I 
113TH CONGRESS 
2D SESSION 
H. R. 5294 
To improve the health of minority individuals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 30, 2014 
Ms. ROYBAL-ALLARD (for herself, Ms. LEE of California, Mrs. CHRISTENSEN, 
Ms. BORDALLO, Ms. BROWN of Florida, Mr. BUTTERFIELD, Ms. CHU, 
Ms. CLARKE of New York, Mr. CA´RDENAS, Mr. CARSON of Indiana, Ms. 
CASTOR of Florida, Mr. CONYERS, Mr. CROWLEY, Mr. CUMMINGS, Mr. 
DANNY K. DAVIS of Illinois, Ms. DEGETTE, Ms. DELAURO, Ms. 
EDWARDS, Mr. ELLISON, Mr. FALEOMAVAEGA, Mr. FARR, Mr. FATTAH, 
Ms. FUDGE, Mr. GARCIA, Mr. GRIJALVA, Ms. MICHELLE LUJAN GRIS-
HAM of New Mexico, Mr. GUTIE´RREZ, Ms. HAHN, Mr. HINOJOSA, Mr. 
HONDA, Ms. JACKSON LEE, Ms. EDDIE BERNICE JOHNSON of Texas, 
Mr. JOHNSON of Georgia, Mr. LEWIS, Ms. LOFGREN, Mrs. LOWEY, Mr. 
BEN RAY LUJA´N of New Mexico, Ms. MATSUI, Ms. MCCOLLUM, Mr. 
MCGOVERN, Mrs. NEGRETE MCLEOD, Mr. MEEKS, Ms. MENG, Mrs. 
NAPOLITANO, Ms. NORTON, Mr. PASTOR of Arizona, Mr. PIERLUISI, Mr. 
RANGEL, Mr. RICHMOND, Mr. RUSH, Mr. SABLAN, Ms. LINDA T. 
SA´NCHEZ of California, Ms. LORETTA SANCHEZ of California, Ms. SCHA-
KOWSKY, Mr. SCHIFF, Mr. DAVID SCOTT of Georgia, Mr. SCOTT of Vir-
ginia, Mr. SERRANO, Mr. SIRES, Ms. SLAUGHTER, Mr. TAKANO, Mr. 
TONKO, Mr. VARGAS, Mr. VELA, Ms. VELA´ZQUEZ, and Ms. WATERS) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Ways and 
Means, Agriculture, Education and the Workforce, the Budget, Veterans’ 
Affairs, Armed Services, the Judiciary, and Natural Resources, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
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A BILL 
To improve the health of minority individuals, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Accountability Act of 2014’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
Sec. 3. Findings. 
TITLE I—DATA COLLECTION AND REPORTING 
Sec. 101. Amendment to the Public Health Service Act. 
Sec. 102. Elimination of prerequisite of direct appropriations for data collection 
and analysis. 
Sec. 103. Collection of race and ethnicity data by the Social Security Adminis-
tration. 
Sec. 104. Revision of HIPAA claims standards. 
Sec. 105. National Center for Health Statistics. 
Sec. 106. Oversampling of Asian-Americans, Native Hawaiians, or Pacific Is-
landers and other underrepresented groups in Federal health 
surveys. 
Sec. 107. Geo-access study. 
Sec. 108. Racial, ethnic, and primary language data collected by the Federal 
Government. 
Sec. 109. Data collection and analysis grants to minority-serving institutions. 
Sec. 110. Standards for measuring sexual orientation and gender identity in 
collection of health data. 
Sec. 111. Standards for measuring socioeconomic status in collection of health 
data. 
Sec. 112. Safety and effectiveness of drugs with respect to racial and ethnic 
background. 
Sec. 113. Improving health data regarding Native Hawaiians and other Pacific 
Islanders. 
Sec. 114. Clarification of simplified administrative reporting requirement. 
TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 
HEALTH CARE 
Sec. 201. Definitions. 
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Sec. 202. Amendment to the Public Health Service Act. 
Sec. 203. Pilot program for improvement and development of State medical in-
terpreting services. 
Sec. 204. Training tomorrow’s doctors for culturally and linguistically appro-
priate care: graduate medical education. 
Sec. 205. Federal reimbursement for culturally and linguistically appropriate 
services under the Medicare, Medicaid, and State Children’s 
Health Insurance Programs. 
Sec. 206. Increasing understanding of and improving health literacy. 
Sec. 207. Assurances for receiving Federal funds. 
Sec. 208. Report on Federal efforts to provide culturally and linguistically ap-
propriate health care services. 
Sec. 209. English for speakers of other languages. 
Sec. 210. Implementation. 
Sec. 211. Language access services. 
TITLE III—HEALTH WORKFORCE DIVERSITY 
Sec. 301. Amendment to the Public Health Service Act. 
Sec. 302. Hispanic-serving health professions schools. 
Sec. 303. Loan repayment program of Centers for Disease Control and Preven-
tion. 
Sec. 304. Cooperative agreements for online degree programs at schools of pub-
lic health and schools of allied health. 
Sec. 305. Sense of Congress on the mission of the National Health Care Work-
force Commission. 
Sec. 306. Scholarship and fellowship programs. 
Sec. 307. McNair Postbaccalaureate Achievement Program. 
Sec. 308. Rules for determination of full-time equivalent residents for cost-re-
porting periods. 
Sec. 309. Developing and implementing strategies for local health equity. 
Sec. 310. Loan forgiveness for mental and behavioral health social workers. 
Sec. 311. Health Professions Workforce Fund. 
Sec. 312. Findings; sense of Congress relating to graduate medical education. 
Sec. 313. Career support for skilled internationally educated health profes-
sionals. 
TITLE IV—IMPROVEMENT OF HEALTH CARE SERVICES 
Subtitle A—Health Empowerment Zones 
Sec. 401. Short title. 
Sec. 402. Findings. 
Sec. 403. Designation of health empowerment zones. 
Sec. 404. Assistance to those seeking designation. 
Sec. 405. Benefits of designation. 
Sec. 406. Definition. 
Sec. 407. Authorization of appropriations. 
Subtitle B—Other Improvements of Health Care Services 
CHAPTER 1—EXPANSION OF COVERAGE 
Sec. 411. Amendment to the Public Health Service Act. 
Sec. 412. Removing citizenship and immigration barriers to access to affordable 
health care under the ACA. 
Sec. 413. Study on the uninsured. 
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Sec. 414. Medicaid payment parity for the territories. 
Sec. 415. Extension of Medicare secondary payer. 
Sec. 416. Border health grants. 
Sec. 417. Removing Medicare barrier to health care. 
Sec. 418. 100 percent FMAP for medical assistance provided by urban Indian 
health centers. 
Sec. 419. 100 percent FMAP for medical assistance provided to a Native Ha-
waiian through a federally qualified health center or a Native 
Hawaiian health care system under the Medicaid program. 
CHAPTER 2—EXPANSION OF ACCESS 
Sec. 421. Grants for racial and ethnic approaches to community health. 
Sec. 422. Critical access hospital improvements. 
Sec. 423. Establishment of Rural Community Hospital (RCH) Program. 
Sec. 424. Medicare remote monitoring pilot projects. 
Sec. 425. Rural health quality advisory commission and demonstration projects. 
Sec. 426. Rural health care services. 
Sec. 427. Community health center collaborative access expansion. 
Sec. 428. Facilitating the provision of telehealth services across State lines. 
Sec. 429. Scoring of preventive health savings. 
Sec. 430. Sense of Congress. 
Sec. 431. Repeal of requirement for documentation evidencing citizenship or 
nationality under the Medicaid program. 
Sec. 432. Office of Minority Health in Veterans Health Administration of De-
partment of Veterans Affairs. 
Sec. 433. Indian defined in PPACA. 
Sec. 434. Study of DSH payments to ensure hospital access for low-income pa-
tients. 
Sec. 435. Assistant Secretary of the Indian Health Service. 
Sec. 436. Reauthorization of the Native Hawaiian Health Care Improvement 
Act. 
TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 
CHILDREN, AND FAMILIES 
Sec. 501. Grants to promote positive health behaviors in women and children. 
Sec. 502. Removing barriers to health care and nutrition assistance for chil-
dren, pregnant women, and lawfully present individuals. 
Sec. 503. Repeal of denial of benefits. 
Sec. 504. Birth defects prevention, risk reduction, and awareness. 
Sec. 505. Uniform State maternal mortality review committees on pregnancy- 
related deaths. 
Sec. 506. Eliminating disparities in maternity health outcomes. 
Sec. 507. Decreasing the risk factors for sudden unexpected infant death and 
sudden unexplained death in childhood. 
Sec. 508. Reducing unintended teenage pregnancies. 
Sec. 509. Gestational diabetes. 
Sec. 510. Emergency contraception education and information programs. 
Sec. 511. Supporting healthy adolescent development. 
Sec. 512. Compassionate assistance for rape emergencies. 
Sec. 513. Access to birth control duties of pharmacies to ensure provision of 
FDA-approved contraception. 
Sec. 514. Additional focus area for the Office on Women’s Health. 
Sec. 515. Interagency coordinating committee on the promotion of optimal ma-
ternity outcomes. 
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Sec. 516. Consumer education campaign. 
Sec. 517. Bibliographic database of systematic reviews for care of childbearing 
women and newborns. 
Sec. 518. Maternity care health professional shortage areas. 
Sec. 519. Expansion of CDC prevention research centers program to include 
centers on optimal maternity outcomes. 
Sec. 520. Expanding models allowed to be tested by Center for Medicare and 
Medicaid Innovation to include maternity care models. 
Sec. 521. Development of interprofessional maternity care educational models 
and tools. 
Sec. 522. Including within inpatient hospital services under Medicare services 
furnished by certain students, interns, and residents supervised 
by certified nurse midwives. 
Sec. 523. Grants to professional organizations to increase diversity in maternity 
care professionals. 
TITLE VI—MENTAL HEALTH 
Sec. 601. Coverage of marriage and family therapist services, mental health 
counselor services, and substance abuse counselor services 
under part B of the Medicare program. 
Sec. 602. Minority Fellowship Program. 
Sec. 603. Integrated Health Care Demonstration Program. 
Sec. 604. Addressing racial and ethnic minority mental health disparities re-
search gaps. 
Sec. 605. Health professions competencies to address racial and ethnic minority 
mental health disparities. 
TITLE VII—ADDRESSING HIGH IMPACT MINORITY DISEASES 
Subtitle A—Cancer 
Sec. 701. Lung cancer mortality reduction. 
Sec. 702. Expanding prostate cancer research, outreach, screening, testing, ac-
cess, and treatment effectiveness. 
Sec. 703. Improved Medicaid coverage for certain breast and cervical cancer pa-
tients in the territories. 
Sec. 704. Cancer prevention and treatment demonstration for ethnic and racial 
minorities. 
Sec. 705. Reducing cancer disparities within Medicare. 
Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 
Sec. 711. Viral hepatitis and liver cancer control and prevention. 
Subtitle C—Acquired Bone Marrow Failure Diseases 
Sec. 721. Acquired bone marrow failure diseases. 
Subtitle D—Cardiovascular Disease, Chronic Disease, and Other Disease 
Issues 
Sec. 731. Guidelines for disease screening for minority patients. 
Sec. 732. CDC Wisewoman Screening Program. 
Sec. 733. Report on cardiovascular care for women and minorities. 
Sec. 734. Coverage of comprehensive tobacco cessation services in Medicaid. 
Sec. 735. Clinical research funding for oral health. 
Sec. 736. Participation by Medicaid beneficiaries in approved clinical trials. 
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Subtitle E—HIV/AIDS 
Sec. 741. Statement of policy. 
Sec. 742. Findings. 
Sec. 743. Additional funding for AIDS drug assistance program treatments. 
Sec. 744. Enhancing the national HIV surveillance system. 
Sec. 745. Evidence-based strategies for improving linkage to and retention in 
appropriate care. 
Sec. 746. Improving entry into and retention in care and antiretroviral adher-
ence for persons with HIV. 
Sec. 747. Services to reduce HIV/AIDS in racial and ethnic minority commu-
nities. 
Sec. 748. Minority AIDS initiative. 
Sec. 749. Health care professionals treating individuals with HIV/AIDS. 
Sec. 750. HIV/AIDS provider loan repayment program. 
Sec. 751. Dental education loan repayment program. 
Sec. 752. Reducing new HIV infections among injecting drug users. 
Sec. 753. Support for expansion of comprehensive sexual health and education 
programs. 
Sec. 754. Elimination of abstinence-only education program. 
Sec. 755. Report on impact of HIV/AIDS in vulnerable populations. 
Sec. 756. National HIV/AIDS observance days. 
Sec. 757. Review of all Federal and State laws, policies, and regulations regard-
ing the criminal prosecution of individuals for HIV-related of-
fenses. 
Sec. 758. Repeal of limitation against use of funds for education or information 
designed to promote or encourage, directly, homosexual or het-
erosexual activity or intravenous substance abuse. 
Sec. 759. Expanding support for condoms in prisons. 
Sec. 760. Automatic reinstatement or enrollment in Medicaid for people who 
test positive for HIV before reentering communities. 
Sec. 761. Stop AIDS in prison. 
Sec. 762. Support data system review and indicators for monitoring HIV care. 
Sec. 763. Transfer of funds for implementation of national HIV/AIDS strategy. 
Sec. 764. HIV integrated services delivery model demonstration. 
Sec. 765. Report on the implementation of goal 4 (improved coordination) of 
the national HIV/AIDS strategy. 
Subtitle F—Diabetes 
Sec. 771. Research, treatment, and education. 
Sec. 772. Research, education, and other activities. 
Sec. 773. Research, education, and other activities. 
Sec. 774. Research, education, and other activities. 
Sec. 775. Updated report on health disparities. 
Subtitle G—Lung Disease 
Sec. 776. Expansion of the National Asthma Education and Prevention Pro-
gram. 
Sec. 777. Asthma-related activities of the Centers for Disease Control and Pre-
vention. 
Sec. 778. Influenza and pneumonia vaccination campaign. 
Sec. 779. Chronic obstructive pulmonary disease action plan. 
Subtitle H—Osteoarthritis and Musculoskeletal Diseases 
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Sec. 781. Findings. 
Sec. 782. Osteoarthritis and other musculoskeletal health-related activities of 
the Centers for Disease Control and Prevention. 
Subtitle I—Sleep and Circadian Rhythm Disorders 
Sec. 791. Short title; findings. 
Sec. 792. Sleep and circadian rhythm disorders research activities of the Na-
tional Institutes of Health. 
Sec. 793. Sleep and circadian rhythm health disparities-related activities of the 
Centers for Disease Control and Prevention. 
TITLE VIII—HEALTH INFORMATION TECHNOLOGY 
Sec. 800. Definitions. 
Subtitle A—Reducing Health Disparities Through Health IT 
Sec. 801. HRSA assistance to health centers for promotion of Health IT. 
Sec. 802. Assessment of impact of Health IT on racial and ethnic minority 
communities; outreach and adoption of Health IT in such com-
munities. 
Subtitle B—Modifications To Achieve Parity in Existing Programs 
Sec. 811. Extending funding to strengthen the Health IT infrastructure in ra-
cial and ethnic minority communities. 
Sec. 812. Prioritizing regional extension center assistance to racial and ethnic 
minority groups. 
Sec. 813. Extending competitive grants for the development of loan programs 
to facilitate adoption of certified EHR technology by providers 
serving racial and ethnic minority groups. 
Sec. 814. Authorization of appropriations. 
Subtitle C—Additional Research and Studies 
Sec. 831. Data collection and assessments conducted in coordination with mi-
nority-serving institutions. 
Sec. 832. Study of health information technology in medically underserved com-
munities. 
Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 
Sec. 841. Application of Medicare HITECH payments to hospitals in Puerto 
Rico. 
Sec. 842. Extending Medicaid EHR incentive payments to rehabilitation facili-
ties, long-term care facilities, and home health agencies. 
Sec. 843. Extending physician assistant eligibility for Medicaid electronic health 
record incentive payments. 
TITLE IX—ACCOUNTABILITY AND EVALUATION 
Sec. 901. Prohibition on discrimination in Federal assisted health care services 
and research programs on the basis of sex, race, color, national 
origin, marital status, familial status, sexual orientation, gen-
der identity, or disability status. 
Sec. 902. Treatment of Medicare payments under title VI of the Civil Rights 
Act of 1964. 
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Sec. 903. Accountability and transparency within the Department of Health 
and Human Services. 
Sec. 904. United States Commission on Civil Rights. 
Sec. 905. Sense of Congress concerning full funding of activities to eliminate 
racial and ethnic health disparities. 
Sec. 906. GAO and NIH reports. 
TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 
ENVIRONMENTAL JUSTICE 
Sec. 1001. Definitions. 
Sec. 1002. Findings. 
Sec. 1003. Health impact assessments. 
Sec. 1004. Implementation of recommendations by Environmental Protection 
Agency. 
Sec. 1005. Grant program to conduct environmental health improvement activi-
ties and to improve social determinants of health. 
Sec. 1006. Additional research on the relationship between the built environ-
ment and the health of community residents. 
Sec. 1007. Environment and public health restoration. 
Sec. 1008. GAO report on health effects of Deepwater Horizon oil rig explosion 
in the Gulf Coast. 
SEC. 3. FINDINGS. 
The Congress finds as follows: 
(1) The population of racial and ethnic minori-
ties is expected to increase over the next few dec-
ades, yet racial and ethnic minorities have the poor-
est health status and face substantial cultural, so-
cial, and economic barriers to obtaining quality 
health care. 
(2) Health disparities are a function of not only 
access to health care, but also the social deter-
minants of health—including the environment, the 
physical structure of communities, nutrition and 
food options, educational attainment, employment, 
race, ethnicity, sex, geography, language preference, 
immigrant or citizenship status, sexual orientation, 
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gender identity, socioeconomic status, or disability 
status—that directly and indirectly affect the health, 
health care, and wellness of individuals and commu-
nities. 
(3) By 2020, the Nation will face a shortage of 
health care providers and allied health workers and 
this shortage disproportionately affects health pro-
fessional shortage areas where many racial and eth-
nic minority populations reside. 
(4) All efforts to reduce health disparities and 
barriers to quality health services require better and 
more consistent data. 
(5) A full range of culturally and linguistically 
appropriate health care and public health services 
must be available and accessible in every community. 
(6) Racial and ethnic minorities and under-
served populations must be included early and equi-
tably in health reform innovations. 
(7) Efforts to improve minority health have 
been limited by inadequate resources in funding, 
staffing, stewardship, and accountability. Targeted 
investments that are focused on disparities elimi-
nation must be made in providing care and services 
that are community-based, including prevention and 
policies addressing social determinants of health. 
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(8) In 2011, the Department of Health and 
Human Services developed the HHS Action Plan to 
Reduce Racial and Ethnic Health Disparities and 
the National Stakeholder Strategy for Achieving 
Health Equity, two strategic plans that represent 
the country’s first coordinated roadmap to reducing 
health disparities. Along with the National Preven-
tion Strategy, Healthy People 2020, and the Na-
tional Health Care Quality Strategy, as well as crit-
ical resources such as the 2012 National Healthcare 
Quality and Disparities Reports, these comprehen-
sive plans will work to increase the number of Amer-
icans who are healthy at every stage of life. 
(9) The Department of Health and Human 
Services also developed other strategic planning doc-
uments to combat disease disparities with a high im-
pact on minority populations including the National 
HIV/AIDS Strategy, and the Action Plan for the 
Prevention, Care and Treatment of Viral Hepatitis. 
(10) The Patient Protection and Affordable 
Care Act, as amended by the Health Care and Edu-
cation Reconciliation Act, represents the biggest ad-
vancement for minority health in the last 40 years. 
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TITLE I—DATA COLLECTION 
AND REPORTING 
SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) PURPOSE.—It is the purpose of this section to 
promote data collection, analysis, and reporting by race, 
ethnicity, sex, primary language, sexual orientation, dis-
ability status, gender identity, and socioeconomic status 
among federally supported health programs. 
(b) AMENDMENT.—Title XXXIV of the Public 
Health Service Act, as amended by titles II and III of 
this Act, is further amended by inserting after subtitle A 
the following: 
‘‘Subtitle 
B—Strengthening 
Data 
Collection, 
Improving 
Data 
Analysis, and Expanding Data 
Reporting 
‘‘SEC. 3431. HEALTH DISPARITY DATA. 
‘‘(a) REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—Each health-related pro-
gram operated by or that receives funding or reim-
bursement, in whole or in part, either directly or in-
directly from the Department of Health and Human 
Services shall— 
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‘‘(A) require the collection, by the agency 
or program involved, of data on the race, eth-
nicity, sex, primary language, sexual orienta-
tion, disability status, gender identity, and so-
cioeconomic status of each applicant for and re-
cipient of health-related assistance under such 
program— 
‘‘(i) using, at a minimum, the stand-
ards for data collection on race, ethnicity, 
sex, primary language, sexual orientation, 
disability status, gender identity, and so-
cioeconomic status developed under section 
3101; 
‘‘(ii) collecting data for additional 
population groups if such groups can be 
aggregated into the race and ethnicity cat-
egories outlined by the standards developed 
under section 3101; 
‘‘(iii) additionally referring, where 
practicable, to the standards developed by 
the Institute of Medicine in ‘Race, Eth-
nicity, and Language Data: Standardiza-
tion for Health Care Quality Improve-
ment’; and 
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‘‘(iv) where practicable, through self- 
reporting; 
‘‘(B) with respect to the collection of the 
data described in subparagraph (A), for appli-
cants and recipients who are minors, require 
communication assistance in speech or writing, 
and for applicants and recipients who are other-
wise legally incapacitated, require that— 
‘‘(i) such data be collected from the 
parent or legal guardian of such an appli-
cant or recipient; and 
‘‘(ii) the primary language of the par-
ent or legal guardian of such an applicant 
or recipient be collected; 
‘‘(C) systematically analyze such data 
using the smallest appropriate units of analysis 
feasible to detect racial and ethnic disparities, 
as well as disparities along the lines of primary 
language, sex, disability status, sexual orienta-
tion, gender identity, and socioeconomic status 
in health and health care, and report the results 
of such analysis to the Secretary, the Director 
of the Office for Civil Rights, each agency listed 
in section 3101(c)(1), the Committee on 
Health, Education, Labor, and Pensions and 
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the Committee on Finance of the Senate, and 
the Committee on Energy and Commerce and 
the Committee on Ways and Means of the 
House of Representatives; 
‘‘(D) provide such data to the Secretary on 
at least an annual basis; and 
‘‘(E) ensure that the provision of assist-
ance to an applicant or recipient of assistance 
is not denied or otherwise adversely affected be-
cause of the failure of the applicant or recipient 
to provide race, ethnicity, primary language, 
sex, sexual orientation, disability status, gender 
identity, and socioeconomic status data. 
‘‘(2) RULES
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to— 
‘‘(A) permit the use of information col-
lected under this subsection in a manner that 
would adversely affect any individual providing 
any such information; or 
‘‘(B) diminish existing or future require-
ments on health care providers to collect data. 
‘‘(3) NO COMPELLED DISCLOSURE OF DATA.— 
This title does not authorize any health care pro-
vider, Federal official, or other entity to compel the 
disclosure of any data collected under this title. The 
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disclosure of any such data by an individual pursu-
ant to this title shall be strictly voluntary. 
‘‘(b) PROTECTION OF DATA.—The Secretary shall 
ensure (through the promulgation of regulations or other-
wise) that all data collected pursuant to subsection (a) are 
protected— 
‘‘(1) under the same privacy protections as the 
Secretary applies to other health data under the reg-
ulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
of 1996 (Public Law 104–191; 110 Stat. 2033) re-
lating to the privacy of individually identifiable 
health information and other protections; and 
‘‘(2) from all inappropriate internal use by any 
entity that collects, stores, or receives the data, in-
cluding use of such data in determinations of eligi-
bility (or continued eligibility) in health plans, and 
from other inappropriate uses, as defined by the 
Secretary. 
‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 
Secretary shall develop and implement a national plan to 
ensure the collection of data in a culturally appropriate 
and competent manner, to improve the collection, analysis, 
and reporting of racial, ethnic, sex, primary language, sex-
ual orientation, disability status, gender identity, and so-
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cioeconomic status data at the Federal, State, territorial, 
tribal, and local levels, including data to be collected under 
subsection (a), and to ensure that data collection activities 
carried out under this section are in compliance with the 
standards developed under section 3101. The Data Coun-
cil of the Department of Health and Human Services, in 
consultation with the National Committee on Vital Health 
Statistics, the Office of Minority Health, Office on Wom-
en’s Health, and other appropriate public and private enti-
ties, shall make recommendations to the Secretary con-
cerning the development, implementation, and revision of 
the national plan. Such plan shall include recommenda-
tions on how to— 
‘‘(1) implement subsection (a) while minimizing 
the cost and administrative burdens of data collec-
tion and reporting; 
‘‘(2) expand awareness among Federal agencies, 
States, territories, Indian tribes, health providers, 
health plans, health insurance issuers, and the gen-
eral public that data collection, analysis, and report-
ing by race, ethnicity, primary language, sexual ori-
entation, disability status, gender identity, and socio-
economic status is legal and necessary to assure eq-
uity and nondiscrimination in the quality of health 
care services; 
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‘‘(3) ensure that future patient record systems 
have data code sets for racial, ethnic, primary lan-
guage, sexual orientation, disability status, gender 
identity, and socioeconomic status identifiers and 
that such identifiers can be retrieved from clinical 
records, including records transmitted electronically; 
‘‘(4) improve health and health care data collec-
tion and analysis for more population groups if such 
groups can be aggregated into the minimum race 
and ethnicity categories, including exploring the fea-
sibility of enhancing collection efforts in States for 
racial and ethnic groups that comprise a significant 
proportion of the population of the State; 
‘‘(5) provide researchers with greater access to 
racial, ethnic, primary language, sexual orientation, 
disability status, gender identity, and socioeconomic 
status data, subject to privacy and confidentiality 
regulations; and 
‘‘(6) safeguard and prevent the misuse of data 
collected under subsection (a). 
‘‘(d) COMPLIANCE WITH STANDARDS.—Data col-
lected under subsection (a) shall be obtained, maintained, 
and presented (including for reporting purposes) in ac-
cordance with the standards developed under section 
3101. 
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‘‘(e) TECHNICAL ASSISTANCE FOR THE COLLECTION 
AND REPORTING OF DATA.— 
‘‘(1) IN GENERAL.—The Secretary may, either 
directly or through grant or contract, provide tech-
nical assistance to enable a health care program or 
an entity operating under such program to comply 
with the requirements of this section. 
‘‘(2) TYPES OF ASSISTANCE.—Assistance pro-
vided under this subsection may include assistance 
to— 
‘‘(A) enhance or upgrade computer tech-
nology that will facilitate racial, ethnic, primary 
language, sexual orientation, disability status, 
gender identity, and socioeconomic status data 
collection and analysis; 
‘‘(B) improve methods for health data col-
lection and analysis, including additional popu-
lation groups if such groups can be aggregated 
into the race and ethnicity categories outlined 
by the standards developed under section 3101; 
‘‘(C) develop mechanisms for submitting 
collected data subject to existing privacy and 
confidentiality regulations; and 
‘‘(D) develop educational programs to in-
form health insurance issuers, health plans, 
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health providers, health-related agencies, and 
the general public that data collection and re-
porting by race, ethnicity, primary language, 
sexual orientation, disability status, gender 
identity, and socioeconomic status are legal and 
essential for eliminating health and health care 
disparities. 
‘‘(f) ANALYSIS OF HEALTH DISPARITY DATA.—The 
Secretary, acting through the Director of the Agency for 
Healthcare Research and Quality and in coordination with 
the Administrator of the Centers for Medicare & Medicaid 
Services, shall provide technical assistance to agencies of 
the Department of Health and Human Services in meeting 
Federal standards for health disparity data collection and 
for analysis of racial and ethnic disparities in health and 
health care in public programs by— 
‘‘(1) identifying appropriate quality assurance 
mechanisms to monitor for health disparities; 
‘‘(2) specifying the clinical, diagnostic, or thera-
peutic measures which should be monitored; 
‘‘(3) developing new quality measures relating 
to racial and ethnic disparities and their overlap 
with other disparity factors in health and health 
care; 
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‘‘(4) identifying the level at which data analysis 
should be conducted; and 
‘‘(5) sharing data with external organizations 
for research and quality improvement purposes. 
‘‘(g) PRIMARY LANGUAGE.—References in this sec-
tion— 
‘‘(1) to primary language data, include spoken 
and written primary language data; and 
‘‘(2) to primary language data collection activi-
ties, include identifying, collecting, storing, tracking, 
and analyzing primary language data and informa-
tion on the methods used to meet the language ac-
cess needs of limited-English-proficient individuals. 
‘‘(h) DEFINITION.—In this section, the term ‘health- 
related program’ mean a program— 
‘‘(1) under the Social Security Act (42 U.S.C. 
301 et seq.) that pays for health care and services; 
and 
‘‘(2) under this Act that provides Federal finan-
cial assistance for health care, biomedical research, 
or health services research and or is designed to im-
prove the public’s health. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2015 through 2020. 
‘‘SEC. 3432. PROVISIONS RELATING TO NATIVE AMERICANS. 
‘‘(a) ESTABLISHMENT
OF
EPIDEMIOLOGY
CEN-
TERS.—The Secretary shall establish an epidemiology cen-
ter in each service area to carry out the functions de-
scribed in subsection (b). Any new center established after 
the date of the enactment of the Health Equity and Ac-
countability Act of 2014 may be operated under a grant 
authorized by subsection (d), but funding under such a 
grant shall not be divisible. 
‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 
and upon the request of Indian tribes, tribal organizations, 
and urban Indian organizations, each service area epide-
miology center established under this subsection shall, 
with respect to such service area— 
‘‘(1) collect data relating to, and monitor 
progress made toward meeting, each of the health 
status objectives of the service, the Indian tribes, 
tribal organizations, and urban Indian organizations 
in the service area; 
‘‘(2) evaluate existing delivery systems, data 
systems, and other systems that impact the improve-
ment of Indian health; 
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‘‘(3) assist Indian tribes, tribal organizations, 
and urban Indian organizations in identifying their 
highest priority health status objectives and the 
services needed to achieve such objectives, based on 
epidemiological data; 
‘‘(4) make recommendations for the targeting 
of services needed by the populations served; 
‘‘(5) make recommendations to improve health 
care delivery systems for Indians and urban Indians; 
‘‘(6) provide requested technical assistance to 
Indian tribes, tribal organizations, and urban Indian 
organizations in the development of local health 
service priorities and incidence and prevalence rates 
of disease and other illness in the community; and 
‘‘(7) provide disease surveillance and assist In-
dian tribes, tribal organizations, and urban Indian 
organizations to promote public health. 
‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 
Centers for Disease Control and Prevention shall provide 
technical assistance to the centers in carrying out the re-
quirements of this subsection. 
‘‘(d) GRANTS FOR STUDIES.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to Indian tribes, tribal organizations, urban 
Indian organizations, and eligible intertribal con-
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sortia to conduct epidemiological studies of Indian 
communities. 
‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 
intertribal consortium is eligible to receive a grant 
under this subsection if— 
‘‘(A) the intertribal consortium is incor-
porated for the primary purpose of improving 
Indian health; and 
‘‘(B) the intertribal consortium is rep-
resentative of the Indian tribes or urban Indian 
communities in which the intertribal consortium 
is located. 
‘‘(3) APPLICATIONS.—An application for a 
grant under this subsection shall be submitted in 
such manner and at such time as the Secretary shall 
prescribe. 
‘‘(4) REQUIREMENTS.—An applicant for a 
grant under this subsection shall— 
‘‘(A) demonstrate the technical, adminis-
trative, and financial expertise necessary to 
carry out the functions described in paragraph 
(5); 
‘‘(B) consult and cooperate with providers 
of related health and social services in order to 
avoid duplication of existing services; and 
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‘‘(C) demonstrate cooperation from Indian 
tribes or urban Indian organizations in the area 
to be served. 
‘‘(5) USE OF FUNDS.—A grant awarded under 
paragraph (1) may be used— 
‘‘(A) to carry out the functions described 
in subsection (b); 
‘‘(B) to provide information to and consult 
with tribal leaders, urban Indian community 
leaders, and related health staff on health care 
and health service management issues; and 
‘‘(C) in collaboration with Indian tribes, 
tribal organizations, and urban Indian commu-
nities, to provide the service with information 
regarding ways to improve the health status of 
Indians. 
‘‘(e) ACCESS
TO INFORMATION.—An epidemiology 
center operated by a grantee pursuant to a grant awarded 
under subsection (d) shall be treated as a public health 
authority for purposes of the Health Insurance Portability 
and Accountability Act of 1996 (Public Law 104–191; 110 
Stat. 2033), as such entities are defined in part 164.501 
of title 45, Code of Federal Regulations (or a successor 
regulation). The Secretary shall grant such grantees ac-
cess to and use of data, data sets, monitoring systems, 
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delivery systems, and other protected health information 
in the possession of the Secretary.’’. 
SEC. 102. ELIMINATION OF PREREQUISITE OF DIRECT AP-
PROPRIATIONS FOR DATA COLLECTION AND 
ANALYSIS. 
Section 3101 of the Public Health Service Act (42 
U.S.C. 300kk) is amended— 
(1) by striking subsection (h); and 
(2) by redesignating subsection (i) as subsection 
(h). 
SEC. 103. COLLECTION OF RACE AND ETHNICITY DATA BY 
THE SOCIAL SECURITY ADMINISTRATION. 
Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 1150C. COLLECTION OF RACE AND ETHNICITY DATA 
BY THE SOCIAL SECURITY ADMINISTRATION. 
‘‘(a) REQUIREMENT.—The Commissioner of Social 
Security, in consultation with the Administrator of the 
Centers for Medicare & Medicaid Services, shall— 
‘‘(1) require the collection of data on the race, 
ethnicity, primary language, and disability status of 
all applicants for Social Security account numbers or 
benefits under title II or part A of title XVIII and 
all individuals with respect to whom the Commis-
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sioner maintains records of wages and self-employ-
ment income in accordance with reports received by 
the Commissioner or the Secretary of the Treas-
ury— 
‘‘(A) using, at a minimum, the standards 
for data collection on race, ethnicity, primary 
language, and disability status developed under 
section 3101 of the Public Health Service Act; 
‘‘(B) where practicable, collecting data for 
additional population groups if such groups can 
be aggregated into the race and ethnicity cat-
egories outlined by the standards developed 
under section 3101 of the Public Health Service 
Act; and 
‘‘(C) additionally referring, where prac-
ticable, to the standards developed by the Insti-
tute of Medicine in ‘Race, Ethnicity, and Lan-
guage Data: Standardization for Health Care 
Quality Improvement’ (released August 31, 
2009); 
‘‘(2) with respect to the collection of the data 
described in paragraph (1) for applicants who are 
under 18 years of age or otherwise legally incapaci-
tated, require that— 
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‘‘(A) such data be collected from the par-
ent or legal guardian of such an applicant; and 
‘‘(B) the primary language of the parent 
or legal guardian of such an applicant or recipi-
ent be used; 
‘‘(3) require that such data be uniformly ana-
lyzed and reported at least annually to the Commis-
sioner of Social Security; 
‘‘(4) be responsible for storing the data re-
ported under paragraph (3); 
‘‘(5) ensure transmission to the Centers for 
Medicare & Medicaid Services and other Federal 
health agencies; 
‘‘(6) provide such data to the Secretary on at 
least an annual basis; and 
‘‘(7) ensure that the provision of assistance to 
an applicant is not denied or otherwise adversely af-
fected because of the failure of the applicant to pro-
vide race, ethnicity, primary language, and disability 
status data. 
‘‘(b) PROTECTION OF DATA.—The Commissioner of 
Social Security shall ensure (through the promulgation of 
regulations or otherwise) that all data collected pursuant 
to subsection (a) are protected— 
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‘‘(1) under the same privacy protections as the 
Secretary applies to health data under the regula-
tions promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
of 1996 (Public Law 104–191; 110 Stat. 2033) re-
lating to the privacy of individually identifiable 
health information and other protections; and 
‘‘(2) from all inappropriate internal use by any 
entity that collects, stores, or receives the data, in-
cluding use of such data in determinations of eligi-
bility (or continued eligibility) in health plans, and 
from other inappropriate uses, as defined by the 
Secretary. 
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit the use of information 
collected under this section in a manner that would ad-
versely affect any individual providing any such informa-
tion. 
‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide technical 
assistance to enable any health entity to comply with the 
requirements of this section. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2015 through 2020.’’. 
SEC. 104. REVISION OF HIPAA CLAIMS STANDARDS. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall revise the regulations promulgated 
under part C of title XI of the Social Security Act (42 
U.S.C. 1320d et seq.), relating to the collection of data 
on race, ethnicity, and primary language in a health-re-
lated transaction, to require— 
(1) the use, at a minimum, of the standards for 
data collection on race, ethnicity, primary language, 
disability, and sex developed under section 3101 of 
the Public Health Service Act (42 U.S.C. 300kk); 
and 
(2) the designation of the racial, ethnic, pri-
mary language, disability, and sex code sets as re-
quired for claims and enrollment data. 
(b) DISSEMINATION.—The Secretary of Health and 
Human Services shall disseminate the new standards de-
veloped under subsection (a) to all health entities that are 
subject to the regulations described in such subsection and 
provide technical assistance with respect to the collection 
of the data involved. 
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(c) COMPLIANCE.—The Secretary of Health and 
Human Services shall require that health entities comply 
with the new standards developed under subsection (a) not 
later than 2 years after the final promulgation of such 
standards. 
SEC. 105. NATIONAL CENTER FOR HEALTH STATISTICS. 
Section 306(n) of the Public Health Service Act (42 
U.S.C. 242k(n)) is amended— 
(1) in paragraph (1), by striking ‘‘2003’’ and 
inserting ‘‘2020’’; 
(2) in paragraph (2), in the first sentence, by 
striking ‘‘2003’’ and inserting ‘‘2020’’; and 
(3) in paragraph (3), by striking ‘‘2002’’ and 
inserting ‘‘2020’’. 
SEC. 106. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 
HAWAIIANS, OR PACIFIC ISLANDERS AND 
OTHER 
UNDERREPRESENTED 
GROUPS 
IN 
FEDERAL HEALTH SURVEYS. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by inserting after sec-
tion 317T the following: 
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‘‘SEC. 317U. OVERSAMPLING OF ASIAN-AMERICANS, NATIVE 
HAWAIIANS, OR PACIFIC ISLANDERS AND 
OTHER 
UNDERREPRESENTED 
GROUPS 
IN 
FEDERAL HEALTH SURVEYS. 
‘‘(a) NATIONAL STRATEGY.— 
‘‘(1) IN GENERAL.—The Secretary of Health 
and Human Services, acting through the Director of 
the National Center for Health Statistics (referred 
to in this section as ‘NCHS’) of the Centers for Dis-
ease Control and Prevention, and other agencies 
within the Department of Health and Human Serv-
ices as the Secretary determines appropriate, shall 
develop and implement an ongoing and sustainable 
national strategy for oversampling Asian-Americans, 
Native Hawaiians, or Pacific Islanders, and other 
underrepresented populations as determined appro-
priate by the Secretary in Federal health surveys. 
‘‘(2) CONSULTATION.—In developing and imple-
menting a national strategy, as described in para-
graph (1), not later than 180 days after the date of 
the enactment of the this section, the Secretary— 
‘‘(A) shall consult with representatives of 
community groups, nonprofit organizations, 
nongovernmental organizations, and govern-
ment agencies working with Asian-Americans, 
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effectiveness of a drug in the same chemical class as 
the drug; 
‘‘(2) evidence that there is a disparity on the 
basis of racial or ethnic background in the way the 
drug is metabolized; and 
‘‘(3) other evidence as the Secretary may deter-
mine. 
‘‘(d) APPLICATIONS UNDER SECTIONS 505(b)(2) 
AND 505(j).— 
‘‘(1) IN GENERAL.—A drug for which an appli-
cation has been submitted or approved under section 
505(j) shall not be considered ineligible for approval 
under that section or misbranded under section 502 
on the basis that the labeling of the drug omits in-
formation relating to a disparity on the basis of ra-
cial or ethnic background as to the safety or effec-
tiveness of the drug, whether derived from investiga-
tions or studies required under this section or de-
rived from other sources, when the omitted informa-
tion is protected by patent or by exclusivity under 
clause (iii) or (iv) of section 505(j)(5)(B). 
‘‘(2) LABELING.—Notwithstanding clauses (iii) 
and (iv) of section 505(j)(5)(B), the Secretary may 
require that the labeling of a drug approved under 
section 505(j) that omits information relating to a 
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preting or interpretation for which the interpreter is 
in the physical presence of the provider of health 
care or health-care-related services and the recipient 
of such services who is limited in English proficiency 
or has a communication impairment such as hear-
ing, vision, or learning. 
‘‘(22) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Services. 
‘‘(23) SIGHT TRANSLATION.—The term ‘sight 
translation’ means the transmission of a written 
message in one language into a spoken or signed 
message in another language, or an alternative for-
mat in English or another language. 
‘‘(24) STATE.—The term ‘State’ means each of 
the several States, the District of Columbia, the 
Commonwealth of Puerto Rico, the Indian tribes, 
the United States Virgin Islands, Guam, American 
Samoa, and the Commonwealth of the Northern 
Mariana Islands. 
‘‘(25) 
TELEPHONIC
INTERPRETATION.—The 
term ‘telephonic interpretation’ (also known as over 
the phone interpretation or OPI) means a method of 
interpreting/interpretation for which the interpreter 
is not in the physical presence of the provider of 
health care or related services and the limited- 
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