep-
tion. 
‘‘(3) DEFINITIONS.—For purposes of this para-
graph: 
‘‘(A) The term ‘emergency contraception’ 
means a drug or device (as such terms are de-
fined in section 201 of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 321)) or a drug 
regimen that— 
‘‘(i) is used postcoitally; 
‘‘(ii) prevents pregnancy primarily by 
preventing or delaying ovulation, and does 
not terminate an established pregnancy; 
and 
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