101
fered for individuals accepting employment as den-
tists in such areas. 
‘‘(2) INDIVIDUALS.—A grant to an individual 
under subsection (a) shall be in the form of a 
$1,000 bonus payment for each month in which such 
individual is in compliance with the eligibility re-
quirements of subsection (b)(2)(C). 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—Notwithstanding any other 
amounts appropriated under section 330 for health 
centers, there is authorized to be appropriated 
$40,000,000 for each of fiscal years 2004 through 
2008 to hire and retain dental health care providers 
under this section. 
‘‘(2) USE OF FUNDS.—Of the amount appro-
priated for a fiscal year under paragraph (1), the 
Secretary shall use—
‘‘(A) not less than 75 percent of such 
amount to make grants to eligible entities; and 
‘‘(B) not more than 25 percent of such 
amount to make grants to eligible individuals.’’. 
SEC. 302. SCHOOL-BASED DENTAL SEALANT PROGRAM. 
Section 317M(c) of the Public Health Service Act (42 
U.S.C. 247b–14) is amended—
102
(1) in paragraph (1), by inserting ‘‘and school-
linked’’ after ‘‘school-based’’; 
(2) in the first sentence of paragraph (2)—
(A) by inserting ‘‘and school-linked’’ after 
‘‘school-based’’; and 
(B) by inserting ‘‘or Indian tribe’’ after 
‘‘State’’; and 
(3) by striking paragraph (3) and inserting the 
following: 
‘‘(3) ELIGIBILITY.—To be eligible to receive 
funds under paragraph (1), an entity shall—
‘‘(A) prepare and submit to the State or 
Indian tribe an application at such time, in 
such manner and containing such information 
as the State or Indian tribe may require; and 
‘‘(B) be a—
‘‘(i) public elementary or secondary 
school—
‘‘(I) that is located in an urban 
area in which and more than 50 per-
cent of the student population is par-
ticipating in Federal or State free or 
reduced meal programs; or 
‘‘(II) that is located in a rural 
area and, with respect to the school
103
district in which the school is located, 
the district involved has a median in-
come that is at or below 235 percent 
of the poverty line, as defined in sec-
tion 673(2) of the Community Serv-
ices Block Grant Act (42 U.S.C. 
9902(2)); or 
‘‘(ii) public or non-profit health orga-
nization, including a grantee under section 
330, that is under contract with an ele-
mentary or secondary school described in 
subparagraph (B) to provide dental serv-
ices to school-age children.’’. 
Subtitle B—Border Health 
SEC. 311. SHORT TITLE. 
This subtitle may be cited as the ‘‘Border Health Se-
curity Act of 2003’’. 
SEC. 312. DEFINITIONS. 
In this subtitle: 
(1) BORDER AREA.—The term ‘‘border area’’ 
has the meaning given the term ‘‘United States-
Mexico Border Area’’ in section 8 of the United 
States-Mexico Border Health Commission Act (22 
U.S.C. 290n–6).
104
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
SEC. 313. BORDER HEALTH SERVICES 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, or community health center 
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, acting through the 
United States members of the United States-Mexico Bor-
der Health Commission, shall award grants to eligible en-
tities to address priorities and recommendations to im-
prove the health of border area residents that are estab-
lished 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.
105
(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) health promotion; 
(E) oral health; 
(F) behavioral and mental health; 
(G) substance abuse; 
(H) health conditions that have a high 
prevalence in the border area; 
(I) medical and health services research; 
(J) 
community 
health 
workers 
or 
promotoras; 
(K) health care infrastructure problems in 
the border area (including planning and con-
struction grants); 
(L) health disparities in the border area; 
(M) environmental health; 
(N) health education; and 
(O) outreach and enrollment services with 
respect to Federal programs (including pro-
106
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). 
(f) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
$200,000,000 for fiscal year 2004, and such sums as may 
be necessary for each succeeding fiscal year. 
SEC. 
314. 
BORDER 
BIOTERRORISM 
PREPAREDNESS 
GRANTS. 
(a) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State, local govern-
ment, or public health entity. 
(b) AUTHORIZATION.—From funds appropriated 
under subsection (e), the Secretary shall award grants to 
eligible entities for bioterrorism preparedness in the bor-
der area. 
(c) APPLICATION.—An eligible entity that desires a 
grant under this section shall submit an application to the
107
Secretary at such time, in such manner, and containing 
such information as the Secretary may require. 
(d) USES OF FUNDS.—An eligible entity that receives 
a grant under subsection (b) shall use the grant funds 
to—
(1) develop and implement bioterror prepared-
ness plans and readiness assessments and purchase 
items necessary for such plans; 
(2) coordinate bioterrorism and emergency pre-
paredness planning in the region; 
(3) improve infrastructure, including surveil-
lance and laboratory capacity; 
(4) create a health alert network, including risk 
communication and information dissemination; 
(5) educate and train clinicians, epidemiolo-
gists, laboratories, and emergency personnel; and 
(6) carry out such other activities identified by 
the Secretary, State and local public health offices, 
and border health offices. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$25,000,000 for fiscal year 2004 and such sums as may 
be necessary for each succeeding fiscal year.
108
SEC. 315. UNITED STATES-MEXICO BORDER HEALTH COM-
MISSION ACT AMENDMENTS. 
The United States-Mexico Border Health Commis-
sion Act (22 U.S.C. 290n et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this Act $10,000,000 for fiscal year 2004 and such sums 
as may be necessary for each succeeding fiscal year.’’. 
Subtitle C—Patient Navigator, Out-
reach, and Chronic Disease Pre-
vention 
SEC. 321. SHORT TITLE. 
This title may be cited as the ‘‘Patient Navigator, 
Outreach, and Chronic Disease Prevention Act of 2003’’. 
SEC. 322. HRSA GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; HRSA GRANTS FOR PATIENT NAVIGA-
TORS. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following:
109
‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 
DISEASE CARE AND PREVENTION; PATIENT 
NAVIGATORS. 
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC 
DISEASE CARE AND PREVENTION.—
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, may make grants to 
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, clinics serving 
Asian Americans and Pacific Islanders and Alaskan 
Natives, and rural health clinics and qualified non-
profit entities that partner with one or more centers 
providing health care to provide navigation services,
which demonstrate the ability to perform all of the 
functions outlined in this subsection and subsections 
(b) and (c)) for the development and operation of 
model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection, 
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases;
110
‘‘(B) ensure that the health services are 
provided to such individuals in a culturally com-
petent manner; 
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
‘‘(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
‘‘(ii) facilitate access to appropriate 
health care services within the health care 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
‘‘(D) require training for patient naviga-
tors employed through such model programs to 
ensure the ability of navigators to perform all
111
of the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
‘‘(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pro-
gram is serving of the services of the model program 
under the grant. Such activities shall include facili-
tating access to appropriate health care services and 
patient navigators within the health care system to 
ensure optimal patient utilization of these services. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective program evaluation, the 
grantee shall collect specific patient data recording 
services provided to each patient served by the pro-
gram and shall establish and implement procedures
112
and protocols, consistent with applicable Federal and 
State laws (including 45 C.F.R. 160 and 164) to en-
sure the confidentiality of all information shared by 
a participant in the program, or their personal rep-
resentative and their health care providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section. 
‘‘(5) EVALUATIONS.—
113
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide 
for evaluations to determine which outreach ac-
tivities under paragraph (2) were most effective 
in informing the public and the specific commu-
nity that the program is serving of the model 
program services and to determine the extent to 
which such programs were effective in providing 
culturally competent services to the health dis-
parity population served by the programs. 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A). 
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (b), with the program under section 
417D, and to the extent practicable, with programs 
for prevention centers that are carried out by the 
Director of the Centers for Disease Control and Pre-
vention. 
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
114
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, may make grants to 
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, clinics serving 
Asian Americans and Pacific Islanders and Alaskan 
Natives, and rural health clinics and qualified non-
profit entities that partner with one or more centers 
providing health care to provide navigation services, 
which demonstrate the ability to perform all of the 
functions outlined in this subsection and subsections 
(a) and (c)) for the development and operation of 
programs to pay the costs of such health centers 
in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for managing the care of individuals of 
health disparity populations for the duration of 
receiving health services from the health cen-
ters, including aid in coordinating and sched-
uling appointments and referrals, community 
outreach, assistance with transportation ar-
rangements, and assistance with insurance
115
issues and other barriers to care and providing 
information about clinical trials; 
‘‘(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
‘‘(C) ensuring that patient navigators with 
direct knowledge of the communities they serve 
provide services to such individuals in a cul-
turally competent manner; 
‘‘(D) developing model practices for patient 
navigators, including with respect to—
‘‘(i) coordination of health services, 
including 
psychosocial 
assessment 
and 
care; 
‘‘(ii) appropriate follow-up care, in-
cluding psychosocial assessment and care; 
‘‘(iii) 
determining 
coverage 
under 
health insurance and health plans for all 
services; 
‘‘(iv) ensuring the initiation, continu-
ation and/or sustained access to care pre-
scribed by the patients’ health care pro-
viders; and
116
‘‘(v) aiding patients with health insur-
ance coverage issues; 
‘‘(E) requiring training for patient naviga-
tors to ensure the ability of navigators to per-
form all of the duties required in this sub-
section and in subsection (a), including training 
to ensure that navigators are informed about 
health insurance systems and are able to aid 
patients in resolving access issues; and 
‘‘(F) ensuring that consumers have direct 
access to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pa-
tient navigator is serving of the services of the model 
program under the grant. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective patient navigator pro-
gram evaluation, the grantee shall collect specific pa-
tient data recording navigation services provided to
117
each patient served by the program and shall estab-
lish and implement procedures and protocols, con-
sistent with applicable Federal and State laws (in-
cluding 45 C.F.R. 160 and 164) to ensure the con-
fidentiality of all information shared by a participant 
in the program, or their personal representative and 
their health care providers, group health plans, or 
health insurance insurers with the program. The pa-
tient navigator program may, consistent with appli-
cable Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
118
formation as the Secretary determines to be nec-
essary to carry out this section. 
‘‘(5) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide 
for evaluations to determine the effects of the 
services of patient navigators on the individuals 
of health disparity populations for whom the 
services were provided, taking into account the 
matters referred to in paragraph (1)(C). 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A).
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (a) and with the program under section 
417D. 
‘‘(c) REQUIREMENTS REGARDING FEES.—
‘‘(1) IN GENERAL.—A condition for the receipt 
of a grant under subsection (a)(1) or (b)(1) is that
119
the program for which the grant is made have in 
effect—
‘‘(A) a schedule of fees or payments for 
the provision of its health care services related 
to the prevention and treatment of disease that 
is consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and 
‘‘(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or 
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to require payment 
for navigation services or to require payment for 
health care services in cases where care is provided 
free of charge, including the case of services pro-
vided through programs of the Indian Health Serv-
ice. 
‘‘(d) MODEL.—Not later than five years after the 
date of the enactment of this section, the Secretary shall 
develop a peer-reviewed model of systems for the services 
provided by this section. The Secretary shall update such 
model as may be necessary to ensure that the best prac-
tices are being utilized.
120
‘‘(e) DURATION
OF GRANT.—The period during 
which payments are made to an entity from a grant under 
subsection (a)(1) or (b)(1) may not exceed five years. The 
provision of such payments are subject to annual approval 
by the Secretary of the payments and subject to the avail-
ability of appropriations for the fiscal year involved to 
make the payments. This subsection may not be construed 
as establishing a limitation on the number of grants under 
such subsection that may be made to an entity. 
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients. 
‘‘(2) The term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care. 
‘‘(3) The term ‘health disparity population’ 
means a population where there exists a significant 
disparity in the overall rate of disease incidence, 
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
121
‘‘(A) racial and ethnic minority groups as 
defined in section 1707; and 
‘‘(B) medically underserved groups, such 
as rural and low-income individuals and individ-
uals with low levels of literacy. 
‘‘(4)(A) The term ‘patient navigator’ means an 
individual whose functions include—
‘‘(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the 
health care system to accomplish the follow-up 
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease including pro-
viding information about clinical trials; and 
‘‘(ii) identifying, anticipating, and helping 
patients overcome barriers within the health 
care system to ensure prompt diagnostic and 
treatment resolution of an abnormal finding of 
cancer or other chronic disease. 
‘‘(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
122
‘‘(1) IN GENERAL.—
‘‘(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) (other than the 
purpose described in paragraph (2)(A)), there 
are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 
2004 through 2008. 
‘‘(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) (other than 
the purpose described in paragraph (2)(B)), 
there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal 
years 2004 through 2008. 
‘‘(C) 
BUREAU
OF
PRIMARY
HEALTH 
CARE.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through 
the Bureau of Primary Health Care. 
‘‘(2) PROGRAMS IN RURAL AREAS.—
‘‘(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) by making grants 
under such subsection for model programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2004 through 2008.
123
‘‘(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) by making 
grants under such subsection for programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2004 through 2008. 
‘‘(C) OFFICE
OF
RURAL
HEALTH
POL-
ICY.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through 
the Office of Rural Health Policy. 
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs 
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs.’’.
SEC. 323. NCI GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; NCI GRANTS FOR PATIENT NAVIGA-
TORS. 
Subpart 1 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285 et seq.) is amended by adding 
at the end following:
125
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
‘‘(D) require training for patient naviga-
tors employed through such model programs to 
ensure the ability of navigators to perform all 
of the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
‘‘(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 
section, an eligible entity is a designated cancer cen-
ter of the Institute, an academic institution, Indian 
Health Service Clinics, tribal governments, urban In-
dian organizations, tribal organizations, a hospital, a 
qualified nonprofit entity that partners with one or
126
more centers providing health care to provide navi-
gation services, which demonstrates the ability to 
perform all of the functions outlined in this sub-
section and subsections (b) and (c), or any other 
public or private entity determined to be appropriate 
by the Director of the Institute, that provides serv-
ices described in paragraph (1)(A) for cancer and 
chronic diseases. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective program evaluation, the 
grantee shall collect specific patient data recording 
services provided to each patient served by the pro-
gram and shall establish and implement procedures 
and protocols, consistent with applicable Federal and 
State laws (including 45 C.F.R. 160 and 164) to en-
sure the confidentiality of all information shared by 
a participant in the program, or their personal rep-
resentative and their health care providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 CFR 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes
127
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pro-
gram is serving of the services of the model program 
under the grant. Such activities shall include facili-
tating access to appropriate health care services and 
patient navigators within the health care system to 
ensure optimal patient utilization of these services. 
‘‘(5) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section. 
‘‘(6) EVALUATIONS.—
128
‘‘(A) IN GENERAL.—The Director of the 
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine which outreach activities under paragraph 
(3) were most effective in informing the public 
and the specific community that the program is 
serving of the model program services and to 
determine the extent to which such programs 
were effective in providing culturally competent 
services to the health disparity population 
served by the programs. 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Director of the Institute shall as appropriate 
disseminate to public and private entities the 
findings made in evaluations under subpara-
graph (A). 
‘‘(7) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under
subsection (b), with the program under section 330I, 
and to the extent practicable, with programs for pre-
vention centers that are carried out by the Director 
of the Centers for Disease Control and Prevention. 
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
129
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of programs to pay the 
costs of such entities in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for managing the care of individuals of 
health disparity populations for the duration of 
receiving health services from the health cen-
ters, including aid in coordinating and sched-
uling appointments and referrals, community 
outreach, assistance with transportation ar-
rangements, and assistance with insurance 
issues and other barriers to care and providing 
information about clinical trials; 
‘‘(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
‘‘(C) ensuring that the patient navigators 
with direct knowledge of the communities they 
serve provide services to such individuals in a 
culturally competent manner;
130
‘‘(D) developing model practices for patient 
navigators, including with respect to—
‘‘(i) coordination of health services, 
including 
psychosocial 
assessment 
and 
care; 
‘‘(ii) follow-up services, including psy-
chosocial assessment and care; 
‘‘(iii) 
determining 
coverage 
under 
health insurance and health plans for all 
services; 
‘‘(iv) ensuring the initiation, continu-
ation and/or sustained access to care pre-
scribed by the patients’ health care pro-
viders; and 
‘‘(v) aiding patients with health insur-
ance coverage issues; 
‘‘(E) requiring training for patient naviga-
tors to ensure the ability of navigators to per-
form all of the duties required in this sub-
section and in subsection (a), including training 
to ensure that navigators are informed about 
health insurance systems and are able to aid 
patients in resolving access issues; and
131
‘‘(F) ensuring that consumers have direct 
access to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pa-
tient navigator is serving of the services of the model 
program under the grant. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective patient navigator pro-
gram evaluation, the grantee shall collect specific pa-
tient data recording navigation services provided to 
each patient served by the program and shall estab-
lish and implement procedures and protocols, con-
sistent with applicable Federal and State laws (in-
cluding 45 C.F.R. 160 and 164) to ensure the con-
fidentiality of all information shared by a participant 
in the program, or their personal representative and 
their health care providers, group health plans, or 
health insurance insurers with the program. The pa-
tient navigator program may, consistent with appli-
132
cable Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section. 
‘‘(5) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Director of the 
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine the effects of the services of patient navi-
gators on the health disparity population for 
whom the services were provided, taking into
133
account the matters referred to in paragraph 
(1)(C).
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Director of the Institute shall as appropriate 
disseminate to public and private entities the 
findings made in evaluations under subpara-
graph (A). 
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (a) and with the program under section 
330I. 
‘‘(c) REQUIREMENTS REGARDING FEES.—
‘‘(1) IN GENERAL.—A condition for the receipt 
of a grant under subsection (a)(1) or (b)(1) is that 
the program for which the grant is made have in ef-
fect—
‘‘(A) a schedule of fees or payments for 
the provision of its health care services related 
to the prevention and treatment of disease that 
is consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and
‘‘(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or
134
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to require payment 
for navigation services or to require payment for 
health care services in cases where care is provided 
free of charge, including the case of services pro-
vided through programs of the Indian Health Serv-
ice. 
‘‘(d) MODEL.—Not later than five years after the 
date of the enactment of this section, the Director of the 
Institute shall develop a peer-reviewed model of systems 
for the services provided by this section. The Director shall 
update such model as may be necessary to ensure that 
the best practices are being utilized. 
‘‘(e) DURATION
OF GRANT.—The period during 
which payments are made to an entity from a grant under 
subsection (a)(1) or (b)(1) may not exceed five years. The 
provision of such payments are subject to annual approval 
by the Director of the Institute of the payments and sub-
ject to the availability of appropriations for the fiscal year 
involved to make the payments. This subsection may not 
be construed as establishing a limitation on the number 
of grants under such subsection that may be made to an 
entity.
135
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients. 
‘‘(2) the term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care. 
‘‘(3) the term ‘health disparity population’ 
means a population where there exists a significant 
disparity in the overall rate of disease incidence, 
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
‘‘(A) racial and ethnic minority groups as 
defined in section 1707; and 
‘‘(B) medically underserved groups, such 
as rural and low-income individuals and individ-
uals with low levels of literacy. 
‘‘(4)(A) the term ‘patient navigator’ means an 
individual whose functions include—
‘‘(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the
136
health care system to accomplish the follow-up 
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease, including pro-
viding information about clinical trials; and 
‘‘(ii) identifying, anticipating, and helping 
patients overcome barriers within the health 
care system to ensure prompt diagnostic and 
treatment resolution of an abnormal finding of 
cancer or other chronic disease. 
‘‘(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) MODEL PROGRAMS.—For the purpose of 
carrying out subsection (a), there are authorized to 
be appropriated such sums as may be necessary for 
each of the fiscal years 2004 through 2008. 
‘‘(2) PATIENT NAVIGATORS.—For the purpose 
of carrying out subsection (b), there are authorized 
to be appropriated such sums as may be necessary 
for each of the fiscal years 2004 through 2008. 
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs
137
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs.’’. 
SEC. 324. IHS GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; IHS GRANTS FOR PATIENT NAVIGA-
TORS. 
(a) MODEL COMMUNITY CANCER AND CHRONIC DIS-
EASE CARE AND PREVENTION.—
(1) IN GENERAL.—The Director of the Indian 
Health Service may make grants to Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, and qualified 
nonprofit entities demonstrating the ability to per-
form all of the functions outlined in this subsection 
and subsections (b) and (c) that partner with pro-
viders or centers providing health care serving Na-
tive American populations to provide navigation 
services, for the development and operation of model 
programs that—
(A) provide to individuals of health dis-
parity populations prevention, early detection,
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases;
138
(B) ensure that the health services are pro-
vided to such individuals in a culturally com-
petent manner; 
(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
(ii) facilitate access to appropriate 
health care services within the health care 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
(D) require training for patient navigators 
employed through such model programs to en-
sure the ability of navigators to perform all of
139
the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
(2) OUTREACH SERVICES.—A condition for the 
receipt of a grant under paragraph (1) is that the 
applicant involved agree to provide ongoing outreach 
activities while receiving the grant, in a manner that 
is culturally competent for the health disparity popu-
lation served by the program, to inform the public 
and the specific community that the program is 
serving of the services of the model program under 
the grant. Such activities shall include facilitating 
access to appropriate health care services and pa-
tient navigators within the health care system to en-
sure optimal patient utilization of these services. 
(3) DATA COLLECTION AND REPORT.—In order 
to allow for effective program evaluation, the grantee 
shall collect specific patient data recording services 
provided to each patient served by the program and 
shall establish and implement procedures and proto-
140
cols, consistent with applicable Federal and State 
laws (including 45 C.F.R. 160 and 164) to ensure 
the confidentiality of all information shared by a 
participant in the program, or their personal rep-
resentative and their health care providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
(4) APPLICATION FOR GRANT.—A grant may be 
made under paragraph (1) only if an application for 
the grant is submitted to the Secretary and the ap-
plication is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section. 
(5) EVALUATIONS.—
141
(A) IN GENERAL.—The Secretary, acting 
through the Director of the Indian Health Serv-
ice, shall, directly or through grants or con-
tracts, provide for evaluations to determine 
which outreach activities under paragraph (2) 
were most effective in informing the public and 
the specific community that the program is 
serving of the model program services and to 
determine the extent to which such programs 
were effective in providing culturally competent 
services to the health disparity population 
served by the programs. 
(B) DISSEMINATION
OF
FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A). 
(6) COORDINATION WITH OTHER PROGRAMS.—
The Secretary shall coordinate the program under 
this subsection with the program under subsection 
(b), with the program under section 417D, and to 
the extent practicable, with programs for prevention 
centers that are carried out by the Director of the 
Centers for Disease Control and Prevention. 
(b) PROGRAM FOR PATIENT NAVIGATORS.—
142
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Indian Health Service, 
may make grants to Indian Health Service Centers, 
tribal governments, urban Indian organizations, trib-
al organizations, and qualified nonprofit entities 
demonstrating the ability to perform all of the func-
tions outlined in this subsection and subsections (a) 
and (c) that partner with providers or centers pro-
viding health care serving Native American popu-
lations to provide navigation services, for the devel-
opment and operation of model programs to pay the 
costs of such organizations in—
(A) assigning patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for individuals of health disparity populations 
for the duration of receiving health services 
from the health centers, including aid in coordi-
nating and scheduling appointments and refer-
rals, community outreach, assistance with 
transportation arrangements, and assistance 
with insurance issues and other barriers to care 
and providing information about clinical trials; 
(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
182
‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head 
of each specified agency shall submit to the Secretary for 
inclusion in each biennial report under section 1707(g) 
(without change) a biennial report describing—
‘‘(1) the extent to which the minority health of-
fice of the agency employs individuals who are mem-
bers of racial and ethnic minority groups, including 
a specification by minority group of the number, se-
ries, and grade levels of such individuals employed 
by such office; 
‘‘(2) the manner in which the agency is com-
plying with Public Law 94–311 (relating to col-
lecting and reporting data on Americans of Spanish 
origin or descent); and 
‘‘(3) the manner in which the agency is com-
plying with services for Limited English Proficient 
persons. 
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) MINORITY
HEALTH
OFFICE.—The term 
‘minority health office’ means an office established 
under subsection (a), subject to subsection (b)(2). 
‘‘(2) RACIAL AND ETHNIC MINORITY GROUP.—
The term ‘racial and ethnic minority group’ has the 
meaning given such term in section 1707(g).