I 
108TH CONGRESS 
1ST SESSION H. R. 3459
To improve the health of minority individuals. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 6, 2003
Mr. CUMMINGS (for himself, Mr. RODRIGUEZ, Mr. KILDEE, Mr. WU, Mrs. 
CHRISTENSEN, Ms. SOLIS, Mr. PALLONE, Mr. HONDA, Ms. BORDALLO, 
Ms. PELOSI, Mr. HOYER, Mr. MENENDEZ, Mr. CLYBURN, Mr. DINGELL, 
Mr. RANGEL, Mr. STARK, Mr. RAHALL, Mr. BROWN of Ohio, Ms. ROY-
BAL-ALLARD, and Mr. CASE) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committees on Education and the Workforce, Resources, the Judici-
ary, Ways and Means, and Agriculture, for a period to be subsequently 
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To improve the health of minority individuals.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Healthcare Equality and Accountability Act’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings and purpose. 
TITLE I—COVERAGE OF THE UNINSURED 
Subtitle A—FamilyCare 
Sec. 101. Short title. 
Sec. 102. Renaming of title XXI program. 
Sec. 103. Familycare coverage of parents under the medicaid program and title 
XXI. 
Sec. 104. Automatic enrollment of children born to title XXI parents. 
Sec. 105. Optional coverage of children through age 20 under the medicaid pro-
gram and title XXI. 
Sec. 106. Allowing States to simplify rules for families. 
Sec. 107. Demonstration programs to improve medicaid and CHIP outreach to 
homeless individuals and families. 
Sec. 108. Additional CHIP revisions. 
Sec. 109. Coordination of title XXI with the maternal and child health pro-
gram. 
Subtitle B—State Option To Provide Coverage for All Residents With Income 
At or Below the Poverty Line 
Sec. 121. State option to provide coverage for all residents with income at or 
below the poverty line. 
Subtitle C—Optional Coverage of Legal Immigrants under the Medicaid 
Program and Title XXI 
Sec. 131. Equal access to health coverage for legal immigrants. 
Subtitle D—Indian Healthcare Funding 
CHAPTER 1—GUARANTEED FUNDING 
Sec. 141. Guaranteed adequate funding for Indian healthcare. 
CHAPTER 2—INDIAN HEALTHCARE PROGRAMS 
Sec. 145. Programs operated by Indian tribes and tribal organizations. 
Sec. 146. Licensing. 
Sec. 147. Authorization for emergency contract health services. 
Sec. 148. Prompt action on payment of claims. 
Sec. 149. Liability for payment. 
Sec. 150. Health services for ineligible persons. 
Sec. 151. Definitions. 
Sec. 152. Authorization of appropriations. 
Subtitle E—Territories 
Sec. 161. Funding for territories. 
Subtitle F—Migrant Workers and Farmworkers Health 
Sec. 171. Demonstration project regarding continuity of coverage of migrant 
workers and farmworkers under medicaid and CHIP. 
Subtitle G—Expanded Access to Health Care
Sec. 181. National Commission for Expanded Access to Health Care. 
TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 
HEALTHCARE 
Sec. 201. Amendment to the Public Health Service Act. 
‘‘TITLE XXIX—MINORITY HEALTH 
‘‘Sec. 2900. Definitions. 
‘‘Subtitle A—Culturally and Linguistically Appropriate Healthcare 
‘‘Sec. 2901. Improving access to services for individuals with Limited 
English Proficiency. 
‘‘Sec. 2902. National standards for culturally and linguistically appropriate 
services in healthcare. 
‘‘Sec. 2903. Center for Cultural and Linguistic Competence in Healthcare. 
‘‘Sec. 2904. Innovations in language access grants. 
‘‘Sec. 2905. Research on language access. 
‘‘Sec. 2906. Toll-free telephone number. 
Sec. 203. Standards for language access services. 
Sec. 204. Federal reimbursement for culturally and linguistically appropriate 
services under the medicare, medicaid and State Children’s 
Health Insurance Program. 
Sec. 205. Increasing understanding of health literacy. 
Sec. 206. Report on Federal efforts to provide culturally and linguistically ap-
propriate healthcare services. 
Sec. 207. General Accounting Office report on impact of language access serv-
ices. 
TITLE III—HEALTH WORKFORCE DIVERSITY 
Sec. 301. Amendment to the Public Health Service Act. 
‘‘Subtitle B—Workforce Diversity 
‘‘Sec. 2911. Report on workforce diversity. 
‘‘Sec. 2912. National working group on workforce diversity. 
‘‘Sec. 2913. Technical clearinghouse for health workforce diversity. 
‘‘Sec. 2914. Evaluation of workforce diversity initiatives. 
‘‘Sec. 2915. Data collection and reporting by health professional schools. 
‘‘Sec. 2916. Support for institutions committed to workforce diversity. 
‘‘Sec. 2917. Career development for scientists and researchers. 
‘‘Sec. 2918. Career support for non-research health professionals. 
‘‘Sec. 2919. Research on the effect of workforce diversity on quality. 
‘‘Sec. 2920. Health disparities education program. 
‘‘Sec. 2920A. Cultural competence training for healthcare professionals. 
Sec. 302. Health careers opportunity program. 
Sec. 303. Program of excellence in health professions education for underrep-
resented minorities. 
Sec. 304. Hispanic-serving health professions schools. 
Sec. 305. Health professions student loan fund; authorizations of appropria-
tions regarding students from disadvantaged backgrounds. 
Sec. 306. National Health Service Corps; recruitment and fellowships for indi-
viduals from disadvantaged backgrounds.
Sec. 307. Loan repayment program of Centers for Disease Control and Preven-
tion. 
Sec. 308. Cooperative agreements for online degree programs at schools of pub-
lic health and schools of allied health. 
Sec. 309. Mid-career health professions scholarship program. 
Sec. 310. National report on the preparedness of health professionals to care 
for diverse populations. 
Sec. 311. Scholarship and fellowship programs. 
‘‘Sec. 2920B. David Satcher Public Health and Health Services Corps. 
‘‘Sec. 2920C. Louis Stokes Public Health Scholars Program. 
‘‘Sec. 2920D. Patsy Mink Health and Gender Research Fellowship Pro-
gram. 
‘‘Sec. 2920E. Paul David Wellstone International Health Fellowship Pro-
gram. 
‘‘Sec. 2920F. Edward R. Roybal Healthcare Scholar Program. 
TITLE IV—REDUCING DISEASE AND DISEASE-RELATED 
COMPLICATIONS 
Subtitle A—Eliminating Disparities in Prevention, Detection, and Treatment 
of Disease 
CHAPTER 1—GENERAL PROVISIONS 
Sec. 401. Guidelines for disease screening for minority patients. 
Sec. 402. Preventive health services block grants, use of allotments. 
Sec. 403. Program for increasing immunization rates for adults and adoles-
cents; collection of additional immunization data. 
Sec. 404. Innovative chronic disease management programs. 
Sec. 405. Grants for racial and ethnic approaches to community health. 
Sec. 406. IOM study request. 
Sec. 407. Strategic plan. 
CHAPTER 2—ENVIRONMENTAL JUSTICE 
Sec. 410. Short title; purposes. 
Sec. 411. Definitions. 
Sec. 412. Environmental justice responsibilities of Federal agencies. 
Sec. 413. Interagency environmental justice working group. 
Sec. 414. Federal agency strategies. 
Sec. 415. Federal Environmental Justice Advisory Committee. 
Sec. 416. Human health and environmental research, data collection and anal-
ysis. 
CHAPTER 3—BORDER HEALTH 
Sec. 421. Short title.
Sec. 422. Definitions. 
Sec. 423. Border health grants. 
Sec. 424. United States-Mexico Border Health Commission Act Amendments. 
‘‘Sec. 9. Authorization of appropriations. 
CHAPTER 4—PATIENT NAVIGATOR, OUTREACH, AND CHRONIC DISEASE 
PREVENTION 
Sec. 425. Short title.
Sec. 426. HRSA grants for model community cancer and chronic disease care 
and prevention; HRSA grants for patient navigators. 
Sec. 427. NCI grants for model community cancer and chronic disease care and 
prevention; NCI grants for patient navigators. 
Sec. 428. IHS grants for model community cancer and chronic disease care and 
prevention; IHS grants for patient navigators. 
CHAPTER 5—COMMUNITY HEALTH WORKERS 
Sec. 431. Short title. 
Sec. 432. Grants to promote positive health behaviors in women. 
CHAPTER 6—HEALTH EMPOWERMENT ZONES 
Sec. 440. Health empowerment zones. 
Subtitle B—Targeting Diseases and Conditions with Particularly Disparate 
Impact 
CHAPTER 1—CANCER REDUCTION 
Sec. 441. Cancer reduction. 
CHAPTER 2—HIV/AIDS REDUCTION 
Sec. 442. HIV/AIDS reduction. 
CHAPTER 3—INFANT MORTALITY REDUCTION 
Sec. 443. Infant mortality reduction. 
CHAPTER 4—FETAL ALCOHOL SYNDROME TREATMENT AND DIAGNOSIS 
Sec. 444. Fetal alcohol syndrome. 
CHAPTER 5—DIABETES PREVENTION AND TREATMENT 
Sec. 445. Monitoring the quality of and disparities in diabetes care. 
Sec. 446. Diabetes prevention, treatment, and control. 
Sec. 447. Genetics of diabetes. 
Sec. 448. Research and training on diabetes in underserved and minority popu-
lations. 
Sec. 449. Authorization of appropriations. 
Sec. 450. Model community diabetes and chronic disease care and prevention 
among Pacific Islanders and Native Hawaiians. 
Sec. 451. Programs of Centers for Disease Control and Prevention. 
CHAPTER 6—STROKE AND HEART DISEASE PREVENTION AND TREATMENT 
Sec. 455. Systems for heart disease and stroke. 
‘‘Subtitle D—Systems for Heart Disease and Stroke 
‘‘CHAPTER 1—HEART DISEASE 
‘‘Sec. 2941. Heart disease. 
‘‘CHAPTER 2—STROKE EDUCATION CAMPAIGN 
‘‘Sec. 2945. Stroke education campaign.
CHAPTER 7—OBESITY AND OVERWEIGHT REDUCTION 
Sec. 461. Overweight and obesity prevention and treatment. 
CHAPTER 8—TUBERCULOSIS CONTROL, PREVENTION, AND TREATMENT 
Sec. 465. Advisory council for the elimination of tuberculosis. 
Sec. 466. National program for tuberculosis elimination. 
Sec. 467. Inclusion of inpatient hospital services for the treatment of TB-in-
fected individuals. 
CHAPTER 9—ASTHMA 
Sec. 471. Provisions regarding national asthma education and prevention pro-
gram of National Heart, Lung, and Blood Institute. 
Sec. 472. Asthma-related activities of Centers for Disease Control and Preven-
tion. 
Sec. 473. Grants for community outreach regarding asthma information, edu-
cation, and services. 
Sec. 474. Action plans of local educational agencies regarding asthma. 
CHAPTER 10—SICKLE CELL DISEASE 
Sec. 481. Demonstration program for the development and establishment of 
systemic mechanisms for the prevention and treatment of sickle 
cell disease. 
CHAPTER 11—AUTOIMMUNE DISEASE IN MINORITY POPULATIONS 
Sec. 482. Research funding for autoimmune disease in minority populations. 
CHAPTER 12—PREVENTION AND CONTROL OF SEXUALLY TRANSMITTED 
DISEASES 
Sec. 485. Prevention and control of sexually transmitted diseases. 
CHAPTER 13—DENTAL DISEASE 
Sec. 486. Grants to improve the provision of dental services under medicaid 
and SCHIP. 
Sec. 487. State option to provide wrap-around SCHIP coverage to children who 
have other health coverage. 
Sec. 488. Grants to improve the provision of dental health services through 
community health centers and public health departments. 
CHAPTER 14—PREVENTION AND CONTROL OF INJURIES 
Sec. 491. Prevention and control of injuries. 
CHAPTER 15—UTERINE FIBROID RESEARCH AND EDUCATION 
Sec. 495. Research with respect to uterine fibroids. 
Sec. 496. Information and education with respect to uterine fibroids. 
TITLE V—DATA COLLECTION AND REPORTING 
Subtitle A—General Provisions 
Sec. 501. Amendment to the Public Health Service Act.
‘‘Subtitle E—Data Collection and Reporting 
‘‘Sec. 2951. Data on race, ethnicity and primary language. 
‘‘Sec. 2952. Provisions relating to Native Americans. 
Sec. 502. Collection of race and ethnicity data by the Social Security Adminis-
tration. 
Sec. 503. Revision of HIPAA claims standards. 
Sec. 504. National Center for Health Statistics. 
Subtitle B—Minority Health and Genomics Commission 
Sec. 511. Short title. 
Sec. 512. Minority Health and Genomics Commission. 
Sec. 513. Report. 
Sec. 514. Membership. 
Sec. 515. Powers of Commission. 
Sec. 516. Termination. 
TITLE VI—ACCOUNTABILITY 
Sec. 601. Report on workforce diversity. 
Sec. 602. Federal agency plan to eliminate disparities and improve the health 
of minority populations. 
Sec. 603. Accountability within the Department of Health and Human Services. 
‘‘Subtitle F—Accountability 
‘‘Sec. 2961. Elevation of the Office of Civil Rights. 
‘‘Sec. 2962. Establishment of Health Program Offices for Civil Rights 
within Federal health and human services agencies. 
Sec. 604. Office of Minority Health. 
Sec. 605. Establishment of the Indian Health Service as an agency of the Pub-
lic Health Service. 
Sec. 606. Office of Minority Health at the Centers for Medicare and Medicaid 
Services. 
Sec. 607. Office of Minority Affairs at the Food and Drug Administration. 
Sec. 608. Safety and effectiveness of drugs with respect to racial and ethnic 
background. 
Sec. 609. United States Commission on Civil Rights. 
Sec. 610. Sense of Congress concerning full funding of activities to eliminate 
racial and ethnic health disparities. 
TITLE VII—STRENGTHENING HEALTH INSTITUTIONS THAT 
PROVIDE HEALTHCARE TO MINORITY POPULATIONS 
Sec. 701. Amendment to the Public Health Service Act. 
‘‘Subtitle G—Strengthening Health Institutions that Provide Healthcare to 
Minority Populations 
‘‘CHAPTER 1—GENERAL PROGRAMS 
‘‘Sec. 2971. Grant support for quality improvement initiatives. 
‘‘Sec. 2971A. Centers of excellence. 
‘‘Sec. 2971B. Consultation, construction and renovation of American In-
dian and Alaska Native facilities; reports.
‘‘Sec. 2971C. Reconstruction and improvement grants for public health 
care facilities serving Pacific Islanders and the insular 
areas. 
‘‘CHAPTER 2—NATIONAL HEALTH SAFETY NET INFRASTRUCTURE 
‘‘SUBCHAPTER A—GENERAL PROVISIONS 
‘‘Sec. 2972. Payments to healthcare facilities. 
‘‘Sec. 2972A. Application for assistance. 
‘‘Sec. 2972B. Public service responsibilities. 
‘‘Sec. 2972C. Health Safety Net Infrastructure Trust Fund. 
‘‘Sec. 2972D. Administration. 
‘‘SUBCHAPTER B—LOAN GUARANTEES 
‘‘Sec. 2973. Provision of loan guarantees to safety net healthcare facilities. 
‘‘Sec. 2973A. Eligible loans. 
‘‘Sec. 2973B. Guarantee allotments. 
‘‘Sec. 2973C. Terms and conditions of loan guarantees. 
‘‘Sec. 2973D. Premiums for loan guarantees. 
‘‘Sec. 2973E. Procedures in the event of loan default. 
‘‘SUBCHAPTER C—GRANTS FOR URGENT CAPITAL NEEDS 
‘‘Sec. 2976. Provision of grants. 
‘‘Sec. 2976B. Eligible projects. 
TITLE VIII—MISCELLANEOUS PROVISIONS 
Sec. 801. Definitions. 
Sec. 802. Davis-Bacon Act.
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Despite significant advances in public 
health and health care, the health status of racial 
and ethnic minority populations continues to lag be-
hind that of the white population. 
(2) The United States is becoming increasingly 
diverse. According to the 2000 United States Cen-
sus, African Americans, American Indians and Alas-
ka Natives, Asians, Hispanics, and Native Hawai-
ians and other Pacific Islanders comprise 30 percent
of the United States population. Racial and ethnic 
minorities are expected to comprise 40 percent of 
the United States population by 2030. 
(3) To improve the health care of racial and 
ethnic minorities and to reduce and eliminate dis-
parities in health care and health outcomes, the fol-
lowing issues must be addressed: 
(A) NEED FOR INSURANCE COVERAGE.—
(i) Disparities in health status can be 
attributed largely to underlying differences 
in socioeconomic status and insurance cov-
erage. Minorities are at a greater risk of 
being uninsured than their white counter-
parts. Lack of health insurance has con-
sistently been associated with worse health 
outcomes. 
(ii) Even after adjusting for dif-
ferences in socioeconomic and insurance 
status, however, racial and ethnic health 
and health care disparities remain. 
(iii) Through treaties and Federal 
statutes, the Federal Government has es-
tablished a trust responsibility to provide 
health care to American Indians and Alas-
ka Natives. In the Indian Health Amend-
ments 
of 
1992, 
Congress 
specifically 
pledged to ‘‘assure the highest possible 
health status for Indians and urban Indi-
ans and to provide all resources necessary 
to effect that policy.’’ Despite those com-
mitments, the unmet health needs of 
American Indians and Alaska Natives re-
main alarmingly severe and their health 
status is far below the health status of the 
general population of the United States. 
The critical shortfall of funding for the In-
dian Health Service is a major source of 
this problem. 
(B) NEED FOR CULTURALLY AND LINGUIS-
TICALLY APPROPRIATE CARE.—
(i) Limited English proficiency ad-
versely affects the care of many racial and 
ethnic minority patients. The lack of avail-
able interpretation and translation services 
or bilingual providers contributes to racial 
and ethnic disparities in health and health 
care. The Federal Government provides 
and funds an array of services that should 
be made accessible to eligible persons who 
are not proficient in the English language.
(ii) Title VI of the Civil Rights Act of 
1964 (42 U.S.C. 2000d et seq.) prohibits 
discrimination on the basis of race, color, 
and national origin in programs and activi-
ties receiving Federal financial assistance. 
Discrimination on the basis of primary lan-
guage has consistently been interpreted as 
discrimination on the basis of national ori-
gin. 
(iii) The provision of effective lan-
guage services has been shown to improve 
care for limited English proficient (re-
ferred to in this section as ‘‘LEP’’) pa-
tients by increasing patient satisfaction, 
access to care, compliance with rec-
ommended medical advice, and appropriate 
utilization. 
(iv) A 2002 study by the Office of 
Management and Budget found that lan-
guage assistance services can substantially 
improve the health and quality of life of 
LEP individuals and their families, in-
crease the efficiency of distribution of gov-
ernment services to LEP individuals, and
measurably increase the effectiveness of 
public health and safety programs. 
(v) The same study estimated that 
language translation services would only 
increase the cost of the average health care 
visit by less than one percent. 
(C) NEED FOR HEALTH WORKFORCE DI-
VERSITY.—
(i) Research has demonstrated that 
minority health professionals dramatically 
increase access to care for minority pa-
tients and improve the quality of care that 
they receive. African Americans, American 
Indians and Alaska Natives, Hispanics, 
Native Hawaiians and other Pacific Island-
ers, and Southeast Asians are significantly 
underrepresented in the health professions, 
exacerbating health disparities. 
(ii) Minority physicians are more like-
ly than white physicians to serve minority 
populations. Nearly 40 percent of all mi-
nority medical school graduates will prac-
tice medicine in underserved areas, com-
pared to 10 percent of their white col-
leagues.
(iii) Minorities often report experi-
ences with discrimination when seeking 
health care. 
(iv) There is substantial evidence to 
demonstrate that race concordance be-
tween physicians and patients increases 
patient satisfaction and participation in 
health decisionmaking. 
(v) Minority health care providers can 
bridge linguistic, cultural, and other bar-
riers that hamper access to care. 
(vi) African Americans, Hispanics, 
and American Indians remain severely 
underrepresented in health professions 
schools. African Americans and Hispanics 
constitute 20 percent and 16 percent, re-
spectively, of the students in public health 
and baccalaureate nursing programs, and 
less than 15 percent of students in all 
other health professions. 
(vi) The number of minorities enroll-
ing in health professional schools has re-
mained stagnant. For example, in 1994, 
1,307 African American and 1,090 His-
panic students enrolled in American med-
ical colleges. In 2000, the figures were es-
sentially unchanged at 1,307 African 
American and 1,033 Hispanic students. 
(D) NEED FOR REDUCTION OF DISEASE 
OCCURRENCE
AND
DISEASE-RELATED
COM-
PLICATIONS AMONG MINORITIES.—
(i) Despite notable progress in the 
overall health of the Nation, there are con-
tinuing disparities in the burden of illness 
and death experienced by minorities com-
pared to the United States population as a 
whole. Minority populations are dispropor-
tionately impacted by acute and chronic 
diseases. 
(ii) Despite suffering a greater burden 
of acute and chronic disease, minorities are 
less likely to receive needed health care. 
Numerous studies have documented that 
minorities receive less preventive care, 
medical therapy, and surgical interven-
tions. 
(E) NEED FOR MINORITY HEALTH DATA 
COLLECTION AND REPORTING.—
(i) Efforts to study disparities in 
health and health care for minorities have
been hampered by the lack of available 
data on race, ethnicity, and primary lan-
guage. 
(ii) Data collection, analysis, and re-
porting by race, ethnicity, and primary lan-
guage is permissible under the law and 
necessary to assure equity and non-
discrimination in the quality of health care 
services. Collection, analysis, and reporting 
of such data is authorized under Title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 
2000d et seq.). Such collection, analysis, 
and reporting should be conducted with ap-
propriate privacy protections in place. 
(F) NEED FOR GREATER ACCOUNTABILITY 
IN GOVERNMENT INSTITUTIONS.—A number of 
studies have shown that differences in health 
care quality contribute to health disparities 
among minority populations. These differences 
may result from bias, stereotyping, and dis-
crimination. Government institutions must be 
held accountable for the quality of healthcare 
delivered to all patient populations and result-
ant health outcomes.
(G) NEED FOR STRENGTHENING HEALTH 
INSTITUTIONS THAT PROVIDE CARE TO MINOR-
ITY POPULATIONS.—
(i) A small segment of health care in-
stitutions 
provide 
a 
disproportionate 
amount of health care to minority popu-
lations. 
(ii) Safety net institutions, including 
public hospitals, community health centers 
and community clinics, provide a dis-
proportionate share of health care to mi-
nority and underserved populations. 
(iii) Financial stress, negative oper-
ating margins, and the overall burden of 
caring for the uninsured and delivering 
high-cost specialty care to the entire com-
munity place undue pressure on core safety 
net providers. These providers are increas-
ingly challenged in their ability to meet the 
day-to-day needs of their patients. 
(b) PURPOSES.—It is the purpose of this Act to im-
prove the health and healthcare of minority populations
and to eliminate racial and ethnic disparities in health and 
healthcare by—
(1) increasing access to health care for all pop-
ulations; 
(2) expanding culturally and linguistically ap-
propriate health services for all populations; 
(3) promoting health workforce diversity; 
(4) supporting and expanding programs and ac-
tivities that will improve the prevention, diagnosis, 
and management of disease in minority populations; 
(5) enhancing racial, ethnic, and primary lan-
guage health data collection at the local, State, and 
Federal level; 
(6) ensuring accountability for the quality of 
health care and health outcomes for minority popu-
lations; and 
(7) strengthening the technical and financial re-
sources of the safety net institutions of the United 
States. 
TITLE I—COVERAGE OF THE 
UNINSURED 
Subtitle A—FamilyCare 
SEC 101. SHORT TITLE. 
This subtitle may be cited as the ‘‘FamilyCare Act 
of 2003’’.
SEC. 102. RENAMING OF TITLE XXI PROGRAM. 
(a) IN GENERAL.—The heading of title XXI of the 
Social Security Act (42 U.S.C. 1397aa et seq.) is amended 
to read as follows: 
‘‘TITLE XXI—FAMILYCARE PROGRAM’’. 
(b) PROGRAM REFERENCES.—Any reference in any 
provision of Federal law or regulation to ‘‘SCHIP’’ or 
‘‘State children’s health insurance program’’ under title 
XXI of the Social Security Act shall be deemed a reference 
to the FamilyCare program under such title. 
SEC. 103. FAMILYCARE COVERAGE OF PARENTS UNDER 
THE MEDICAID PROGRAM AND TITLE XXI. 
(a) INCENTIVES TO IMPLEMENT FAMILYCARE COV-
ERAGE.—
(1) UNDER MEDICAID.—
(A) ESTABLISHMENT OF NEW OPTIONAL 
ELIGIBILITY
CATEGORY.—Section 1902(a)(10) 
(A)(ii) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(A)(ii)) is amended—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVII); 
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVIII); and 
(iii) by adding at the end the fol-
lowing:
‘‘(XIX) who are individuals de-
scribed in subsection (k)(1) (relating 
to parents of categorically eligible chil-
dren);’’. 
(B) PARENTS DESCRIBED.—Section 1902 
of the Social Security Act is further amended 
by inserting after subsection (j) the following: 
‘‘(k)(1)(A) Individuals described in this paragraph 
are individuals—
‘‘(i) who are the parents of an individual who 
is under 19 years of age (or such higher age as the 
State may have elected under section 1902(l)(1)(D)) 
and who is eligible for medical assistance under sub-
section (a)(10)(A); 
‘‘(ii) who are not otherwise eligible for medical 
assistance under such subsection or under a waiver 
approved under section 1115 or otherwise (except 
under 
section 
1931 
or 
under 
subsection 
(a)(10)(A)(ii)(XIX)); and 
‘‘(iii) whose family income or resources exceeds 
the effective income level or resource level applicable 
under the State plan under part A of title IV as in 
effect as of July 16, 1996, but does not exceed the 
highest effective income or resource level (if any) ap-
plicable to a child in the family under this title.
‘‘(B) In establishing an income eligibility level for in-
dividuals described in this paragraph, a State may vary 
such level consistent with the various income levels estab-
lished under subsection (l)(2) in order to ensure, to the 
maximum extent possible, that such individuals shall be 
enrolled in the same program as their children. 
‘‘(C) An individual may not be treated as being de-
scribed in this paragraph unless, at the time of the individ-
ual’s enrollment under this title, the child referred to in 
subparagraph (A)(i) of the individual is also enrolled 
under this title or otherwise insured. 
‘‘(D) In this subsection, the term ‘parent’ includes 
an individual treated as a caretaker for purposes of car-
rying out section 1931. 
‘‘(E) In this subsection, the term ‘effective income 
level’ means the income level expressed as a percent of 
the poverty line and considering applicable income dis-
regards. 
‘‘(2) The State shall provide for coverage of a parent 
described in paragraph (1) or section 2111 of a child who 
is covered under this title or title XXI under the same 
title as the title as such child is covered. In the case of 
a parent described in paragraph (1) who is also the parent 
of a child who is eligible for child health assistance under 
title XXI, the State may elect (on a uniform basis) to
cover all such parents under section 2111 or under this 
title.’’. 
(C) ENHANCED MATCHING FUNDS AVAIL-
ABLE IF CERTAIN CONDITIONS MET.—Section 
1905 of the Social Security Act (42 U.S.C. 
1396d) is amended—
(i) in the fourth sentence of sub-
section (b), by striking ‘‘or subsection 
(u)(3)’’ and inserting ‘‘, (u)(3), or (u)(4)’’; 
and 
(ii) in subsection (u)—
(I) by redesignating paragraph 
(4) as paragraph (6), and 
(II) by inserting after paragraph 
(3) the following:
‘‘(4) For purposes of subsection (b) and section 
2105(a)(1): 
‘‘(A) FAMILYCARE
PARENTS.—The expendi-
tures described in this subparagraph are the expend-
itures described in the following clauses (i) and (ii): 
‘‘(i) PARENTS.—If the conditions described 
in clauses (iii) and (iv) are met, expenditures 
for medical assistance for parents described in 
section 1902(k)(1) and for parents who would 
be described in such section but for the fact
that they are eligible for medical assistance 
under section 1931 or under a waiver approved 
under section 1115. 
‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 
conditions described in clause (v) are met, ex-
penditures for medical assistance for pregnant 
women described in subsection (n) or under sec-
tion 1902(l)(1)(A) in a family the income of 
which exceeds the effective income level applica-
ble under subsection (a)(10)(A)(i)(III) or 
(l)(2)(A) of section 1902 to a family of the size 
involved as of January 1, 2004. 
‘‘(iii) CONDITIONS RELATING TO ENSURING 
CHILDREN’S COVERAGE FOR ENHANCED MATCH 
FOR
PARENTS.—The conditions described in 
this clause are the following: 
‘‘(I) The State has a State child 
health plan under title XXI which (wheth-
er implemented under such title or under 
this title) has an effective income level for 
children that is at least 200 percent of the 
poverty line. 
‘‘(II) Such State child health plan 
does not limit the acceptance of applica-
tions, does not use a waiting list for chil-
dren who meet eligibility standards to 
qualify for assistance, and provides bene-
fits to all children in the State who apply 
for and meet eligibility standards. 
‘‘(III) Effective for determinations of 
eligibility made on or after the date that is 
1 year after the date of the enactment of 
this clause, the application and renewal 
procedures for individuals under 19 years 
of age (or such higher age as the State has 
elected under section 1902(l)(1)(D)) for 
medical 
assistance 
under 
section 
1902(a)(10)(A) are not be more restrictive 
or burdensome than such procedures used 
for children with higher income under the 
State child health plan under title XXI. 
‘‘(iv) CONDITIONS RELATING TO MINIMUM 
COVERAGE
FOR
PARENTS
FOR
ENHANCED 
MATCH
FOR
PARENTS.—The conditions de-
scribed in this clause are the following: 
‘‘(I) The State does not apply an in-
come level for parents that is lower than 
the effective income level (expressed as a 
percent of the poverty line) that has been 
specified under the State plan under title
XIX (including under a waiver authorized 
by 
the 
Secretary 
or 
under 
section 
1902(r)(2)), as of January 1, 2004, to be 
eligible for medical assistance as a parent 
under this title. 
‘‘(II) The State plans under this title 
and title XXI do not provide coverage for 
parents with higher family income without 
covering parents with a lower family in-
come. 
‘‘(v) CONDITIONS FOR ENHANCED MATCH 
FOR CERTAIN PREGNANT WOMEN.—The condi-
tions described in this clause are the following: 
‘‘(I) The State has established an ef-
fective income eligibility level for pregnant 
women under subsection (a)(10)(A)(i)(III) 
or (l)(2)(A) of section 1902 that is at least 
185 percent of the poverty line. 
‘‘(II) The State plans under this title 
and title XXI do not provide coverage for 
pregnant women described in subpara-
graph (A)(ii) with higher family income 
without covering such pregnant women 
with a lower family income.
‘‘(III) The State does not apply an in-
come level for pregnant women that is 
lower than the effective income level that 
has been specified under the State plan 
under 
subsection 
(a)(10)(A)(i)(III) 
or 
(l)(2)(A) of section 1902, as of January 1, 
2004, to be eligible for medical assistance 
as a pregnant woman. 
‘‘(IV) The State satisfies the condi-
tions described in subclauses (I) and (II) 
of clause (iii). 
‘‘(vi) DEFINITIONS.—For purposes of this 
subsection: 
‘‘(I) The term ‘parent’ has the mean-
ing given such term for purposes of section 
1902(k)(1). 
‘‘(II) The term ‘poverty line’ has the 
meaning given such term in section 
2110(c)(5).’’. 
(D) APPROPRIATION FROM TITLE XXI AL-
LOTMENT FOR CERTAIN MEDICAID EXPANSION 
COSTS.—Section 2105(a) of the Social Security 
Act (42 U.S.C. 1397ee(a)) is amended—
(i) in paragraph (1), by redesignating 
subparagraphs (B) through (D) as sub-
paragraphs (C) through (E), respectively, 
and by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) for medical assistance that is attrib-
utable to expenditures described in section 
1905(u)(4)(A);’’; and 
(ii) in paragraph (2), by adding at the 
end the following new subparagraph: 
‘‘(E) Fifth, for expenditures for items de-
scribed in paragraph (1)(E).’’. 
(2) UNDER TITLE XXI.—
(A) FAMILYCARE COVERAGE.—Title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.) is amended by adding at the end the fol-
lowing: 
‘‘SEC. 2111. OPTIONAL FAMILYCARE COVERAGE OF PAR-
ENTS OF TARGETED LOW-INCOME CHILDREN. 
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 
other provision of this title, a State may provide for cov-
erage, through an amendment to its State child health 
plan under section 2102, of parent health assistance for 
targeted low-income parents, health care assistance for 
targeted low-income pregnant women, or both, in accord-
ance with this section, but only if—
‘‘(1) with respect to the provision of parent 
health assistance, the State meets the conditions de-
scribed in clause (iii) of section 1905(u)(4)(A); 
‘‘(2) with respect to the provision of health care 
assistance for pregnant women, the State meets the 
conditions described in clause (iv) of section 
1905(u)(4)(A); and 
‘‘(3) in the case of parent health assistance for 
targeted low-income parents, the State elects to pro-
vide 
medical 
assistance 
under 
section 
1902(a)(10)(A)(ii)(XIX), under section 1931, or 
under a waiver under section 1115 to individuals de-
scribed in section 1902(k)(1)(A)(i) and elects an ef-
fective income level that, consistent with paragraphs 
(1)(B) and (2) of section 1902(k), ensures to the 
maximum extent possible, that such individuals shall 
be enrolled in the same program as their children if 
their children are eligible for coverage under title 
XIX (including under a waiver authorized by the 
Secretary or under section 1902(r)(2)). 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) PARENT HEALTH ASSISTANCE.—The term 
‘parent health assistance’ has the meaning given the 
term child health assistance in section 2110(a) as if
any reference to targeted low-income children were 
a reference to targeted low-income parents. 
‘‘(2) PARENT.—The term ‘parent’ has the 
meaning given the term ‘caretaker relative’ for pur-
poses of carrying out section 1931. 
‘‘(3) HEALTH
CARE
ASSISTANCE
FOR
PREG-
NANT WOMEN.—The term ‘health care assistance for 
pregnant women’ has the meaning given the term 
child health assistance in section 2110(a) as if any 
reference to targeted low-income children were a ref-
erence to targeted low-income pregnant women. 
‘‘(4) TARGETED
LOW-INCOME
PARENT.—The 
term ‘targeted low-income parent’ has the meaning 
given the term targeted low-income child in section 
2110(b) as if the reference to a child were deemed 
a reference to a parent (as defined in paragraph (3)) 
of the child; except that in applying such section—
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2004, 
shall be substituted for July 1, 1997; and 
‘‘(C) in paragraph (4), January 1, 2004, 
shall be substituted for March 31, 1997.
‘‘(5) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ has the meaning given the term targeted 
low-income child in section 2110(b) as if any ref-
erence to a child were a reference to a woman dur-
ing pregnancy and through the end of the month in 
which the 60-day period beginning on the last day 
of her pregnancy ends; except that in applying such 
section—
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2004, 
shall be substituted for July 1, 1997; and 
‘‘(C) in paragraph (4), January 1, 2004, 
shall be substituted for March 31, 1997. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of parent health assistance to targeted 
low-income parents or health care assistance to targeted 
low-income pregnant women under subsection (a), the fol-
lowing special rules apply: 
‘‘(1) Any reference in this title (other than in 
subsection (b)) to a targeted low-income child is
deemed to include a reference to a targeted low-in-
come parent or a targeted low-income pregnant 
woman (as applicable). 
‘‘(2) Any such reference to child health assist-
ance—
‘‘(A) with respect to such parents is 
deemed a reference to parent health assistance; 
and 
‘‘(B) with respect to such pregnant women, 
is deemed a reference to health care assistance 
for pregnant women.
‘‘(3) In applying section 2103(e)(3)(B) in the 
case of a family (consisting of a parent and one or 
more children) provided coverage under this section 
or a pregnant woman provided coverage under this 
section without covering other family members, the 
limitation on total annual aggregate cost-sharing 
shall be applied to such entire family or such preg-
nant woman, respectively. 
‘‘(4) In applying section 2110(b)(4), any ref-
erence to ‘section 1902(l)(2) or 1905(n)(2) (as se-
lected by a State)’ is deemed a reference to the ef-
fective income level applicable to parents under sec-
tion 1931 or under a waiver approved under section
1115, or, in the case of a pregnant woman, the in-
come level established under section 1902(l)(2)(A). 
‘‘(5) In applying section 2102(b)(3)(B), any 
reference to children found through screening to be 
eligible for medical assistance under the State med-
icaid plan under title XIX is deemed a reference to 
parents and pregnant women.’’. 
(B) ADDITIONAL ALLOTMENT FOR STATES 
PROVIDING FAMILYCARE.—
(i) IN GENERAL.—Section 2104 of the 
Social Security Act (42 U.S.C. 1397dd) is 
amended by inserting after subsection (c) 
the following: 
‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE PRO-
VIDING FAMILYCARE.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.—
For the purpose of providing additional allotments 
to States to provide FamilyCare coverage under sec-
tion 2111, there is appropriated, out of any money 
in the Treasury not otherwise appropriated—
‘‘(A) for fiscal year 2004, $2,000,000,000; 
‘‘(B) for fiscal year 2005, $2,000,000,000; 
‘‘(C) for fiscal year 2006, $3,000,000,000; 
and 
‘‘(D) for fiscal year 2007, $3,000,000,000.
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—
‘‘(A) IN GENERAL.—In addition to the al-
lotments provided under subsections (b) and 
(c), subject to paragraphs (3) and (4), of the 
amount available for the additional allotments 
under paragraph (1) for a fiscal year, the Sec-
retary shall allot to each State with a State 
child health plan approved under this title—
‘‘(i) in the case of such a State other 
than a commonwealth or territory de-
scribed in clause (ii), the same proportion 
as the proportion of the State’s allotment 
under subsection (b) (determined without 
regard to subsection (f)) to 98.95 percent 
of the total amount of the allotments 
under such section for such States eligible 
for an allotment under this subparagraph 
for such fiscal year; and 
‘‘(ii) in the case of a commonwealth or 
territory described in subsection (c)(3), the 
same proportion as the proportion of the 
commonwealth’s or territory’s allotment 
under subsection (c) (determined without 
regard to subsection (f)) to 1.05 percent of 
the total amount of the allotments under
such section for commonwealths and terri-
tories eligible for an allotment under this 
subparagraph for such fiscal year. 
‘‘(B) AVAILABILITY AND REDISTRIBUTION 
OF
UNUSED
ALLOTMENTS.—In applying sub-
sections (e) and (f) with respect to additional 
allotments made available under this subsection, 
the procedures established under such sub-
sections shall ensure such additional allotments 
are only made available to States which have 
elected to provide coverage under section 2111. 
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are 
not available for amounts expended before October 
1, 2003. Such amounts are available for amounts ex-
pended on or after such date for child health assist-
ance for targeted low-income children, as well as for 
parent health assistance for targeted low-income 
parents, and health care assistance for targeted low-
income pregnant women. 
‘‘(4) REQUIRING ELECTION TO PROVIDE COV-
ERAGE.—No payments may be made to a State 
under this title from an allotment provided under 
this subsection unless the State has made an elec-
tion to provide parent health assistance for targeted
low-income parents, or health care assistance for 
targeted low-income pregnant women.’’. 
(ii) 
CONFORMING
AMENDMENTS.—
Section 2104 of the Social Security Act 
(42 U.S.C. 1397dd) is amended—
(I) in subsection (a), by inserting 
‘‘subject to subsection (d),’’ after 
‘‘under this section,’’; 
(II) in subsection (b)(1), by in-
serting ‘‘and subsection (d)’’ after 
‘‘Subject to paragraph (4)’’; and 
(III) in subsection (c)(1), by in-
serting ‘‘subject to subsection (d),’’ 
after ‘‘for a fiscal year,’’. 
(C) NO COST-SHARING FOR PREGNANCY-
RELATED
BENEFITS.—Section 2103(e)(2) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(e)(2)) is amended—
(i) in the heading, by inserting ‘‘AND 
PREGNANCY-RELATED
SERVICES’’ 
after 
‘‘PREVENTIVE SERVICES’’; and 
(ii) by inserting before the period at 
the end the following: ‘‘and for pregnancy-
related services’’.
(3) EFFECTIVE DATE.—The amendments made 
by this subsection apply to items and services fur-
nished on or after October 1, 2003, whether or not 
regulations implementing such amendments have 
been issued. 
(b) RULES FOR IMPLEMENTATION BEGINNING WITH 
FISCAL YEAR 2005.—
(1) EXPANSION
OF
AVAILABILITY
OF
EN-
HANCED
MATCH
UNDER
MEDICAID
FOR
PRE-CHIP 
EXPANSIONS.—Paragraph (4) of section 1905(u) of 
the Social Security Act (42 U.S.C. 1396d(u)), as in-
serted by subsection (a)(1)(C), is amended—
(A) by amending clause (ii) of subpara-
graph (A) to read as follows: 
‘‘(ii) CERTAIN
PREGNANT
WOMEN.—Ex-
penditures for medical assistance for pregnant 
women under section 1902(l)(1)(A) in a family 
the income of which exceeds the 133 percent of 
the income official poverty line, but only if the 
income 
level 
established 
under 
section 
1902(l)(2) (or under a Statewide waiver under 
section 1115) for pregnant women is 185 per-
cent of the income official poverty line.’’; and 
(B) by adding at the end the following:
‘‘(B) CHILDREN
IN
FAMILIES
WITH
INCOME 
ABOVE
MEDICAID
MANDATORY
LEVEL
NOT
PRE-
VIOUSLY
DESCRIBED.—The expenditures described 
in this subparagraph are expenditures (other than 
expenditures described in paragraph (2) or (3)) for 
medical assistance made available to any child who 
is 
eligible 
for 
assistance 
under 
section 
1902(a)(10)(A) (other than under clause (i)) and 
the income of whose family exceeds the minimum in-
come level required under subsection 1902(l)(2) (or, 
if higher, the minimum level required under section 
1931 for that State) for a child of the age involved 
(treating any child who is 19 or 20 years of age as 
being 18 years of age).’’. 
(2) OFFSET
OF
ADDITIONAL
EXPENDITURES 
FOR
ENHANCED
MATCH
FOR
PRE-CHIP
EXPAN-
SION.—Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended—
(A) in the fourth sentence of subsection 
(b), by inserting ‘‘(except in the case of expend-
itures described in subsection (u)(5))’’ after ‘‘do 
not exceed’’; 
(B) in subsection (u), by inserting after 
paragraph (4) (as inserted by subparagraph 
(C)), the following:
‘‘(5) For purposes of the fourth sentence of sub-
section (b) and section 2105(a), the following payments 
under this title do not count against a State’s allotment 
under section 2104: 
‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR 
PREGNANT WOMEN WITH INCOME ABOVE 133 PER-
CENT OF POVERTY.—The portion of the payments 
made for expenditures described in paragraph 
(4)(A)(ii) that represents the amount that would 
have been paid if the enhanced FMAP had not been 
substituted for the Federal medical assistance per-
centage. 
‘‘(B) FAMILYCARE
PARENTS.—Payments for 
expenditures described in paragraph (4)(A)(i). 
‘‘(C) REGULAR FMAP FOR EXPENDITURES FOR 
CERTAIN
CHILDREN
IN
FAMILIES
WITH
INCOME 
ABOVE MEDICAID MANDATORY LEVEL.—The portion 
of the payments made for expenditures described in 
paragraph (4)(B) that represents the amount that 
would have been paid if the enhanced FMAP had 
not been substituted for the Federal medical assist-
ance percentage.’’. 
(B) CONFORMING
AMENDMENTS.—Sub-
paragraph (B) of section 2105(a)(1) of the So-
cial Security Act, as amended by subsection 
(a)(1)(D), is amended to read as follows: 
‘‘(B) CERTAIN FAMILYCARE PARENTS AND 
OTHERS.—Expenditures for medical assistance 
that is attributable to expenditures described in 
section 1905(u)(4), except as provided in sec-
tion 1905(u)(5).’’.
(3) EFFECTIVE DATE.—The amendments made 
by this subsection apply as of October 1, 2004, to 
fiscal years beginning on or after such date and to 
expenditures under the State plan on and after such 
date, whether or not regulations implementing such 
amendments have been issued. 
(c) GAO STUDY.—
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study regarding fund-
ing under title XXI of the Social Security Act that 
examines—
(A) the adequacy of overall funding under 
such title; 
(B) the formula for determining allotments 
and for redistribution of unspent funds under 
such title; and 
(C) the effect of waiting lists and caps on 
enrollment under such title.
(2) REPORT.—Not later than July 1, 2005, the 
Comptroller General shall submit a report on the 
study conducted under paragraph (1). Such report 
shall include recommendations regarding a better 
mechanism for determining State allotments and re-
distribution of unspent funds under such title in 
order to ensure all eligible families in need can ac-
cess coverage through such title. 
(d) CONFORMING AMENDMENTS.—
(1) 
ELIGIBILITY
CATEGORIES.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter before para-
graph (1)—
(A) by striking ‘‘or’’ at the end of clause 
(xii); 
(B) by inserting ‘‘or’’ at the end of clause 
(xiii); and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) who are parents described (or treated as 
if described) in section 1902(k)(1),’’. 
(2) INCOME LIMITATIONS.—Section 1903(f)(4) 
of the Social Security Act (42 U.S.C. 1396b(f)(4)) 
is amended by inserting ‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after ‘‘1902(a)(10)(A)(ii)(XVIII),’’.
(3) CONFORMING
AMENDMENT
RELATING
TO 
NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec-
tion 2102(b)(1)(B) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)(B)) is amended—
(A) by striking ‘‘, and’’ at the end of 
clause (i) and inserting a semicolon; 
(B) by striking the period at the end of 
clause (ii) and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(iii) may not apply a waiting period 
(including a waiting period to carry out 
paragraph (3)(C)) in the case of a targeted 
low-income parent who is pregnant.’’. 
SEC. 104. AUTOMATIC ENROLLMENT OF CHILDREN BORN 
TO TITLE XXI PARENTS. 
Section 2102(b)(1) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)) is amended by adding at the end 
the following: 
‘‘(C) AUTOMATIC
ELIGIBILITY
OF
CHIL-
DREN
BORN
TO
A
PARENT
BEING
PROVIDED 
FAMILYCARE.—Such eligibility standards shall 
provide for automatic coverage of a child born 
to an individual who is provided assistance 
under this title in the same manner as medical 
assistance would be provided under section
1902(e)(4) to a child described in such sec-
tion.’’. 
SEC. 105. OPTIONAL COVERAGE OF CHILDREN THROUGH 
AGE 20 UNDER THE MEDICAID PROGRAM AND 
TITLE XXI. 
(a) MEDICAID.—
(1) IN GENERAL.—Section 1902(l)(1)(D) of the 
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 
amended by inserting ‘‘(or, at the election of a 
State, 20 or 21 years of age)’’ after ‘‘19 years of 
age’’. 
(2) CONFORMING AMENDMENTS.—
(A) Section 1902(e)(3)(A) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(3)(A)) is 
amended by inserting ‘‘(or 1 year less than the 
age the State has elected under subsection 
(l)(1)(D))’’ after ‘‘18 years of age’’. 
(B) Section 1902(e)(12) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(12)) is amend-
ed by inserting ‘‘or such higher age as the State 
has elected under subsection (l)(1)(D)’’ after 
‘‘19 years of age’’. 
(C) Section 1920A(b)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–1a(b)(1)) is 
amended by inserting ‘‘or such higher age as
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D)’’ after ‘‘19 years of age’’. 
(D) Section 1928(h)(1) of the Social Secu-
rity Act (42 U.S.C. 1396s(h)(1)) is amended by 
inserting ‘‘or 1 year less than the age the State 
has elected under section 1902(l)(1)(D)’’ before 
the period at the end. 
(E) Section 1932(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is 
amended by inserting ‘‘(or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D))’’ after ‘‘19 years of age’’. 
(b) TITLE XXI.—Section 2110(c)(1) of the Social 
Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-
serting ‘‘(or such higher age as the State has elected under 
section 1902(l)(1)(D))’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on January 1, 2004, and apply to 
medical assistance and child health assistance provided on 
or after such date, whether or not regulations imple-
menting such amendments have been issued. 
SEC. 106. ALLOWING STATES TO SIMPLIFY RULES FOR FAM-
ILIES. 
(a) PRESUMPTIVE ELIGIBILITY.—
(1) APPLICATION TO PRESUMPTIVE ELIGIBILITY 
FOR PREGNANT WOMEN UNDER MEDICAID.—Section 
1920(b) of the Social Security Act (42 U.S.C. 
1396r–1(b)) is amended by adding at the end after 
and below paragraph (2) the following flush sen-
tence: 
‘‘The term ‘qualified provider’ includes a qualified entity 
as defined in section 1920A(b)(3).’’. 
(2) OPTIONAL APPLICATION OF PRESUMPTIVE 
ELIGIBILITY
PROVISIONS
TO
PARENTS.—Section 
1920A of the Social Security Act (42 U.S.C. 1396r–
1a) is amended by adding at the end the following: 
‘‘(e) A State may elect to apply the previous provi-
sions of this section to provide for a period of presumptive 
eligibility for medical assistance for a parent of a child 
with respect to whom such a period is provided under this 
section.’’. 
(3) APPLICATION UNDER TITLE XXI.—Section 
2107(e)(1)(D) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(D) Sections 1920 and 1920A (relating to 
presumptive eligibility).’’. 
(b) 12-MONTHS CONTINUOUS ELIGIBILITY.—
(1) MEDICAID.—Section 1902(e)(12) of the So-
cial Security Act (42 U.S.C. 1396a(e)(12)) is 
amended—
(A) by striking ‘‘At the option of the State, 
the plan may’’ and inserting ‘‘The plan shall’’; 
(B) by striking ‘‘an age specified by the 
State (not to exceed 19 years of age)’’ and in-
serting ‘‘19 years of age (or such higher age as 
the 
State 
has 
elected 
under 
subsection 
(l)(1)(D)) or, at the option of the State, who is 
eligible for medical assistance as the parent of 
such a child’’; and 
(C) in subparagraph (A), by striking ‘‘a 
period (not to exceed 12 months) ’’ and insert-
ing ‘‘the 12-month period beginning on the 
date’’. 
(2) TITLE
XXI.—Section 2102(b)(2) of such 
Act (42 U.S.C. 1397bb(b)(2)) is amended by adding 
at the end the following: ‘‘Such methods shall pro-
vide continuous eligibility for children under this 
title in a manner that is no less generous than the 
12-months continuous eligibility provided under sec-
tion 1902(e)(12) for children described in such sec-
tion under title XIX. If a State has elected to apply 
section 1902(e)(12) to parents, such methods may
provide continuous eligibility for parents under this 
title in a manner that is no less generous than the 
12-months continuous eligibility provided under such 
section for parents described in such section under 
title XIX.’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall take effect on July 1, 2004 
(or, if later, 60 days after the date of the enactment 
of this Act), whether or not regulations imple-
menting such amendments have been issued. 
(c) PROVISION OF MEDICAID AND CHIP APPLICA-
TIONS AND INFORMATION UNDER THE SCHOOL LUNCH 
PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell 
National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 
amended—
(1) by striking ‘‘(B) Applications’’ and inserting 
‘‘(B)(i) Applications’’; and 
(2) by adding at the end the following: 
‘‘(ii)(I) Applications for free and reduced price 
lunches that are distributed pursuant to clause (i) to par-
ents or guardians of children in attendance at schools par-
ticipating in the school lunch program under this Act shall 
also contain information on the availability of medical as-
sistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and of child health and FamilyCare
assistance under title XXI of such Act, including informa-
tion on how to obtain an application for assistance under 
such programs. 
‘‘(II) Information on the programs referred to in sub-
clause (I) shall be provided on a form separate from the 
application form for free and reduced price lunches under 
clause (i).’’. 
SEC. 107. DEMONSTRATION PROGRAMS TO IMPROVE MED-
ICAID AND CHIP OUTREACH TO HOMELESS 
INDIVIDUALS AND FAMILIES. 
(a) AUTHORITY.—The Secretary of Health and 
Human Services may award demonstration grants to not 
more than 7 States (or other qualified entities) to conduct 
innovative programs that are designed to improve out-
reach to homeless individuals and families under the pro-
grams described in subsection (b) with respect to enroll-
ment of such individuals and families under such pro-
grams and the provision of services (and coordinating the 
provision of such services) under such programs. 
(b) PROGRAMS FOR HOMELESS DESCRIBED.—The 
programs described in this subsection are as follows: 
(1) MEDICAID.—The program under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.). 
(2) CHIP.—The program under title XXI of 
the Social Security Act (42 U.S.C. 1397aa et seq.).
(3) TANF.—The program under part of A of 
title IV of the Social Security Act (42 U.S.C. 601 
et seq.). 
(4) SAMHSA BLOCK GRANTS.—The program 
of grants under part B of title XIX of the Public 
Health Service Act (42 U.S.C. 300x–1 et seq.). 
(5) FOOD
STAMP
PROGRAM.—The program 
under the Food Stamp Act of 1977 (7 U.S.C. 2011 
et seq.). 
(6) WORKFORCE INVESTMENT ACT.—The pro-
gram under the Workforce Investment Act of 1999 
(29 U.S.C. 2801 et seq.). 
(7) WELFARE-TO-WORK.—The welfare-to-work 
program under section 403(a)(5) of the Social Secu-
rity Act (42 U.S.C. 603(a)(5)). 
(8) OTHER PROGRAMS.—Other public and pri-
vate benefit programs that serve low-income individ-
uals. 
(c) APPROPRIATIONS.—For the purposes of carrying 
out this section, there is appropriated for fiscal year 2004, 
out of any funds in the Treasury not otherwise appro-
priated, $10,000,000, to remain available until expended. 
SEC. 108. ADDITIONAL CHIP REVISIONS.
(a) LIMITING COST-SHARING TO 2.5 PERCENT FOR 
FAMILIES WITH INCOME BELOW 150 PERCENT OF POV-
ERTY.—Section 2103(e)(3)(A) of the Social Security Act 
(42 U.S.C. 1397cc(e)(3)(A)) is amended—
(1) by striking ‘‘and’’ at the end of clause (i); 
(2) by striking the period at the end of clause 
(ii) and inserting ‘‘; and’’; and 
(3) by adding at the end the following new 
clause: 
‘‘(iii) total annual aggregate cost-
sharing described in clauses (i) and (ii) 
with respect to all such targeted low-in-
come children in a family under this title 
that exceeds 2.5 percent of such family’s 
income for the year involved.’’. 
(b) EMPLOYER COVERAGE WAIVER CHANGES.—Sec-
tion 2105(c)(3) of such Act (42 U.S.C. 1397ee(c)(3)) is 
amended—
(1) by redesignating subparagraphs (A) and 
(B) as clauses (i) and (ii) and indenting appro-
priately; 
(2) by designating the matter beginning with 
‘‘Payment may be made’’ as a subparagraph (A) 
with the heading ‘‘IN GENERAL’’ and indenting ap-
propriately; and 
(3) by adding at the end the following new sub-
paragraph:
‘‘(B) APPLICATION OF REQUIREMENTS.—
In carrying out subparagraph (A)—
‘‘(i) in determining cost-effectiveness, 
the Secretary shall measure against family 
coverage costs to the extent that a State 
has expanded coverage to parents pursuant 
to section 2111; 
‘‘(ii) subject to clause (iii), the State 
shall provide satisfactory assurances that 
the minimum benefits and cost-sharing 
protections established under this title are 
provided, either through the coverage 
under subparagraph (A) or as a supple-
ment to such coverage; and 
‘‘(iii) coverage under such subpara-
graph shall not be considered to violate 
clause (ii) because it does not comply with 
requirements relating to reviews of health 
service decisions if the enrollee involved is 
provided the option of being provided bene-
fits directly under this title.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section apply as of January 1, 2004, whether or not 
regulations implementing such amendments have been 
issued.
SEC. 109. COORDINATION OF TITLE XXI WITH THE MATER-
NAL AND CHILD HEALTH PROGRAM. 
(a) IN GENERAL.—Section 2102(b)(3) of the Social 
Security Act (42 U.S.C. 1397bb(b)(3)) is amended—
(1) in subparagraph (D), by striking ‘‘and’’ at 
the end; 
(2) in subparagraph (E), by striking the period 
and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(F) that operations and activities under 
this title are developed and implemented in con-
sultation and coordination with the program op-
erated by the State under title V in areas in-
cluding outreach and enrollment, benefits and 
services, service delivery standards, public 
health and social service agency relationships, 
and quality assurance and data reporting.’’. 
(b) CONFORMING MEDICAID AMENDMENT.—Section 
1902(a)(11) of such Act (42 U.S.C. 1396a(a)(11)) is 
amended—
(1) by striking ‘‘and’’ before ‘‘(C)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (D) provide that operations and 
activities under this title are developed and imple-
mented in consultation and coordination with the
program operated by the State under title V in areas 
including outreach and enrollment, benefits and 
services, service delivery standards, public health 
and social service agency relationships, and quality 
assurance and data reporting’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on January 1, 2004. 
Subtitle B—State Option To Pro-
vide Coverage for All Residents 
With Income At or Below the 
Poverty Line 
SEC. 121. STATE OPTION TO PROVIDE COVERAGE FOR ALL 
RESIDENTS WITH INCOME AT OR BELOW THE 
POVERTY LINE. 
(a) IN GENERAL.—Section 1902(a)(10)(A)(ii) of the 
Social Security Act (42 U.S.C. 1396a(a)(10)(A)(ii)) is 
amended—
(1) by striking ‘‘or’’ at the end of subclause 
(XVII); 
(2) by adding ‘‘or’’ at the end of subclause 
(XVIII); and 
(3) by adding at the end the following new sub-
clause: 
‘‘(XIX) any individual whose 
family income does not exceed 100
percent of the income official poverty 
line (as defined by the Office of Man-
agement and Budget, and revised an-
nually in accordance with section 
673(2) of the Omnibus Budget Rec-
onciliation Act of 1981) applicable to 
a family of the size involved and who 
is not otherwise eligible for medical 
assistance under this title;’’. 
(b) CONFORMING AMENDMENTS.—
(1) Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in the matter before para-
graph (1)—
(A) by striking ‘‘or’’ at the end of clause 
(xii); 
(B) by adding ‘‘or’’ at the end of clause 
(xiii); and 
(C) by inserting after clause (xiii) the fol-
lowing new clause: 
‘‘(xii) 
individuals 
described 
in 
section 
1902(a)(10)(A)(ii)(XIX),’’. 
(2) Section 1903(f)(4) of such Act (42 U.S.C. 
1396b(f)(4)) 
is 
amended 
by 
inserting 
‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after 
‘‘1902(a)(10)(A)(ii)(XVIII),’’.
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on October 1, 2004. 
Subtitle C—Optional Coverage of 
Legal 
Immigrants 
under 
the 
Medicaid Program and Title XXI 
SEC. 131. EQUAL ACCESS TO HEALTH COVERAGE FOR 
LEGAL IMMIGRANTS. 
(a) IN GENERAL.—Section 401(b)(1) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1611(b)(1)) is amended—
(1) by striking subparagraph (A) and inserting 
the following: 
‘‘(A) Medical assistance under title XIX of 
the Social Security Act.’’; and 
(2) by adding at the end the following: 
‘‘(F) Child health assistance under title 
XXI of the Social Security Act.’’. 
(b) CONFORMING AMENDMENTS.—
(1) Section 402(b) of the Personal Responsi-
bility and Work Opportunity Reconciliation Act of 
1996 (8 U.S.C. 1612(b)) is amended—
(A) in paragraph (2)—
(i) in subparagraph (A)—
(I) by striking clause (i);
(II) by redesignating clause (ii) 
as subparagraph (A) and realigning 
the margins accordingly; and 
(III) by redesignating subclauses 
(I) through (V) of subparagraph (A), 
as so redesignated, as clauses (i) 
through (v), respectively and realign-
ing the margins accordingly; and 
(ii) by striking subparagraphs (E) and 
(F); and 
(B) in paragraph (3), by striking subpara-
graph (C). 
(2) Section 403 of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1613)) is amended— 
(A) in subsection (c), by adding at the end 
the following: 
‘‘(M) Child health assistance provided 
under title XXI of the Social Security Act.’’; 
and 
(B) in subsection (d)(1), by striking ‘‘pro-
grams specified in subsections (a)(3) and 
(b)(3)(C)’’ and inserting ‘‘program specified in 
subsection (a)(3)’’.
(3) Section 421 of the Personal Responsibility 
and Work Opportunity Reconciliation Act of 1996 (8 
U.S.C. 1631)) is amended by adding at the end the 
following: 
‘‘(g) EXCEPTIONS.—This section shall not apply to—
‘‘(1) medical assistance provided under a State 
plan approved under title XIX of the Social Security 
Act; and 
‘‘(2) child health assistance provided under title 
XXI of the Social Security Act.’’. 
(4) Section 423(d) of the Personal Responsi-
bility and Work Opportunity Reconciliation Act of 
1996 is amended by adding at the end the following: 
‘‘(12) Child health assistance provided under 
title XXI of the Social Security Act.’’. 
(c) EFFECTIVE DATE.—
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
take effect on the date of enactment of this Act and 
apply to medical assistance provided under title XIX 
of the Social Security Act and child health assist-
ance provided under title XXI of the Social Security 
Act on or after that date. 
(2) REQUIREMENTS FOR SPONSOR’S AFFIDAVIT 
OF SUPPORT.—Section 423(d) of the Personal Re-
sponsibility and Work Opportunity Reconciliation 
Act of 1996 shall be applied as if the amendments 
made by this Act were enacted on December 1, 
2002. 
Subtitle D—Indian Healthcare 
Funding 
CHAPTER 1—GUARANTEED FUNDING 
SEC. 141. GUARANTEED ADEQUATE FUNDING FOR INDIAN 
HEALTHCARE. 
Section 825 of the Indian Health Care Improvement 
Act (25 U.S.C. 1680o) is amended to read as follows: 
‘‘SEC. 825. FUNDING. 
‘‘(a) IN GENERAL.—Notwithstanding any other pro-
vision of law, not later than 30 days after the date of en-
actment of this section, on October 1, 2003, and on each 
October 1 thereafter, out of any funds in the Treasury 
not otherwise appropriated, the Secretary of the Treasury 
shall transfer to the Secretary to carry out this title the 
amount determined under subsection (d). 
‘‘(b) USE AND AVAILABILITY.—
‘‘(1) IN
GENERAL.—An amount transferred 
under subsection (a)—
‘‘(A) shall remain available until expended; 
and
‘‘(B) shall be used to carry out any pro-
grams, functions, and activities relating to clin-
ical services (as defined in paragraph (2)) of 
the Service and Service units. 
‘‘(2) CLINICAL SERVICES DEFINED.—For pur-
poses of paragraph (1)(B), the term ‘clinical serv-
ices’ includes all programs of the Indian Health 
Service which are funded directly or under the au-
thority of the Indian Self-Determination and Edu-
cation Assistance Act, for the purposes of—
‘‘(A) clinical care, including inpatient care, 
outpatient care (including audiology, clinical eye 
and vision care), primary care, secondary and 
tertiary care, and long term care; 
‘‘(B) preventive health, including mam-
mography and other cancer screening; 
‘‘(C) dental care; 
‘‘(D) mental health, including community 
mental health services, inpatient mental health 
services, dormitory mental health services, 
therapeutic and residential treatment centers; 
‘‘(E) emergency medical services; 
‘‘(F) treatment and control of, and reha-
bilitative care related to, alcoholism and drug
abuse (including fetal alcohol syndrome) among 
Indians; 
‘‘(G) accident prevention programs; 
‘‘(H) home healthcare; 
‘‘(I) community health representatives; 
‘‘(J) maintenance and repair; and 
‘‘(K) traditional healthcare practices and 
training of traditional healthcare practitioners. 
‘‘(c) RECEIPT
AND ACCEPTANCE.—The Secretary 
shall be entitled to receive, shall accept, and shall use to 
carry out this title the funds transferred under subsection 
(a), without further appropriation. 
‘‘(d) AMOUNT.—The amount referred to in sub-
section (a) is—
‘‘(1) for fiscal year 2004, the amount equal to 
390 percent of the amount obligated by the Service 
during fiscal year 2002 for the purposes described in 
subsection (b)(2); and 
‘‘(2) for fiscal year 2005 and each fiscal year 
thereafter, the amount equal to the product obtained 
by multiplying—
‘‘(A) the number of Indians served by the 
Service as of September 30 of the preceding the 
fiscal year; and
‘‘(B) the per capita baseline amount, as 
determined under subsection (e). 
‘‘(e) PER CAPITA BASELINE AMOUNT.—
‘‘(1) IN GENERAL.—For the purpose of sub-
section (d)(2)(B), the per capita baseline amount 
shall be equal to the sum of—
‘‘(A) the quotient obtained by dividing—
‘‘(i) the amount specified in sub-
section (d)(1); by 
‘‘(ii) the number of Indians served by 
the Service as of September 30, 2002; and 
‘‘(B) any applicable increase under para-
graph (2). 
‘‘(2) INCREASE.—For each fiscal year, the Sec-
retary shall provide a percentage increase (rounded 
to the nearest dollar) in the per capita baseline 
amount equal to the percentage by which—
‘‘(A) the Consumer Price Index for all 
Urban Consumers published by the Department 
of Labor (relating to the United States city av-
erage for medical care and not seasonally ad-
justed) for the 1-year period ending on the 
June 30 of the fiscal year preceding the fiscal 
year for which the increase is made; exceeds
‘‘(B) that Consumer Price Index for the 1-
year period preceding the 1-year period de-
scribed in subparagraph (A).’’. 
CHAPTER 2—INDIAN HEALTHCARE 
PROGRAMS 
SEC. 145. PROGRAMS OPERATED BY INDIAN TRIBES AND 
TRIBAL ORGANIZATIONS. 
The Service shall provide funds for healthcare pro-
grams and facilities operated by Indian tribes and tribal 
organizations under funding agreements with the Service 
entered into under the Indian Self-Determination and 
Education Assistance Act on the same basis as such funds 
are provided to programs and facilities operated directly 
by the Service. 
SEC. 146. LICENSING. 
Healthcare professionals employed by Indian tribes 
and tribal organizations to carry out agreements under the 
Indian Self-Determination and Education Assistance Act, 
shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the agreement is per-
formed. 
SEC. 147. AUTHORIZATION FOR EMERGENCY CONTRACT 
HEALTH SERVICES. 
With respect to an elderly Indian or an Indian with 
a disability receiving emergency medical care or services
from a non-Service provider or in a non-Service facility 
under the authority of the Indian Health Care Improve-
ment Act, the time limitation (as a condition of payment) 
for notifying the Service of such treatment or admission 
shall be 30 days. 
SEC. 148. PROMPT ACTION ON PAYMENT OF CLAIMS. 
(a) REQUIREMENT.—The Service shall respond to a 
notification of a claim by a provider of a contract care 
service with either an individual purchase order or a denial 
of the claim within 5 working days after the receipt of 
such notification. 
(b) FAILURE TO RESPOND.—If the Service fails to 
respond to a notification of a claim in accordance with 
subsection (a), the Service shall accept as valid the claim 
submitted by the provider of a contract care service. 
(c) PAYMENT.—The Service shall pay a valid contract 
care service claim within 30 days after the completion of 
the claim. 
SEC. 149. LIABILITY FOR PAYMENT. 
(a) NO LIABILITY.—A patient who receives contract 
healthcare services that are authorized by the Service shall 
not be liable for the payment of any charges or costs asso-
ciated with the provision of such services. 
(b) NOTIFICATION.—The Secretary shall notify a 
contract care provider and any patient who receives con-
tract healthcare services authorized by the Service that 
such patient is not liable for the payment of any charges 
or costs associated with the provision of such services. 
(c) LIMITATION.—Following receipt of the notice pro-
vided under subsection (b), or, if a claim has been deemed 
accepted under section 154(b), the provider shall have no 
further recourse against the patient who received the serv-
ices involved. 
SEC. 150. HEALTH SERVICES FOR INELIGIBLE PERSONS. 
(a) INELIGIBLE PERSONS.—
(1) IN GENERAL.—Any individual who—
(A) has not attained 19 years of age; 
(B) is the natural or adopted child, step-
child, foster-child, legal ward, or orphan of an 
eligible Indian; and 
(C) is not otherwise eligible for the health 
services provided by the Service, 
shall be eligible for all health services provided by 
the Service on the same basis and subject to the 
same rules that apply to eligible Indians until such 
individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be 
taken into consideration by the Service in deter-
mining the need for, or the allocation of, the health 
resources of the Service. If such an individual has
been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall re-
main eligible for such services until one year after 
the date such disability has been removed. 
(2) SPOUSES.—Any spouse of an eligible Indian 
who is not an Indian, or who is of Indian descent 
but not otherwise eligible for the health services pro-
vided by the Service, shall be eligible for such health 
services if all of such spouses or spouses who are 
married to members of the Indian tribe being served 
are made eligible, as a class, by an appropriate reso-
lution of the governing body of the Indian tribe or 
tribal organization providing such services. The 
health needs of persons made eligible under this 
paragraph shall not be taken into consideration by 
the Service in determining the need for, or allocation 
of, its health resources. 
(b) PROGRAMS AND SERVICES.—
(1) PROGRAMS.—
(A) IN
GENERAL.—The Secretary may 
provide health services under this subsection 
through health programs operated directly by 
the Service to individuals who reside within the 
service area of a service unit and who are not 
eligible for such health services under any other
subsection of this section or under any other 
provision of law if—
(i) the Indian tribe (or, in the case of 
a multi-tribal service area, all the Indian 
tribes) served by such service unit requests 
such provision of health services to such 
individuals; and 
(ii) the Secretary and the Indian tribe 
or tribes have jointly determined that—
(I) the provision of such health 
services will not result in a denial or 
diminution of health services to eligi-
ble Indians; and 
(II) there is no reasonable alter-
native health program or services, 
within or without the service area of 
such service unit, available to meet 
the health needs of such individuals. 
(B) FUNDING AGREEMENTS.—In the case 
of health programs operated under a funding 
agreement entered into under the Indian Self-
Determination and Educational Assistance Act, 
the governing body of the Indian tribe or tribal 
organization providing health services under 
such funding agreement is authorized to deter-
mine whether health services should be provided 
under such funding agreement to individuals 
who are not eligible for such health services 
under any other subsection of this section or 
under any other provision of law. In making 
such determinations, the governing body of the 
Indian tribe or tribal organization shall take 
into account the considerations described in 
subparagraph (A)(ii). 
(2) LIABILITY FOR PAYMENT.—
(A) 
IN
GENERAL.—Persons 
receiving 
health services provided by the Service by rea-
son of this subsection shall be liable for pay-
ment of such health services under a schedule 
of charges prescribed by the Secretary which, in 
the judgment of the Secretary, results in reim-
bursement in an amount not less than the ac-
tual cost of providing the health services. Not-
withstanding section 1880 of the Social Secu-
rity Act or any other provision of law, amounts 
collected under this subsection, including medi-
care or medicaid reimbursements under titles 
XVIII and XIX of the Social Security Act, shall 
be credited to the account of the program pro-
viding the service and shall be used solely for
the provision of health services within that pro-
gram. Amounts collected under this subsection 
shall be available for expenditure within such 
program for not to exceed 1 fiscal year after 
the fiscal year in which collected. 
(B) SERVICES FOR INDIGENT PERSONS.—
Health services may be provided by the Sec-
retary through the Service under this sub-
section to an indigent person who would not be 
eligible for such health services but for the pro-
visions of paragraph (1) only if an agreement 
has been entered into with a State or local gov-
ernment under which the State or local govern-
ment agrees to reimburse the Service for the 
expenses incurred by the Service in providing 
such health services to such indigent person. 
(3) SERVICE AREAS.—
(A) SERVICE TO ONLY ONE TRIBE.—In the 
case of a service area which serves only one In-
dian tribe, the authority of the Secretary to 
provide health services under paragraph (1)(A) 
shall terminate at the end of the fiscal year suc-
ceeding the fiscal year in which the governing 
body of the Indian tribe revokes its concurrence 
to the provision of such health services.
(B) MULTI-TRIBAL AREAS.—In the case of 
a multi-tribal service area, the authority of the 
Secretary to provide health services under para-
graph (1)(A) shall terminate at the end of the 
fiscal year succeeding the fiscal year in which at 
least 51 percent of the number of Indian tribes 
in the service area revoke their concurrence to 
the provision of such health services. 
(c) PURPOSE FOR PROVIDING SERVICES.—The Serv-
ice may provide health services under this subsection to 
individuals who are not eligible for health services provided 
by the Service under any other subsection of this section 
or under any other provision of law in order to—
(1) achieve stability in a medical emergency; 
(2) prevent the spread of a communicable dis-
ease or otherwise deal with a public health hazard; 
(3) provide care to non-Indian women pregnant 
with an eligible Indian’s child for the duration of the 
pregnancy through post partum; or 
(4) provide care to immediate family members 
of an eligible person if such care is directly related 
to the treatment of the eligible person. 
(d) HOSPITAL PRIVILEGES.—Hospital privileges in 
health facilities operated and maintained by the Service 
or operated under a contract entered into under the Indian
Self-Determination Education Assistance Act may be ex-
tended to non-Service healthcare practitioners who provide 
services to persons described in subsection (a) or (b). Such 
non-Service healthcare practitioners may be regarded as 
employees of the Federal Government for purposes of sec-
tion 1346(b) and chapter 171 of title 28, United States 
Code (relating to Federal tort claims) only with respect 
to acts or omissions which occur in the course of providing 
services to eligible persons as a part of the conditions 
under which such hospital privileges are extended. 
(e) DEFINITION.—In this section, the term ‘‘eligible 
Indian’’ means any Indian who is eligible for health serv-
ices provided by the Service without regard to the provi-
sions of this section. 
SEC. 151. DEFINITIONS. 
For purposes of this chapter, the definitions con-
tained in section 4 of the Indian Health Care Improve-
ment Act shall apply. 
SEC. 152. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal 
year 2015 to carry out this chapter.
Subtitle E—Territories 
SEC. 161. FUNDING FOR TERRITORIES. 
(a) TEMPORARY ELIMINATION OF SPENDING CAP.—
Section 1108 of the Social Security Act (42 U.S.C. 1308) 
is amended—
(1) in subsection (f), by striking ‘‘subsection 
(g)’’ and inserting ‘‘subsections (g) and (h)’’; and 
(2) by adding at the end the following: 
‘‘(h) TEMPORARY ELIMINATION OF CAPS.—With re-
spect to each of fiscal years 2004 through 2007, the Sec-
retary shall make payments under title XIX to Puerto 
Rico, the Virgin Islands, Guam, the Northern Mariana Is-
lands, and American Samoa without regard to the limita-
tions on the amount of such payments imposed under sub-
sections (f) and (g).’’. 
(b) TEMPORARY INCREASE
IN FMAP.—The first 
sentence of section 1905(b) of the Social Security Act (42 
U.S.C. 1396d(b)) is amended by inserting ‘‘(except that, 
only with respect to fiscal years 2004 through 2007 and 
only for purposes of expenditures under this title, such 
percentage shall be 77 percent)’’ after ‘‘50 per centum’’.
Subtitle F—Migrant Workers and 
Farmworkers Health 
SEC. 171. DEMONSTRATION PROJECT REGARDING CON-
TINUITY OF COVERAGE OF MIGRANT WORK-
ERS AND FARMWORKERS UNDER MEDICAID 
AND CHIP. 
(a) AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall conduct a demonstration 
project for the purpose of evaluating methods for 
strengthening the health coverage of, and continuity 
of coverage of, migrant workers and farmworkers 
under the medicaid and State children’s health in-
surance programs (42 U.S.C. 1396 et seq., 1397aa 
et seq.). 
(2) WAIVER
AUTHORITY.—The Secretary of 
Health and Human Services shall waive compliance 
with the requirements of titles XI, XIX, and XXI of 
the Social Security Act (42 U.S.C. 1301 et seq, 
1396 et seq., 1397aa et seq.) to such extent and for 
such period as the Secretary determines is necessary 
to conduct the demonstration project under this sec-
tion.
(b) REQUIREMENTS.—The demonstration project 
conducted under this section shall provide for—
(1) uniform eligibility criteria under the med-
icaid and State children’s health insurance programs 
with respect to migrant workers and farmworkers; 
and 
(2) the portability of coverage of such workers 
under those programs between participating States. 
(c) REPORT.—Not later than March 31, 2005, the 
Secretary of Health and Human Services shall submit a 
report to Congress on the demonstration project con-
ducted under this section that contains such recommenda-
tions for legislative action as the Secretary determines is 
appropriate. 
Subtitle G—Expanded Access to 
Health Care 
SEC. 181. NATIONAL COMMISSION FOR EXPANDED ACCESS 
TO HEALTH CARE. 
(a) ESTABLISHMENT.—There is established a com-
mission to be known as the National Commission for Ex-
panded Access to Health Care (referred to in this section 
as the ‘‘Commission’’). 
(b) APPOINTMENT OF MEMBERS.—
(1) IN GENERAL.—Not later than 45 days after 
the date of enactment of this Act—
(A) the majority and minority leaders of 
the Senate and the Speaker and minority leader 
of the House of Representatives shall each ap-
point 7 members of the Commission; and 
(B) the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Sec-
retary’’) shall appoint 1 member of the Com-
mission. 
(2) CRITERIA.—Members of the Commission 
shall include representatives of the following: 
(A) Consumers of health insurance. 
(B) Health care professionals. 
(C) State and territorial officials. 
(D) Health economists. 
(E) Health care providers. 
(F) Experts on health insurance. 
(G) Experts on expanding health care to 
individuals who are uninsured. 
(H) Experts on the elimination of racial 
and ethnic health disparities. 
(I) Experts on health care in the United 
States territories. 
(3) CHAIRPERSON.—At the first meeting of the 
Commission, the Commission shall select a Chair-
person from among its members.
(c) MEETINGS.—
(1) IN GENERAL.—After the initial meeting of 
the Commission, which shall be called by the Sec-
retary, the Commission shall meet at the call of the 
Chairperson. 
(2) QUORUM.—A majority of the members of 
the Commission shall constitute a quorum, but a 
lesser number of members may hold hearings. 
(3) SUPERMAJORITY VOTING REQUIREMENT.—
To approve a report required under paragraph (1), 
(2), or (3) of subsection (e), at least 60 percent of 
the membership of the Commission must vote in 
favor of such a report. 
(d) DUTIES.—The Commission shall—
(1) assess the effectiveness of programs de-
signed to expand health care coverage or make 
health care coverage affordable to uninsured individ-
uals by identifying the accomplishments and needed 
improvements of each program; 
(2) make recommendations regarding the bene-
fits and cost-sharing that should be included in 
health care coverage for various groups, taking into 
account—
(A) the special health care needs of chil-
dren and individuals with disabilities;
(B) the different ability of various popu-
lations to pay out-of-pocket costs for services; 
(C) incentives for efficiency and cost-con-
tainment; 
(D) racial and ethnic disparities in health 
status and health care; 
(E) incremental changes to the United 
States health care delivery system and changes 
to achieve fundamental restructuring of the sys-
tem; 
(F) populations who are traditionally more 
difficult to cover, including immigrants and 
homeless persons; 
(G) preventive care, diagnostic services, 
disease management services, and other factors; 
(H) quality improvement initiatives among 
health institutions serving disadvantaged pa-
tient populations; and 
(I) the feasibility of and barriers to the de-
velopment of a comprehensive system of health 
care; 
(3) recommend mechanisms to expand health 
care coverage to uninsured individuals; 
(4) recommend automatic enrollment and reten-
tion procedures and other measures to increase
health care coverage among those eligible for assist-
ance; and 
(5) analyze the size, effectiveness, and efficiency 
of current tax and other subsidies for health care 
coverage and recommend improvements. 
(e) REPORTS.—
(1) ANNUAL REPORTS.—The Commission shall 
submit annual reports to the President and the ap-
propriate committees of Congress addressing the 
matters identified in subsection (d). 
(2) BIENNIAL REPORT.—The Commission shall 
submit biennial reports to the President and the ap-
propriate committees of Congress containing—
(A) recommendations concerning essential 
benefits and maximum out-of-pocket cost-shar-
ing for—
(i) the general population; and 
(ii) individuals with limited ability to 
pay; and 
(B) proposed legislative language to imple-
ment such recommendations. 
(3) COMMISSION REPORT.—Not later than Jan-
uary 15, 2007, the Commission shall submit a re-
port to the President and the appropriate commit-
tees of Congress, which shall include—
(A) recommendations on policies to provide 
health care coverage to uninsured individuals; 
(B) recommendations on changes to poli-
cies enacted under this Act; and 
(C) proposed legislative language to imple-
ment such recommendations. 
(f) ADMINISTRATION.—
(1) POWERS.—
(A) HEARINGS.—The Commission may 
hold such hearings, sit and act at such times 
and places, take such testimony, and receive 
such evidence as the Commission considers ad-
visable to carry out this section. 
(B) INFORMATION FROM FEDERAL AGEN-
CIES.—The Commission may secure directly 
from any Federal department or agency such 
information as the Commission considers nec-
essary to carry out this section. Upon request 
of the Chairperson of the Commission, the head 
of such department or agency shall furnish such 
information to the Commission. 
(C) POSTAL SERVICES.—The Commission 
may use the United States mails in the same 
manner and under the same conditions as other
departments and agencies of the Federal Gov-
ernment. 
(D) GIFTS.—The Commission may accept, 
use, and dispose of donations of services or 
property. 
(2) COMPENSATION.—
(A) IN GENERAL.—Each member of the 
Commission who is not an officer or employee 
of the Federal Government shall be com-
pensated at a rate equal to the daily equivalent 
of the annual rate of basic pay prescribed for 
level IV of the Executive Schedule under section 
5315 of title 5, United States Code, for each 
day (including travel time) during which such 
member is engaged in the performance of duties 
of the Commission. All members of the Com-
mission who are officers or employees of the 
United States shall serve without compensation 
in addition to that received for their services as 
officers or employees of the United States. 
(B) TRAVEL EXPENSES.—The members of 
the Commission shall be allowed travel ex-
penses, as authorized by the Chairperson of the 
Commission, including per diem in lieu of sub-
sistence, at rates authorized for employees of
agencies under subchapter I of chapter 57 of 
title 5, United States Code, while away from 
their homes or regular places of business in the 
performance of services for the Commission. 
(3) STAFF.—
(A) IN GENERAL.—The Chairperson of the 
Commission may appoint an executive director 
such other staff as may be necessary to enable 
the Commission to perform its duties. The em-
ployment of an executive director shall be sub-
ject to confirmation by the Commission. 
(B) STAFF
COMPENSATION.—The Chair-
person of the Commission may fix the com-
pensation of personnel without regard to chap-
ter 51 and subchapter III of chapter 53 of title 
5, United States Code, relating to classification 
of positions and General Schedule pay rates, ex-
cept that the rate of pay for personnel may not 
exceed the rate payable for level V of the Exec-
utive Schedule under section 5316 of such title. 
(C) DETAIL
OF
GOVERNMENT
EMPLOY-
EES.—Any Federal Government employee may 
be detailed to the Commission without reim-
bursement, and such detail shall be without
interruption or loss of civil service status or 
privilege. 
(D) PROCUREMENT OF TEMPORARY AND 
INTERMITTENT SERVICES.—The Chairperson of 
the Commission may procure temporary and 
intermittent services under section 3109(b) of 
title 5, United States Code, at rates for individ-
uals which do not exceed the daily equivalent of 
the annual rate of basic pay prescribed for level 
V of the Executive Schedule under section 5316 
of such title. 
(g) TERMINATION.—Except with respect to activities 
in connection with the ongoing biennial report required 
under subsection (e)(2), the Commission shall terminate 
90 days after the date on which the Commission submits 
the report required under subsection (e)(3). 
(h) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
such sums as may be necessary for fiscal year 2005 and 
each subsequent fiscal year.
TITLE II—CULTURALLY AND LIN-
GUISTICALLY 
APPROPRIATE 
HEALTHCARE 
SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE XXIX—MINORITY HEALTH 
‘‘SEC. 2900. DEFINITIONS. 
‘‘In this title, the definitions contained in section 801 
of the Healthcare Equality and Accountability Act shall 
apply. 
‘‘Subtitle A—Culturally and Lin-
guistically 
Appropriate 
Healthcare 
‘‘SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVID-
UALS WITH LIMITED ENGLISH PROFICIENCY. 
‘‘(a) PURPOSE.—As provided in Executive Order 
13166, it is the purpose of this section—
‘‘(1) to improve access to Federally conducted 
and Federally assisted programs and activities for 
individuals who are limited in their English pro-
ficiency; 
‘‘(2) to require each Federal agency to examine 
the services it provides and develop and implement
a system by which limited English proficient individ-
uals can enjoy meaningful access to those services 
consistent with, and without substantially burdening, 
the fundamental mission of the agency; 
‘‘(3) to require each Federal agency to ensure 
that recipients of Federal financial assistance pro-
vide meaningful access to their limited English pro-
ficient applicants and beneficiaries; 
‘‘(4) to ensure that recipients of Federal finan-
cial assistance take reasonable steps, consistent with 
the guidelines set forth in the Limited English Pro-
ficient Guidance of the Department of Justice (as 
issued on June 12, 2002), to ensure meaningful ac-
cess to their programs and activities by limited 
English proficient individuals; and 
‘‘(5) to ensure compliance with title VI of the 
Civil Rights Act of 1964 and that healthcare pro-
viders and organizations do not discriminate in the 
provision of services. 
‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC-
TIVITIES.—
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency that carries out health care-related activities 
shall prepare a plan to improve access to the feder-
ally conducted health care-related programs and ac-
tivities of the agency by limited English proficient 
individuals. 
‘‘(2) PLAN REQUIREMENT.—Each plan under 
paragraph (1) shall be consistent with the standards 
set forth in section 204 of the Healthcare Equality 
and Accountability Act, and shall include the steps 
the agency will take to ensure that limited English 
proficient individuals have access to the agency’s 
health care-related programs and activities. Each 
agency shall send a copy of such plan to the Depart-
ment of Justice, which shall serve as the central re-
pository of the agencies’ plans. 
‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI-
TIES.—
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency providing health care-related Federal finan-
cial assistance shall ensure that the guidance for re-
cipients of Federal financial assistance developed by 
the agency to ensure compliance with title VI of the 
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 
is specifically tailored to the recipients of such as-
sistance and is consistent with the standards de-
scribed in section 204 of the Healthcare Equality
and Accountability Act. Each agency shall send a 
copy of such guidance to the Department of Justice 
which shall serve as the central repository of the 
agencies’ plans. After approval by the Department of 
Justice, each agency shall publish its guidance docu-
ment in the Federal Register for public comment. 
‘‘(2) 
REQUIREMENTS.—The 
agency-specific 
guidance developed under paragraph (1) shall—
‘‘(A) detail how the general standards es-
tablished under section 204 of the Healthcare 
Equality and Accountability Act will be applied 
to the agency’s recipients; and 
‘‘(B) take into account the types of health 
care services provided by the recipients, the in-
dividuals served by the recipients, and other 
factors set out in such standards. 
‘‘(3) EXISTING GUIDANCES.—A Federal agency 
that has developed a guidance for purposes of title 
VI of the Civil Rights Act of 1964 that the Depart-
ment of Justice determines is consistent with the 
standards described in section 204 of the Healthcare 
Equality and Accountability Act shall examine such 
existing guidance, as well as the programs and ac-
tivities to which such guidance applies, to determine
if modification of such guidance is necessary to com-
ply with this subsection. 
‘‘(4) CONSULTATION.—Each Federal agency 
shall consult with the Department of Justice in es-
tablishing the guidances under this subsection. 
‘‘(d) CONSULTATIONS.—
‘‘(1) IN GENERAL.—In carrying out this sec-
tion, each Federal agency that carriers out health 
care-related activities shall ensure that stakeholders, 
such as limited English proficient individuals and 
their representative organizations, recipients of Fed-
eral assistance, and other appropriate individuals or 
entities, have an adequate and comparable oppor-
tunity to provide input with respect to the actions of 
the agency. 
‘‘(2) EVALUATION
OF
NEEDS.—Each Federal 
agency described in paragraph (1) shall evaluate the 
particular needs of the limited English proficient in-
dividuals served by the agency, and by a recipient of 
assistance provided by the agency, and the burdens 
of compliance with the agency guidance and its re-
cipients of the requirements of this section.
‘‘SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTHCARE. 
‘‘Recipients of Federal financial assistance from the 
Secretary shall, to the extent reasonable and practicable 
after applying the 4-factor analysis described in title V 
of the Guidance to Federal Financial Assistance Recipi-
ents Regarding Title VI Prohibition Against National Ori-
gin Discrimination Affecting Limited-English Proficient 
Persons (June 12, 2002)—
‘‘(1) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
provide culturally and linguistically appropriate 
healthcare to patient populations of the service area 
of the organization; 
‘‘(2) ensure that staff at all levels and across all 
disciplines of the organization receive ongoing edu-
cation and training in culturally and linguistically 
appropriate service delivery; 
‘‘(3) offer and provide language assistance serv-
ices, including bilingual staff and interpreter serv-
ices, at no cost to each patient with limited English 
proficiency at all points of contact, in a timely man-
ner during all hours of operation;
‘‘(4) notify patients of their right to receive lan-
guage assistance services in their primary language; 
‘‘(5) ensure the competence of language assist-
ance provided to limited English proficient patients 
by interpreters and bilingual staff, and ensure that 
family and friends are not used to provide interpre-
tation services—
‘‘(A) except in case of emergency; or 
‘‘(B) except on request of the patient, who 
has been informed in his or her preferred lan-
guage of the availability of free interpretation 
services; 
‘‘(6) make available easily understood patient-
related materials including information or notices 
about termination of benefits and post signage in 
the languages of the commonly encountered groups 
or groups represented in the service area of the or-
ganization; 
‘‘(7) develop and implement clear goals, poli-
cies, operational plans, and management account-
ability and oversight mechanisms to provide cul-
turally and linguistically appropriate services; 
‘‘(8) conduct initial and ongoing organizational 
self-assessments of culturally and linguistically ap-
propriate services-related activities and integrate cul-
tural and linguistic competence-related measures 
into the internal audits, performance improvement 
programs, patient satisfaction assessments, and out-
comes-based evaluations of the organization; 
‘‘(9) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
mulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 (42 
U.S.C. 1320d–2 note)—
‘‘(A) data on the individual patient’s race, 
ethnicity, and primary language are collected in 
health records, integrated into the organiza-
tion’s management information systems, and 
periodically updated; and 
‘‘(B) if the patient is a minor or is inca-
pacitated, the primary language of the parent 
or legal guardian is collected; 
‘‘(10) maintain a current demographic, cultural, 
and epidemiological profile of the community as well 
as a needs assessment to accurately plan for and im-
plement services that respond to the cultural and 
linguistic characteristics of the service area of the 
organization; 
‘‘(11) develop participatory, collaborative part-
nerships with communities and utilize a variety of
formal and informal mechanisms to facilitate com-
munity and patient involvement in designing and im-
plementing culturally and linguistically appropriate 
services-related activities; 
‘‘(12) ensure that conflict and grievance resolu-
tion processes are culturally and linguistically sen-
sitive and capable of identifying, preventing, and re-
solving cross-cultural conflicts or complaints by pa-
tients; 
‘‘(13) regularly make available to the public in-
formation about their progress and successful inno-
vations in implementing the standards under this 
section and provide public notice in their commu-
nities about the availability of this information; and 
‘‘(14) regularly make available to the head of 
each Federal entity from which Federal funds are 
received, information about their progress and suc-
cessful innovations in implementing the standards 
under this section as required by the head of such 
entity. 
‘‘SEC. 2903. CENTER FOR CULTURAL AND LINGUISTIC COM-
PETENCE IN HEALTHCARE. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director of the Office of Minority Health, 
shall establish and support a center to be known as the
‘Center for Cultural and Linguistic Competence in 
Healthcare’ (referred to in this section as the ‘Center’) 
to carry out the following activities: 
‘‘(1) REMOTE
MEDICAL
INTERPRETATION.—
The Center shall provide remote medical interpreta-
tion, directly or through contract, at no cost to 
healthcare providers. Methods of interpretation may 
include remote, simultaneous or consecutive inter-
preting through telephonic systems, video confer-
encing, and other methods determined appropriate 
by the Secretary for patients with limited English 
proficiency. The quality of such interpretation shall 
be monitored and reported publicly. Nothing in this 
paragraph shall be construed to limit the ability of 
healthcare providers or organizations to provide 
medical interpretation services directly and obtain 
reimbursement for such services as provided for 
under the medicare, medicaid or SCHIP programs 
under titles XVIII, XIX, or XXI of the Social Secu-
rity Act. 
‘‘(2) TRANSLATION OF WRITTEN MATERIAL.—
The Center shall provide, directly or through con-
tract, for the translation of written materials for 
healthcare providers and healthcare organizations 
(as defined in section 2902(b)) at no cost to such
providers and organizations. Materials may be sub-
mitted for translation into non-English languages. 
Translation services shall be provided in a timely 
and reasonable manner. The quality of such trans-
lation shall be monitored and reported publicly. 
‘‘(3) MODEL
LANGUAGE
ASSISTANCE
PRO-
GRAMS.—The Center shall provide for the collection 
and dissemination of information on current model 
language assistance programs and strategies to im-
prove language access to healthcare for individuals 
with limited English proficiency, including case stud-
ies using de-identified patient information, program 
summaries, and program evaluations. 
‘‘(4) 
MEDICAL
INTERPRETATION
GUIDE-
LINES.—
‘‘(A) IN GENERAL.—The Center shall con-
vene a working group to develop quality guide-
lines and standards for the training of medical 
interpreters and translators. Such group shall 
include—
‘‘(i) representatives from the Office of 
Minority Health, the National Center on 
Minority Health and Health Disparities, 
the Agency for Healthcare Research and 
Quality, the Centers for Medicare and
Medicaid Services, the Office for Civil 
Rights of the Department of Health and 
Human Services, and other Federal agen-
cies determined appropriate by the Sec-
retary; and 
‘‘(ii) representatives of communities 
with a significant proportion of limited 
English proficient individuals, professional 
interpreter associations, medical interpre-
tation service providers, and other public 
or private organizations determined appro-
priate by the Secretary. 
‘‘(B) PUBLICATION.—Not later than 18 
months after the date of enactment of this Act, 
the Center shall publish guidelines and stand-
ards developed under this paragraph in the 
Federal Register. 
‘‘(5) INTERNET
HEALTH
CLEARINGHOUSE.—
The Center shall develop and maintain an Internet 
clearinghouse 
to 
reduce 
medical 
errors 
and 
healthcare costs caused by communication with indi-
viduals with limited English proficiency or low func-
tional health literacy and reduce or eliminate the du-
plication of effort to translate materials by—
‘‘(A) developing and making available tem-
plates for standard documents that are nec-
essary for patients and consumers to access and 
make educated decisions about their healthcare, 
including—
‘‘(i) administrative and legal docu-
ments such as informed consent, advanced 
directives, and waivers of rights; 
‘‘(ii) clinical information such as how 
to take medications, how to prevent trans-
mission of a contagious disease, and other 
prevention and treatment instructions; and 
‘‘(iii) patient education and outreach 
materials such as immunization notices, 
health warnings, or screening notices; 
‘‘(B) ensuring that the documents are 
posted in English and non-English languages 
and are culturally appropriate; 
‘‘(C) allowing public review of the docu-
ments before dissemination in order to ensure 
that the documents are understandable and cul-
turally appropriate for the target populations; 
‘‘(D) allowing healthcare providers to cus-
tomize the documents for their use;
‘‘(E) facilitating access to these docu-
ments; 
‘‘(F) providing technical assistance with 
respect to the access and use of such informa-
tion; and 
‘‘(G) carrying out any other activities the 
Secretary determines to be useful to fulfill the 
purposes of the Clearinghouse. 
‘‘(6) PROVISION OF INFORMATION.—The Cen-
ter shall provide information relating to culturally 
and linguistically competent healthcare for minority 
populations residing in the United States to all 
healthcare providers and healthcare organizations at 
no cost. Such information shall include—
‘‘(A) tenets of culturally and linguistically 
competent care; 
‘‘(B) cultural and linguistic competence 
self-assessment tools; 
‘‘(C) cultural and linguistic competence 
training tools; 
‘‘(D) strategic plans to increase cultural 
and linguistic competence in different types of 
healthcare organizations; and
‘‘(E) resources for cultural competence in-
formation for educators, practitioners and re-
searchers. 
‘‘(b) DIRECTOR.—The Center shall be headed by a 
Director to be appointed by the Director of the Office of 
Minority Health who shall report to the Director of the 
Office of Minority Health. 
‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di-
rector shall collaborate with the Administrator of the Cen-
ters for Medicare and Medicaid Services and the Adminis-
trator of the Health Resources and Services Administra-
tion, to notify healthcare providers and healthcare organi-
zations about the availability of language access services 
by the Center. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2904. INNOVATIONS IN LANGUAGE ACCESS GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Centers for Medicare and Med-
icaid Services, the Administrator of the Health Resources 
and Services Administration, and the Director of the Of-
fice of Minority Health, shall award grants to eligible enti-
ties to enable such entities to design, implement, and
evaluate innovative, cost-effective programs to improve lin-
guistic access to healthcare for individuals with limited 
English proficiency.
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall—
‘‘(1) be a city, county, Indian tribe, State, terri-
tory, 
community-based 
nonprofit 
organization, 
health center or community clinic, university, col-
lege, or other entity designated by the Secretary; 
and 
‘‘(2) prepare and submit to the Secretary an 
application, at such time, in such manner, and ac-
companied by such additional information as the 
Secretary may require. 
‘‘(c) USE OF FUNDS.—An entity shall use funds re-
ceived under a grant under this section to—
‘‘(1) develop, implement, and evaluate models of 
providing real-time interpretation services through 
in-person interpretation, communications, and com-
puter technology, including the Internet, teleconfer-
encing, or video conferencing; 
‘‘(2) develop short-term medical interpretation 
training 
courses 
and 
incentives 
for 
bilingual 
healthcare staff who are asked to interpret in the 
workplace;
‘‘(3) develop formal training programs for indi-
viduals interested in becoming dedicated healthcare 
interpreters; 
‘‘(4) provide language training courses for 
healthcare staff; 
‘‘(5) provide basic healthcare-related English 
language instruction for limited English proficient 
individuals; and 
‘‘(6) develop other language assistance services 
as determined appropriate by the Secretary. 
‘‘(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to entities that have 
developed partnerships with organizations or agencies with 
experience in language access services. 
‘‘(e) EVALUATION.—An entity that receives a grant 
under this section shall submit to the Secretary an evalua-
tion that describes the activities carried out with funds 
received under the grant, and how such activities improved 
access to healthcare services and the quality of healthcare 
for individuals with limited English proficiency. Such eval-
uation shall be collected and disseminated through the 
Center for Linguistic and Cultural Competence in 
Healthcare established under section 2903. 
‘‘(f) GRANTEE CONVENTION.—The Secretary, acting 
through the Director of the Center for Linguistic and Cul-
tural Competence in Healthcare, shall at the end of the 
grant cycle convene grantees under this section to share 
findings and develop and disseminate model programs and 
practices. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2905. RESEARCH ON LANGUAGE ACCESS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Agency for Healthcare Research and 
Quality, shall expand research concerning—
‘‘(1) the barriers to healthcare services that are 
faced by limited English proficient individuals; 
‘‘(2) the impact of language barriers on the 
quality of healthcare and the health status of limited 
English proficient individuals and populations; 
‘‘(3) healthcare provider attitudes, knowledge, 
and awareness of the barriers described in para-
graphs (1) and (2); and 
‘‘(4) the means by which oral or written lan-
guage interpretation services are provided to limited 
English proficient individuals and whether such serv-
ices are effective in improving the quality of care.
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2906. TOLL-FREE TELEPHONE NUMBER. 
‘‘The Secretary shall provide, through a toll-free 
number, for a means by which limited English proficient 
individuals who are seeking information about, or assist-
ance with, Federal healthcare programs who phone such 
toll-free number are transferred (without charge) to ap-
propriate translators for the provision of such information 
or assistance.’’. 
SEC. 203. STANDARDS FOR LANGUAGE ACCESS SERVICES. 
Not later than 120 days after the date of enactment 
of this Act, the head of each Federal agency that carries 
out health care-related activities shall develop and adopt 
a guidance on language services for those with limited 
English proficiency who attempt to have access to or par-
ticipate in such activities that provides at the minimum 
the factors and principles set forth in the Department of 
Justice guidance published on June 12, 2002.
SEC. 204. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID AND 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAM. 
(a) DEMONSTRATION PROJECT PROMOTING ACCESS 
FOR MEDICARE BENEFICIARIES WITH LIMITED ENGLISH 
PROFICIENCY.—
(1) IN GENERAL.—The Secretary shall conduct 
a demonstration project (in this section referred to 
as the ‘project’) to demonstrate the impact on costs 
and health outcomes of providing reimbursement for 
interpreter services to certain medicare beneficiaries 
who are limited English proficient in urban and 
rural areas. 
(2) SCOPE.—The Secretary shall carry out the 
project in not less than 30 States through contracts 
with up to—
(A) ten health plans (under part C of title 
XVIII of the Social Security Act); 
(B) ten small providers; and 
(C) ten hospitals. 
(3) DURATION.—Each contract entered into 
under the project shall extend over a period of not 
longer than 2 years.
100
(4) REPORT.—Upon completion of the project, 
the Secretary shall submit a report to Congress on 
the project which shall include recommendations re-
garding the extension of such project to the entire 
medicare program. 
(5) EVALUATION.—The Director of the Agency 
for Healthcare Research and Quality shall award 
grants to public and private nonprofit entities for 
the evaluation of the project. Such evaluations shall 
focus on access, utilization, efficiency, cost-effective-
ness, patient satisfaction, and select health out-
comes. 
(b) MEDICAID.—Section 1903(a)(3) of the Social Se-
curity Act (42 U.S.C. 1396b(a)(3)) is amended—
(1) in subparagraph (D), by striking ‘‘plus’’ at 
the end and inserting ‘‘and’’; and 
(2) by adding at the end the following: 
‘‘(E) 90 percent of the sums expended with 
respect to costs incurred during such quarter as 
are attributable to the provision of culturally 
and linguistically appropriate services, including 
oral interpretation, translations of written ma-
terials, and other cultural and linguistic services 
for individuals with limited English proficiency 
and disabilities who apply for, or receive, med-
101
ical assistance under the State plan (including 
any waiver granted to the State plan); plus’’.
(c) SCHIP.—Section 2105(a)(1) of the Social Secu-
rity Act (42 U.S.C.1397ee(a)), as amended by section 
515, is amended—
(1) in the matter preceding subparagraph (A), 
by inserting ‘‘or, in the case of expenditures de-
scribed in subparagraph (D)(iv), 90 percent’’ after 
‘‘enhanced FMAP’’; and 
(2) in subparagraph (D)—
(A) in clause (iii), by striking ‘‘and’’ at the 
end; 
(B) by redesignating clause (iv) as clause 
(v); and 
(C) by inserting after clause (iii) the fol-
lowing: 
‘‘(iv) for expenditures attributable to 
the provision of culturally and linguistically 
appropriate services, including oral inter-
pretation, translations of written materials, 
and other language services for individuals 
with limited English proficiency and dis-
abilities who apply for, or receive, child 
health assistance under the plan; and’’.
102
(d) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2005. 
SEC. 205. INCREASING UNDERSTANDING OF HEALTH LIT-
ERACY. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity and the Administrator of the Health Resources and 
Services Administration, shall award grants to eligible en-
tities to improve healthcare for patient populations that 
have low functional health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall—
(1) be a hospital, health center or clinic, health 
plan, or other health entity; and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
(c) USE OF FUNDS.—
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—Grants awarded under subsection (a) 
through the Agency for Healthcare Research and 
Quality shall be used—
(A) to define and increase the under-
standing of health literacy;
104
(F) other activities determined appropriate 
by the Administrator of the Health Resources 
and Services Administration. 
(d) DEFINITIONS.—In this section, the term ‘‘low 
health literacy’’ means the inability of an individual to ob-
tain, process, and understand basic health information 
and services needed to make appropriate health decisions. 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
SEC. 206. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTHCARE SERVICES. 
Not later than 1 year after the date of enactment 
of this Act and annually thereafter, the Secretary of 
Health and Human Services shall enter into a contract 
with the Institute of Medicine for the preparation and 
publication of a report that describes federal efforts to en-
sure that all individuals have meaningful access to cul-
turally and linguistically appropriate healthcare services. 
Such report shall include—
(1) a description and evaluation of the activities 
carried out under this title; and
105
(2) a description of best practices, model pro-
grams, guidelines, and other effective strategies for 
providing access to culturally and linguistically ap-
propriate healthcare services. 
SEC. 207. GENERAL ACCOUNTING OFFICE REPORT ON IM-
PACT OF LANGUAGE ACCESS SERVICES. 
Not later than 3 years after the date of enactment 
of this Act, the Comptroller General of the United States 
shall examine, and prepare and publish a report on, the 
impact of language access services on the health and 
healthcare of limited English proficient populations. Such 
report shall include—
(1) recommendations on the development and 
implementation 
of 
policies 
and 
practices 
by 
healthcare organizations and providers for limited 
English proficient patient populations; 
(2) a description of the effect of providing lan-
guage access services on quality of healthcare and 
access to care; and 
(3) a description of the costs associated with or 
savings related to provision of language access serv-
ices.
106
TITLE III—HEALTH WORKFORCE 
DIVERSITY 
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXIX of the Public Health Service Act, as 
added by section 202, is amended by adding at the end 
the following: 
‘‘Subtitle B—Workforce Diversity 
‘‘SEC. 2911. REPORT ON WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—Not later than July 1, 2006, and 
biannually thereafter, the Secretary, acting through the 
director of each entity within the Department of Health 
and Human Services, shall prepare and submit to the 
Committee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Commerce 
of the House of Representatives a report on health work-
force diversity. 
‘‘(b) REQUIREMENT.—The report under subsection 
(a) shall contain the following information: 
‘‘(1) A description of any grant support that is 
provided by each entity for workforce diversity ini-
tiatives with the following information—
‘‘(A) the number of grants made; 
‘‘(B) the purpose of the grants;
107
‘‘(C) the populations served through the 
grants; 
‘‘(D) the organizations and institutions re-
ceiving the grants; and 
‘‘(E) the tracking efforts that were used to 
follow the progress of participants. 
‘‘(2) A description of the entity’s plan to 
achieve workforce diversity goals that includes, to 
the extent relevant to such entity—
‘‘(A) the number of underrepresented mi-
nority health professionals that will be needed 
in various disciplines over the next 10 years to 
achieve population parity; 
‘‘(B) the level of funding needed to fully 
expand and adequately support health profes-
sions pipeline programs; 
‘‘(C) the impact such programs have had 
on the admissions practices and policies of 
health professions schools; 
‘‘(D) the management strategy necessary 
to effectively administer and institutionalize 
health profession pipeline programs; and 
‘‘(E) the impact that the Government Per-
formance and Results Act (GPRA) has had on 
evaluating the performance of grantees and
108
whether the GPRA is the best assessment tool 
for programs under titles VII and VIII. 
‘‘(3) A description of measurable objectives of 
each entity relating to workforce diversity initiatives. 
‘‘(c) PUBLIC AVAILABILITY.—The report under sub-
section (a) shall be made available for public review and 
comment. 
‘‘SEC. 2912. NATIONAL WORKING GROUP ON WORKFORCE 
DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Bureau of Health Professions within the Health Re-
sources and Services Administration, shall award a grant 
to an entity determined appropriate by the Secretary for 
the establishment of a national working group on work-
force diversity. 
‘‘(b) REPRESENTATION.—In establishing the national 
working group under subsection (a), the grantee shall en-
sure that the group has representation from the following 
entities: 
‘‘(1) The Health Resources and Services Ad-
ministration. 
‘‘(2) The Department of Health and Human 
Services Data Council. 
‘‘(3) The Bureau of Labor Statistics of the De-
partment of Labor.
109
‘‘(4) The Public Health Practice Program Of-
fice—Office of Workforce Policy and Planning. 
‘‘(5) The National Center on Minority Health 
and Health Disparities. 
‘‘(6) The Agency for Healthcare Research and 
Quality. 
‘‘(7) The Institute of Medicine Study Com-
mittee for the 2004 workforce diversity report. 
‘‘(8) The Indian Health Service. 
‘‘(9) Academic institutions. 
‘‘(10) Consumer organizations. 
‘‘(11) Health professional associations, includ-
ing those that represent underrepresented minority 
populations. 
‘‘(12) Researchers in the area of health work-
force. 
‘‘(13) Health workforce accreditation entities. 
‘‘(14) Private foundations that have sponsored 
workforce diversity initiatives. 
‘‘(15) Not less than 5 health professions stu-
dents representing various health profession fields 
and levels of training. 
‘‘(c) ACTIVITIES.—The working group established 
under subsection (a) shall convene at least twice each year 
to complete the following activities:
110
‘‘(1) Review current public and private health 
workforce diversity initiatives. 
‘‘(2) Identify successful health workforce diver-
sity programs and practices. 
‘‘(3) Examine challenges relating to the devel-
opment and implementation of health workforce di-
versity initiatives. 
‘‘(4) Draft a national strategic work plan for 
health workforce diversity, including recommenda-
tions for public and private sector initiatives. 
‘‘(5) Develop a framework and methods for the 
evaluation of current and future health workforce di-
versity initiatives. 
‘‘(6) Develop recommended standards for work-
force diversity that could be applicable to all health 
professions programs and programs funded under 
this Act. 
‘‘(7) Develop curriculum guidelines for diversity 
training. 
‘‘(8) Develop a strategy for the inclusion of 
community members on admissions committees for 
health profession schools. 
‘‘(9) Other activities determined appropriate by 
the Secretary.
111
‘‘(d) ANNUAL REPORT.—Not later than 1 year after 
the establishment of the working group under subsection 
(a), and annually thereafter, the working group shall pre-
pare and make available to the general public for com-
ment, an annual report on the activities of the working 
group. Such report shall include the recommendations of 
the working group for improving health workforce diver-
sity. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2913. TECHNICAL CLEARINGHOUSE FOR HEALTH 
WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Office of Minority Health, and in collaboration with 
the Bureau of Health Professions within the Health Re-
sources and Services Administration, shall establish a 
technical clearinghouse on health workforce diversity with-
in the Office of Minority Health and coordinate current 
and future clearinghouses. 
‘‘(b) INFORMATION AND SERVICES.—The clearing-
house established under subsection (a) shall offer the fol-
lowing information and services:
112
‘‘(1) Information on the importance of health 
workforce diversity. 
‘‘(2) Statistical information relating to under-
represented minority representation in health and al-
lied health professions and occupations. 
‘‘(3) Model health workforce diversity practices 
and programs. 
‘‘(4) Admissions policies that promote health 
workforce diversity and are in compliance with Fed-
eral and State laws. 
‘‘(5) Lists of scholarship, loan repayment, and 
loan cancellation grants as well as fellowship infor-
mation for underserved populations for health pro-
fessions schools. 
‘‘(6) Foundation and other large organizational 
initiatives relating to health workforce diversity. 
‘‘(c) CONSULTATION.—In carrying out this section, 
the Secretary shall consult with non-Federal entities which 
may include minority health professional associations to 
ensure the adequacy and accuracy of information. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010.
113
‘‘SEC. 2914. EVALUATION OF WORKFORCE DIVERSITY INI-
TIATIVES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Bureau of Health Professions within the Health Re-
sources and Services Administration, shall award grants 
to eligible entities for the conduct of an evaluation of cur-
rent health workforce diversity initiatives funded by the 
Department of Health and Human Services. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall—
‘‘(1) be a city, county, Indian tribe, State, terri-
tory, 
community-based 
nonprofit 
organization, 
health center, university, college, or other entity de-
termined appropriate by the Secretary; 
‘‘(2) with respect to an entity that is not an 
academic medical center, university, or private re-
search institution, carry out activities under the 
grant in partnership with an academic medical cen-
ter, university, or private research institution; and 
‘‘(3) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts awarded under a 
grant under subsection (a) shall be used to support the 
following evaluation activities:
114
‘‘(1) Determinations of measures of health 
workforce diversity success. 
‘‘(2) The short- and long-term tracking of par-
ticipants in health workforce diversity pipeline pro-
grams funded by the Department of Health and 
Human Services. 
‘‘(3) 
Assessments 
of 
partnerships 
formed 
through activities to increase health workforce diver-
sity. 
‘‘(4) Assessments of barriers to health work-
force diversity. 
‘‘(5) Assessments of policy changes at the Fed-
eral, State, and local levels. 
‘‘(6) Assessments of coordination within and be-
tween Federal agencies and other institutions. 
‘‘(7) Other activities determined appropriate by 
the Secretary and the Working Group established 
under section 2912. 
‘‘(d) REPORT.—Not later than 1 year after the date 
of enactment of this title, the Bureau of Health Profes-
sions within the Health Resources and Services Adminis-
tration shall prepare and make available for public com-
ment a report that summarizes the findings made by enti-
ties under grants under this section.
115
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 
2915. 
DATA 
COLLECTION 
AND 
REPORTING 
BY 
HEALTH PROFESSIONAL SCHOOLS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Bureau of Health Professions of the Health Resources 
and Services Administration and the Office of Minority 
Health, shall establish an aggregated database on health 
professional students. 
‘‘(b) REQUIREMENT
TO
COLLECT
DATA.—Each 
health professional school (including medical, dental, and 
nursing schools) and allied health profession school and 
program that receives Federal funds shall collect race, eth-
nicity, and language proficiency data concerning those stu-
dents enrolled at such schools or in such programs. In col-
lecting such data, a school or program shall—
‘‘(1) at a minimum, use the categories for race 
and ethnicity described in the 1997 Office of Man-
agement and Budget Standards for Maintaining, 
Collecting, and Presenting Federal Data on Race 
and Ethnicity and available language standards; and
116
‘‘(2) if practicable, collect data on additional 
population groups if such data can be aggregated 
into the minimum race and ethnicity data categories. 
‘‘(c) USE OF DATA.—Data on race, ethnicity, and 
primary language collected under this section shall be re-
ported to the database established under subsection (a) 
on an annual basis. Such data shall be available for public 
use. 
‘‘(d) PRIVACY.—The Secretary shall ensure that all 
data collected under this section is protected from inap-
propriate internal and external use by any entity that col-
lects, stores, or receives the data and that such data is 
collected without personally identifiable information. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2916. SUPPORT FOR INSTITUTIONS COMMITTED TO 
WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall award grants to eligible entities that 
demonstrate a commitment to health workforce diversity. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall—
117
‘‘(1) be an educational institution or entity that 
historically produces or trains meaningful numbers 
of underrepresented minority health professionals, 
including—
‘‘(A) Historically Black Colleges and Uni-
versities; 
‘‘(B) Hispanic-Serving Health Professions 
Schools; 
‘‘(C) Hispanic-Serving Institutions; 
‘‘(D) Tribal Colleges and Universities; 
‘‘(E) Asian American and Pacific Islander-
serving institutions; 
‘‘(F) institutions that have programs to re-
cruit and retain underrepresented minority 
health professionals, in which a significant 
number of the enrolled participants are under-
represented minorities; 
‘‘(G) 
health 
professional 
associations, 
which may include underrepresented minority 
health professional associations; and 
‘‘(H) institutions—
‘‘(i) located in communities with pre-
dominantly underrepresented minority pop-
ulations;
118
‘‘(ii) with whom partnerships have 
been formed for the purpose of increasing 
workforce diversity; and 
‘‘(iii) in which at least 20 percent of 
the enrolled participants are underrep-
resented minorities; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant under subsection (a) shall be used to expand existing 
workforce diversity programs, implement new workforce 
diversity programs, or evaluate existing or new workforce 
diversity programs. Such programs shall enhance diversity 
by considering minority status as part of an individualized 
consideration of qualifications. Possible activities may in-
clude—
‘‘(1) educational outreach programs relating to 
opportunities in the health professions; 
‘‘(2) scholarship, fellowship, grant, loan repay-
ment, and loan cancellation programs; 
‘‘(3) post-baccalaureate programs; 
‘‘(4) academic enrichment programs, particu-
larly targeting those who would not be competitive 
for health professions schools;
119
‘‘(5) kindergarten through 12th grade and 
other health pipeline programs; 
‘‘(6) mentoring programs; 
‘‘(7) internship or rotation programs involving 
hospitals, health systems, health plans and other 
health entities; 
‘‘(8) community partnership development for 
purposes relating to workforce diversity; or 
‘‘(9) leadership training. 
‘‘(d) REPORTS.—Not later than 1 year after receiving 
a grant under this section, and annually for the term of 
the grant, a grantee shall submit to the Secretary a report 
that summarizes and evaluates all activities conducted 
under the grant. 
‘‘(e) DEFINITION.—In this section, the term ‘Asian 
American and Pacific Islander-serving institutions’ means 
institutions—
‘‘(1) that are eligible institutions under section 
312(b) of the Higher Education Act of 1965; and 
‘‘(2) that, at the time of their application, have 
an enrollment of undergraduate students that is 
made up of at least 10 percent Asian American and 
Pacific Islander students. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section,