660 
and at least one representative of a minority-serving 
institution.’’ after ‘‘ ‘and of Federal officials.’’; and 
(2) by inserting ‘‘and shall determine the de-
gree to which such center provides outreach and as-
sistance to providers predominantly serving racial 
and ethnic minority groups (as defined in section 
1707(g))’’ after ‘‘specified in paragraph (3)’’. 
SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE-
VELOPMENT OF LOAN PROGRAMS TO FACILI-
TATE ADOPTION OF CERTIFIED EHR TECH-
NOLOGY BY PROVIDERS SERVING RACIAL 
AND ETHNIC MINORITY GROUPS. 
Section 3014(e) of the Public Health Service Act (42 
U.S.C. 300jj–34(e)) is amended— 
(1) in paragraph (3), by striking at the end 
‘‘or’’; 
(2) in paragraph (4), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(5) carry out any of the activities described in 
a previous paragraph of this subsection with respect 
to communities with a high proportion of individuals 
from racial and ethnic minority groups (as defined 
in section 1707(g)).’’. 
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SEC. 814. AUTHORIZATION OF APPROPRIATIONS. 
Section 3018 of the Public Health Service Act (42 
U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 
2009 through 2013’’ and inserting ‘‘fiscal years 2014 
through 2021’’. 
Subtitle C—Additional Research 
and Studies 
SEC. 831. DATA COLLECTION AND ASSESSMENTS CON-
DUCTED IN COORDINATION WITH MINORITY- 
SERVING INSTITUTIONS. 
Section 3001(c)(6) of the Public Health Service Act 
(42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 
end the following new subparagraph: 
‘‘(F) DATA
COLLECTION
AND
ASSESS-
MENTS
CONDUCTED
IN
COORDINATION
WITH 
MINORITY-SERVING INSTITUTIONS.— 
‘‘(i) IN
GENERAL.—In carrying out 
subparagraph (C) with respect to commu-
nities with a high proportion of individuals 
from racial and ethnic minority groups (as 
defined in section 1707(g)), the National 
Coordinator shall, to the greatest extent 
possible, coordinate with an entity de-
scribed in clause (ii). 
‘‘(ii) 
MINORITY-SERVING
INSTITU-
TIONS.—For purposes of clause (i), an en-
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tity described in this clause is a historically 
Black college or university, a Hispanic- 
serving institution, a tribal college or uni-
versity, or an Asian-American-, Native 
American-, and Pacific Islander-serving in-
stitution with an accredited public health, 
health policy, or health services research 
program.’’. 
SEC. 832. STUDY OF HEALTH INFORMATION TECHNOLOGY 
IN 
MEDICALLY 
UNDERSERVED 
COMMU-
NITIES. 
(a) IN GENERAL.—Not later than 24 months after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall— 
(1) enter into an agreement with the Institute 
of Medicine of the National Academies (or, if the In-
stitute of Medicine declines, another appropriate 
public or nonprofit private entity) to conduct a study 
on the development, implementation, and effective-
ness of health information technology within medi-
cally underserved areas (as described in subsection 
(c)); and 
(2) submit a report to Congress describing the 
results of such study, including any recommenda-
tions for legislative or administrative action. 
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(b) STUDY.—The study described in subsection 
(a)(1) shall— 
(1) identify barriers to successful implementa-
tion of health information technology in medically 
underserved areas; 
(2) examine the impact of health information 
technology on providing quality care and reducing 
the cost of care to individuals in such areas, includ-
ing the impact of such technology on improved 
health outcomes for individuals, including which 
technology worked for which population and how it 
improved health outcomes for that population; 
(3) examine the impact of health information 
technology on improving health-care-related deci-
sions by both patients and providers in such areas; 
(4) identify specific best practices for using 
health information technology to foster the con-
sistent provision of physical accessibility and reason-
able policy accommodations in health care to individ-
uals with disabilities in such areas; 
(5) assess the feasibility and costs associated 
with the use of health information technology in 
such areas; 
(6) evaluate whether the adoption and use of 
qualified electronic health records (as described in 
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section 3000(13) of the Public Health Service Act 
(42 U.S.C. 300jj(13)) is effective in reducing health 
disparities, including analysis of clinical quality 
measures reported by Medicare and Medicaid pro-
viders pursuant to programs to encourage the adop-
tion and use of certified EHR technology; 
(7) identify providers in medically underserved 
areas that are not electing to adopt and use elec-
tronic health records and determine what barriers 
are preventing those providers from adopting and 
using such records; and 
(8) examine urban and rural community health 
systems and determine the impact that health infor-
mation technology may have on the capacity of pri-
mary health providers in those systems. 
(c) MEDICALLY UNDERSERVED AREA.—The term 
‘‘medically underserved area’’ means— 
(1) a population that has been designated as a 
medically underserved population under section 
330(b)(3) of the Public Health Service Act (42 
U.S.C. 254b(b)(3)); 
(2) an area that has been designated as a 
health professional shortage area under section 332 
of the Public Health Service Act (42 U.S.C. 254e); 
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(3) an area or population that has been des-
ignated as a medically underserved community under 
section 799B(6) of the Public Health Service Act 
(42 U.S.C. 295p(6)); or 
(4) an area or population that— 
(A) is not described in paragraphs (1) 
through (3) of this subsection; 
(B) experiences significant barriers to ac-
cessing quality health services; and 
(C) has a high prevalence of diseases or 
conditions described in title VII of this Act, 
with such diseases or conditions having a dis-
proportionate impact on racial and ethnic mi-
nority groups (as defined in section 1707(g) of 
the Public Health Service Act (42 U.S.C. 300u- 
6(g))) or a subgroup of people with disabilities 
who have specific functional impairments. 
Subtitle D—Closing Gaps in 
Funding To Adopt Certified EHRs 
SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS 
TO HOSPITALS IN PUERTO RICO. 
(a) IN GENERAL.—Subsection (n)(6)(B) of section 
1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended by striking ‘‘subsection (d) hospital’’ and insert-
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SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAY-
MENTS 
TO 
REHABILITATION 
FACILITIES, 
LONG-TERM CARE FACILITIES, AND HOME 
HEALTH AGENCIES. 
Section 1903(t)(2)(B) of the Social Security Act (42 
U.S.C. 1396b(t)(2)(B)) is amended— 
(1) in clause (i), by striking ‘‘, or’’ and insert-
ing a semicolon; 
(2) in clause (ii), by striking the period at the 
end and inserting a semicolon; and 
(3) by inserting after clause (ii) the following 
new clauses: 
‘‘(iii) a rehabilitation facility (as defined in 
section 1886(j)(1)) that furnishes acute or 
subacute rehabilitation services; 
‘‘(iv) a long-term care hospital (as defined 
in section 1886(d)(1)(B)(iv)(I)); or 
‘‘(v) a home health agency (as defined in 
section 1861(o)).’’. 
SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 
FOR 
MEDICAID 
ELECTRONIC 
HEALTH 
RECORD INCENTIVE PAYMENTS. 
(a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 
Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 
amended to read as follows: 
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‘‘(v) physician assistant, in the case 
that the assistant is a primary care pro-
vider, including an assistant who practices 
in a rural health clinic that is led by a phy-
sician assistant or practices in a federally 
qualified health center that is so led.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to amounts ex-
pended under section 1903(a)(3)(F) of the Social Security 
Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be-
ginning on or after the date of the enactment of this Act. 
TITLE IX—ACCOUNTABILITY 
AND EVALUATION 
SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 
ASSISTED HEALTH CARE SERVICES AND RE-
SEARCH PROGRAMS ON THE BASIS OF SEX, 
RACE, COLOR, NATIONAL ORIGIN, MARITAL 
STATUS, FAMILIAL STATUS, SEXUAL ORI-
ENTATION, 
GENDER 
IDENTITY, 
OR 
DIS-
ABILITY STATUS. 
(a) IN GENERAL.—No person in the United States 
shall, on the basis of sex, race, color, national origin, mar-
ital status, familial status, sexual orientation, gender iden-
tity, or disability status, be excluded from participation 
in, be denied the benefits of, or be subjected to discrimina-
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tion under any health program or activity, including any 
health research program or activity, receiving Federal fi-
nancial assistance. 
(b) DEFINITION.—In this section, the term ‘‘familial 
status’’ means, with respect to one or more individuals— 
(1) being domiciled with any individual related 
by blood or affinity whose close association with the 
individual is the equivalent of a family relationship; 
(2) being in the process of securing legal cus-
tody of any individual; or 
(3) being pregnant. 
SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 
A payment to a provider of services, physician, or 
other supplier under part B, C, or D of title XVIII of 
the Social Security Act shall be deemed a grant, and not 
a contract of insurance or guaranty, for the purposes of 
title VI of the Civil Rights Act of 1964. 
SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 
THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES. 
Title XXXIV of the Public Health Service Act, as 
amended by titles I, II, and III of this Act, is further 
amended by inserting after subtitle B the following: 
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‘‘Subtitle C—Strengthening 
Accountability 
‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
within the Office for Civil Rights an Office of Health Dis-
parities, which shall be headed by a director to be ap-
pointed by the Secretary. 
‘‘(b) PURPOSE.—The Office of Health Disparities 
shall ensure that the health programs, activities, and oper-
ations of health entities which receive Federal financial as-
sistance are in compliance with title VI of the Civil Rights 
Act, which prohibits discrimination on the basis of race, 
color, or national origin. The activities of the Office shall 
include the following: 
‘‘(1) The development and implementation of 
an action plan to address racial and ethnic health 
care disparities, which shall address concerns relat-
ing to the Office for Civil Rights as released by the 
United States Commission on Civil Rights in the re-
port entitled ‘Health Care Challenge: Acknowledging 
Disparity, Confronting Discrimination, and Ensur-
ing Equity’ (September 1999) in conjunction with 
the reports by the Institute of Medicine entitled ‘Un-
equal Treatment: Confronting Racial and Ethnic 
Disparities in Health Care’, ‘Crossing the Quality 
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Chasm: A New Health System for the 21st Cen-
tury’, ‘In the Nation’s Compelling Interest: Ensur-
ing Diversity in the Health Care Workforce’, ‘The 
National Partnership for Action to End Health Dis-
parities’, and ‘The Health of Lesbian, Gay, Bisexual, 
and Transgender People’, and other related reports 
by the Institute of Medicine. This plan shall be pub-
licly disclosed for review and comment and the final 
plan shall address any comments or concerns that 
are received by the Office. 
‘‘(2) Investigative and enforcement actions 
against intentional discrimination and policies and 
practices that have a disparate impact on minorities. 
‘‘(3) The review of racial, ethnic, gender iden-
tity, sexual orientation, sex, disability status, socio-
economic status, and primary language health data 
collected by Federal health agencies to assess health 
care disparities related to intentional discrimination 
and policies and practices that have a disparate im-
pact on minorities. 
‘‘(4) Outreach and education activities relating 
to compliance with title VI of the Civil Rights Act. 
‘‘(5) The provision of technical assistance for 
health entities to facilitate compliance with title VI 
of the Civil Rights Act. 
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‘‘(6) Coordination and oversight of activities of 
the civil rights compliance offices established under 
section 3442. 
‘‘(7) Ensuring— 
‘‘(A) at a minimum, compliance with the 
1997 Office of Management and Budget Stand-
ards for Maintaining, Collecting, and Pre-
senting Federal Data on Race and Ethnicity; 
and 
‘‘(B) consideration of available data and 
language standards such as— 
‘‘(i) the standards for collecting and 
reporting data under section 3101; and 
‘‘(ii) the National Standards on Cul-
turally 
and 
Linguistically 
Appropriate 
Services of the Office of Minority Health 
within the Department of Health and 
Human Services. 
‘‘(c) FUNDING AND STAFF.—The Secretary shall en-
sure the effectiveness of the Office of Health Disparities 
by ensuring that the Office is provided with— 
‘‘(1) adequate funding to enable the Office to 
carry out its duties under this section; and 
‘‘(2) staff with expertise in— 
‘‘(A) epidemiology; 
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‘‘(B) statistics; 
‘‘(C) health quality assurance; 
‘‘(D) minority health and health dispari-
ties; 
‘‘(E) cultural and linguistic competency; 
‘‘(F) civil rights; and 
‘‘(G) social, behavioral, and economic de-
terminants of health. 
‘‘(d) REPORT.—Not later than December 31, 2015, 
and annually thereafter, the Secretary, in collaboration 
with the Director of the Office for Civil Rights and the 
Deputy Assistant Secretary for Minority Health, shall 
submit a report to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives 
that includes— 
‘‘(1) the number of cases filed, broken down by 
category; 
‘‘(2) the number of cases investigated and 
closed by the office; 
‘‘(3) the outcomes of cases investigated; 
‘‘(4) the staffing levels of the office including 
staff credentials; 
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‘‘(5) the number of other lingering and emerg-
ing cases in which civil rights inequities can be dem-
onstrated; and 
‘‘(6) the number of cases remaining open and 
an explanation for their open status. 
‘‘(e) 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. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF-
FICES FOR CIVIL RIGHTS WITHIN FEDERAL 
HEALTH AND HUMAN SERVICES AGENCIES. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
civil rights compliance offices in each agency within the 
Department of Health and Human Services that admin-
isters health programs. 
‘‘(b) PURPOSE OF OFFICES.—Each office established 
under subsection (a) shall ensure that recipients of Fed-
eral financial assistance under Federal health programs 
administer their programs, services, and activities in a 
manner that— 
‘‘(1) does not discriminate, either intentionally 
or in effect, on the basis of race, national origin, lan-
guage, ethnicity, sex, age, disability, sexual orienta-
tion, and gender identity; and 
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‘‘(2) promotes the reduction and elimination of 
disparities in health and health care based on race, 
national origin, language, ethnicity, sex, age, dis-
ability, sexual orientation, and gender identity. 
‘‘(c) POWERS AND DUTIES.—The offices established 
in subsection (a) shall have the following powers and du-
ties: 
‘‘(1) The establishment of compliance and pro-
gram participation standards for recipients of Fed-
eral financial assistance under each program admin-
istered by an agency within the Department of 
Health and Human Services including the establish-
ment of disparity reduction standards to encompass 
disparities in health and health care related to race, 
national origin, language, ethnicity, sex, age, dis-
ability, sexual orientation, and gender identity. 
‘‘(2) The development and implementation of 
program-specific guidelines that interpret and apply 
Department of Health and Human Services guid-
ance under title VI of the Civil Rights Act of 1964 
and section 1557 of the Patient Protection and Af-
fordable Care Act to each Federal health program 
administered by the agency. 
‘‘(3) The development of a disparity-reduction 
impact analysis methodology that shall be applied to 
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every rule issued by the agency and published as 
part of the formal rulemaking process under sections 
555, 556, and 557 of title 5, United States Code. 
‘‘(4) Oversight of data collection, analysis, and 
publication requirements for all recipients of Federal 
financial assistance under each Federal health pro-
gram administered by the agency; compliance with, 
at a minimum, the 1997 Office of Management and 
Budget Standards for Maintaining, Collecting, and 
Presenting Federal Data on Race and Ethnicity; and 
consideration of available data and language stand-
ards such as— 
‘‘(A) the standards for collecting and re-
porting data under section 3101; and 
‘‘(B) the National Standards on Culturally 
and Linguistically Appropriate Services of the 
Office of Minority Health within the Depart-
ment of Health and Human Services. 
‘‘(5) The conduct of publicly available studies 
regarding discrimination within Federal health pro-
grams administered by the agency as well as dis-
parity reduction initiatives by recipients of Federal 
financial assistance under Federal health programs. 
‘‘(6) Annual reports to the Committee on 
Health, Education, Labor, and Pensions and the 
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Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce and the Committee 
on Ways and Means of the House of Representatives 
on the progress in reducing disparities in health and 
health care through the Federal programs adminis-
tered by the agency. 
‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 
IN THE DEPARTMENT OF JUSTICE.— 
‘‘(1) DEPARTMENT
OF
HEALTH
AND
HUMAN 
SERVICES.—The Office for Civil Rights in the De-
partment of Health and Human Services shall pro-
vide standard-setting and compliance review inves-
tigation support services to the Civil Rights Compli-
ance Office for each agency. 
‘‘(2) DEPARTMENT
OF
JUSTICE.—The Office 
for Civil Rights in the Department of Justice shall 
continue to maintain the power to institute formal 
proceedings when an agency Office for Civil Rights 
determines that a recipient of Federal financial as-
sistance is not in compliance with the disparity re-
duction standards of the agency. 
‘‘(e) DEFINITION.—In this section, the term ‘Federal 
health programs’ mean programs— 
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‘‘(1) under the Social Security Act (42 U.S.C. 
301 et seq.) that pay for health care and services; 
and 
‘‘(2) under this Act that provide Federal finan-
cial assistance for health care, biomedical research, 
health services research, and programs designed to 
improve the public’s health, including health service 
programs.’’. 
SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 
(a) COORDINATION WITHIN DEPARTMENT OF JUS-
TICE
OF
ACTIVITIES
REGARDING
HEALTH
DISPARI-
TIES.—Section 3(a) of the Civil Rights Commission Act 
of 1983 (42 U.S.C. 1975a(a)) is amended— 
(1) in paragraph (1), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (2), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(3) shall, with respect to activities carried out 
in health care and correctional facilities toward the 
goal of eliminating health disparities between the 
general population and members of racial or ethnic 
minority groups, coordinate such activities of— 
‘‘(A) the Office for Civil Rights within the 
Department of Justice; 
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‘‘(B) the Office of Justice Programs within 
the Department of Justice; 
‘‘(C) the Office for Civil Rights within the 
Department of Health and Human Services; 
and 
‘‘(D) the Office of Minority Health within 
the Department of Health and Human Services 
(headed by the Deputy Assistant Secretary for 
Minority Health).’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 
1975c) is amended by striking the first sentence and in-
serting the following: ‘‘For the purpose of carrying out 
this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2015, and such sums as may 
be necessary for each of the fiscal years 2016 through 
2020.’’. 
SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND-
ING OF ACTIVITIES TO ELIMINATE RACIAL 
AND ETHNIC HEALTH DISPARITIES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) The health status of the American populace 
is declining and the United States currently ranks 
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below most industrialized nations in health status 
measured by longevity, sickness, and mortality. 
(2) Racial and ethnic minority populations tend 
have the poorest health status and face substantial 
cultural, social, and economic barriers to obtaining 
quality health care. 
(3) Lesbian, gay, bisexual and transgender 
(LGBT) populations experience significant personal 
and structural barriers to obtaining high-quality 
health care. 
(4) Efforts to improve minority health have 
been limited by inadequate resources (funding, staff-
ing, and stewardship) and lack of accountability. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) funding should be doubled by fiscal year 
2016 for the National Institute for Minority Health 
Disparities, the Office of Civil Rights in the Depart-
ment of Health and Human Services, the National 
Institute of Nursing Research, and the Office of Mi-
nority Health; 
(2) adequate funding by fiscal year 2016, and 
subsequent funding increases, should be provided for 
health and human service professions training pro-
grams, the Racial and Ethnic Approaches to Com-
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munity Health (REACH) Initiative at the Centers 
for Disease Control and Prevention, the Minority 
HIV/AIDS Initiative, and the Excellence Centers to 
Eliminate Ethnic/Racial Disparities (EXCEED) 
Program at the Agency for Healthcare Research and 
Quality; 
(3) funding should be fully restored to the Ra-
cial and Ethnic Approaches to Community Health 
(REACH) Initiative at the Centers for Disease Con-
trol and Prevention, which has been a successful 
program at the community health level, and efforts 
should continue to place a strong emphasis on build-
ing community capacity to secure financial resources 
and technical assistance to eliminate health dispari-
ties; 
(4) adequate funding for fiscal year 2016 and 
increased funding for future years should be pro-
vided for the REACH Initiative’s United States Risk 
Factor Survey to ensure adequate data collection to 
track health disparities, and there should be appro-
priate avenues provided to disseminate findings to 
the general public; 
(5) current and newly created health disparity 
elimination incentives, programs, agencies, and de-
partments under this Act (and the amendments 
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made by this Act) should receive adequate staffing 
and funding by fiscal year 2016; and 
(6) stewardship and accountability should be 
provided to the Congress and the President for 
measurable and sustainable progress toward health 
disparity elimination. 
SEC. 906. GAO AND NIH REPORTS. 
(a) GAO REPORT ON NIH GRANT RACIAL AND ETH-
NIC DIVERSITY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study on the racial 
and ethnic diversity among the following groups: 
(A) All applicants for grants, contracts, 
and cooperative agreements awarded by the Na-
tional Institutes of Health during the period be-
ginning on January 1, 1990, and ending De-
cember 31, 2013. 
(B) All recipients of such grants, con-
tracts, and cooperative agreements. 
(C) All members of the peer review panels 
of such applicants and recipients, respectively. 
(2) REPORT.—Not later than six months after 
the date of the enactment of this Act, the Comp-
troller General shall complete the study under para-
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