208 
(2) 
2-FISCAL-YEAR
TRANSITION.—Notwith-
standing any other provision of law, during fiscal 
years 2018 and 2019, the Federal medical assist-
ance percentage established under section 1905(b) of 
the Social Security Act (42 U.S.C. 1396d(b)) for 
Puerto Rico, the United States Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana 
Islands, and American Samoa shall be the highest 
such Federal medical assistance percentage applica-
ble to any of the 50 States or the District of Colum-
bia for the fiscal year involved. 
(3) PER CAPITA INCOME DATA.— 
(A) REPORT
TO
CONGRESS.—Not later 
than October 1, 2018, the Secretary of Health 
and Human Services shall submit to Congress 
a report that describes the per capita income 
data used to promulgate the Federal medical 
assistance percentage in the territories and how 
such data differ from the per capita income 
data used to promulgate Federal medical assist-
ance percentages for the 50 States and the Dis-
trict of Columbia. The report should include 
recommendations on how the Federal medical 
assistance percentages can be calculated for the 
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territories to ensure parity with the 50 States 
and the District of Columbia. 
(B) APPLICATION.—Section 1101(a)(8)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1308(a)(8)(B)) is amended— 
(i) by striking ‘‘(other than Puerto 
Rico, the United States Virgin Islands, and 
Guam)’’ and inserting ‘‘(including Puerto 
Rico, the United States Virgin Islands, 
Guam, the Commonwealth of the Northern 
Mariana Islands, and American Samoa)’’; 
and 
(ii) by inserting ‘‘(or, if such satisfac-
tory data are not available in the case of 
the United States Virgin Islands, Guam, 
the Northern Mariana Islands, or Amer-
ican Samoa, satisfactory data available 
from the Department of the Interior for 
the same period, or if such satisfactory 
data are not available in the case of Puerto 
Rico, satisfactory data available from the 
government of the Commonwealth of Puer-
to Rico for the same period)’’ after ‘‘De-
partment of Commerce’’. 
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SEC. 415. EXTENSION OF MEDICARE SECONDARY PAYER. 
(a) IN GENERAL.—Section 1862(b)(1)(C) of the So-
cial Security Act (42 U.S.C. 1395y(b)(1)(C)) is amend-
ed— 
(1) in the last sentence, by inserting ‘‘, and be-
fore January 1, 2017’’ after ‘‘prior to such date)’’; 
and 
(2) by adding at the end the following new sen-
tence: ‘‘Effective for items and services furnished on 
or after January 1, 2017 (with respect to periods 
beginning on or after the date that is 42 months 
prior to such date), clauses (i) and (ii) shall be ap-
plied by substituting ‘42-month’ for ‘12-month’ each 
place it appears in the first sentence.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on the date of enactment of 
this Act. For purposes of determining an individual’s sta-
tus under section 1862(b)(1)(C) of the Social Security Act 
(42 U.S.C. 1395y(b)(1)(C)), as amended by subsection 
(a), an individual who is within the coordinating period 
as of the date of enactment of this Act shall have that 
period extended to the full 42 months described in the last 
sentence of such section, as added by the amendment 
made by subsection (a)(2). 
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SEC. 416. BORDER HEALTH GRANTS. 
(a) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State, public institution 
of higher education, local government, tribal government, 
nonprofit health organization, community health center, or 
community clinic receiving assistance under section 330 
of the Public Health Service Act (42 U.S.C. 254b), that 
is located in the border area. 
(b) AUTHORIZATION.—From funds appropriated 
under subsection (f), the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’), 
acting through the United States members of the United 
States-Mexico Border Health Commission, shall award 
grants to eligible entities to address priorities and rec-
ommendations to improve the health of border area resi-
dents that are established by— 
(1) the United States members of the United 
States-Mexico Border Health Commission; 
(2) the State border health offices; and 
(3) the Secretary. 
(c) APPLICATION.—An eligible entity that desires a 
grant under subsection (b) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require. 
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(d) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (b) shall use the grant funds 
for— 
(1) programs relating to— 
(A) maternal and child health; 
(B) primary care and preventative health; 
(C) public health and public health infra-
structure; 
(D) musculoskeletal health and obesity; 
(E) health education and promotion; 
(F) oral health; 
(G) mental and behavioral health; 
(H) substance abuse; 
(I) health conditions that have a high prev-
alence in the border area; 
(J) medical and health services research; 
(K) workforce training and development; 
(L) community health workers, patient 
navigators, and promotoras; 
(M) health care infrastructure problems in 
the border area (including planning and con-
struction grants); 
(N) health disparities in the border area; 
(O) environmental health; and 
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(P) outreach and enrollment services with 
respect to Federal programs (including pro-
grams authorized under titles XIX and XXI of 
the Social Security Act (42 U.S.C. 1396 and 
1397aa)); and 
(2) other programs determined appropriate by 
the Secretary. 
(e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro-
vided to an eligible entity awarded a grant under sub-
section (b) shall be used to supplement and not supplant 
other funds available to the eligible entity to carry out the 
activities described in subsection (d). 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
$200,000,000 for fiscal year 2017, and such sums as may 
be necessary for each succeeding fiscal year. 
SEC. 417. REMOVING MEDICARE BARRIER TO HEALTH 
CARE. 
(a) PART A.—Section 1818(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395i–2(a)(3)) is amended by striking 
‘‘an alien’’ and all that follows through ‘‘under this sec-
tion’’ and inserting ‘‘an individual who is lawfully present 
in the United States’’. 
(b) PART B.—Section 1836(2) of the Social Security 
Act (42 U.S.C. 1395o(2)) is amended by striking ‘‘an 
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alien’’ and all that follows through ‘‘under this part’’ and 
inserting ‘‘an individual who is lawfully present in the 
United States’’. 
SEC. 418. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED BY URBAN INDIAN HEALTH CEN-
TERS. 
(a) IN GENERAL.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396(b)) 
is amended by inserting ‘‘or are received through a pro-
gram operated by an urban Indian organization through 
a grant or contract under title V of such Act’’ after ‘‘(as 
defined in section 4 of the Indian Health Care Improve-
ment Act)’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to medical assistance provided on 
or after the date of enactment of this Act. 
SEC. 419. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED TO A NATIVE HAWAIIAN THROUGH 
A FEDERALLY QUALIFIED HEALTH CENTER 
OR A NATIVE HAWAIIAN HEALTH CARE SYS-
TEM UNDER THE MEDICAID PROGRAM. 
(a) IN GENERAL.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), 
as amended by section 418(a), is amended by inserting 
before the period the following: ‘‘; and, with respect to 
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medical assistance provided to a Native Hawaiian (as de-
fined in section 12(2) of the Native Hawaiian Health Care 
Improvement Act) through a federally qualified health 
center or a Native Hawaiian health care system (as de-
fined in section 12(6) of such Act), whether directly, by 
referral, or under contract or other arrangement between 
such federally qualified health center or Native Hawaiian 
health care system and another health care provider’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to medical assistance provided on 
or after the date of enactment of this Act. 
CHAPTER 2—EXPANSION OF ACCESS 
SEC. 431. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the awarding of grants to assist communities 
in mobilizing and organizing resources in support of effec-
tive and sustainable programs that will reduce or eliminate 
disparities in health and health care experienced by racial 
and ethnic minority individuals. 
(b) AUTHORITY TO AWARD GRANTS.—The Secretary 
of Health and Human Services, acting through the Ad-
ministrator of the Health Resources and Services Admin-
istration, shall award grants to eligible entities to assist 
in designing, implementing, and evaluating culturally and 
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linguistically appropriate, science-based, and community- 
driven sustainable strategies to eliminate racial and ethnic 
health and health care disparities. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall— 
(1) represent a coalition— 
(A) whose principal purpose is to develop 
and implement interventions to reduce or elimi-
nate a health or health care disparity in a tar-
geted racial or ethnic minority group in the 
community served by the coalition; and 
(B) that includes— 
(i) members selected from among— 
(I) public health departments; 
(II) community-based organiza-
tions; 
(III) university and research or-
ganizations; 
(IV) American Indian tribal or-
ganizations, national American Indian 
organizations, Indian Health Service, 
or organizations serving Alaska Na-
tives; and 
(V) interested public or private 
health care providers or organizations 
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as deemed appropriate by the Sec-
retary; and 
(ii) at least 1 member from a commu-
nity-based organization that represents the 
targeted racial or ethnic minority group; 
and 
(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require, which shall 
include— 
(A) a description of the targeted racial or 
ethnic populations in the community to be 
served under the grant; 
(B) a description of at least 1 health dis-
parity that exists in the racial or ethnic tar-
geted populations, including health issues such 
as infant mortality, breast and cervical cancer 
screening and management, musculoskeletal 
diseases and obesity, prostate cancer screening 
and management, cardiovascular disease, diabe-
tes, child and adult immunization levels, or 
other health priority areas as designated by the 
Secretary; and 
(C) a demonstration of a proven record of 
accomplishment of the coalition members in 
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serving and working with the targeted commu-
nity. 
(d) SUSTAINABILITY.—The Secretary shall give pri-
ority to an eligible entity under this section if the entity 
agrees that, with respect to the costs to be incurred by 
the entity in carrying out the activities for which the grant 
was awarded, the entity (and each of the participating 
partners in the coalition represented by the entity) will 
maintain its expenditures of non-Federal funds for such 
activities at a level that is not less than the level of such 
expenditures during the fiscal year immediately preceding 
the first fiscal year for which the grant is awarded. 
(e) NONDUPLICATION.—Funds provided through this 
grant program should supplement, not supplant, existing 
Federal funding, and the funds should not be used to du-
plicate the activities of the other health disparity grant 
programs in this Act. 
(f) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide any entity 
that receives a grant under this section with technical and 
other nonfinancial assistance necessary to meet the re-
quirements of this section. 
(g) DISSEMINATION.—The Secretary shall encourage 
and enable grantees to share best practices, evaluation re-
sults, and reports with communities not affiliated with 
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grantees using the Internet, conferences, and other perti-
nent information regarding the projects funded by this 
section, including the outreach efforts of the Office of Mi-
nority Health and Health Disparity Elimination and the 
Centers for Disease Control and Prevention. 
(h) ADMINISTRATIVE
BURDENS.—The Secretary 
shall make every effort to minimize duplicative or unneces-
sary administrative burdens on grantees. 
(i) DEFINITION.—In this section, the term ‘‘Sec-
retary’’ means the Secretary of Health and Human Serv-
ices. 
(j) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
SEC. 432. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 
(a) ELIMINATION OF ISOLATION TEST FOR COST- 
BASED AMBULANCE REIMBURSEMENT.— 
(1) IN
GENERAL.—Section 1834(l)(8) of the 
Social Security Act (42 U.S.C. 1395m(l)(8)) is 
amended— 
(A) in subparagraph (B)— 
(i) by striking ‘‘owned and’’; and 
(ii) by inserting ‘‘(including when 
such services are provided by the entity 
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under an arrangement with the hospital)’’ 
after ‘‘hospital’’; and 
(B) by striking the comma at the end of 
subparagraph (B) and all that follows and in-
serting a period. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to services furnished 
on or after January 1, 2015. 
(b) PROVISION OF A MORE FLEXIBLE ALTERNATIVE 
TO THE CAH DESIGNATION 25 INPATIENT BED LIMIT 
REQUIREMENT.— 
(1) IN
GENERAL.—Section 1820(c)(2) of the 
Social Security Act (42 U.S.C. 1395i–4(c)(2)) is 
amended— 
(A) in subparagraph (B)(iii), by striking 
‘‘provides not more than’’ and inserting ‘‘sub-
ject to subparagraph (F), provides not more 
than’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(F) ALTERNATIVE TO 25 INPATIENT BED 
LIMIT REQUIREMENT.— 
‘‘(i) IN GENERAL.—A State may elect 
to treat a facility, with respect to the des-
ignation of the facility for a cost-reporting 
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period, as satisfying the requirement of 
subparagraph (B)(iii) relating to a max-
imum number of acute care inpatient beds 
if the facility elects, in accordance with a 
method specified by the Secretary and be-
fore the beginning of the cost reporting pe-
riod, to meet the requirement under clause 
(ii). 
‘‘(ii) ALTERNATE
REQUIREMENT.— 
The requirement under this clause, with 
respect to a facility and a cost-reporting 
period, is that the total number of inpa-
tient bed days described in subparagraph 
(B)(iii) during such period will not exceed 
7,300. For purposes of this subparagraph, 
an individual who is an inpatient in a bed 
in the facility for a single day shall be 
counted as one inpatient bed day. 
‘‘(iii) WITHDRAWAL OF ELECTION.— 
The option described in clause (i) shall not 
apply to a facility for a cost-reporting pe-
riod if the facility (for any two consecutive 
cost-reporting periods during the previous 
5 cost-reporting periods) was treated under 
such option and had a total number of in-
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patient bed days for each of such two cost- 
reporting periods that exceeded the num-
ber specified in such clause.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost-reporting peri-
ods beginning on or after the date of the enactment 
of this Act. 
SEC. 433. ESTABLISHMENT OF RURAL COMMUNITY HOS-
PITAL (RCH) PROGRAM. 
(a) IN GENERAL.—Section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395x), as amended by section 
205(b)(1), is amended by adding at the end of the fol-
lowing new subsection: 
‘‘Rural Community Hospital; Rural Community Hospital 
Services 
‘‘(jjj)(1) The term ‘rural community hospital’ means 
a hospital (as defined in subsection (e)) that— 
‘‘(A) is located in a rural area (as defined in 
section 1886(d)(2)(D)) or treated as being so lo-
cated pursuant to section 1886(d)(8)(E); 
‘‘(B) subject to paragraph (2), has less than 51 
acute care inpatient beds, as reported in its most re-
cent cost report; 
‘‘(C) makes available 24-hour emergency care 
services; 
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‘‘(D) subject to paragraph (3), has a provider 
agreement in effect with the Secretary and is open 
to the public as of January 1, 2010; and 
‘‘(E) applies to the Secretary for such designa-
tion. 
‘‘(2) For purposes of paragraph (1)(B), beds in a 
psychiatric or rehabilitation unit of the hospital which is 
a distinct part of the hospital shall not be counted. 
‘‘(3) Paragraph (1)(D) shall not be construed to pro-
hibit any of the following from qualifying as a rural com-
munity hospital: 
‘‘(A) A replacement facility (as defined by the 
Secretary in regulations in effect on January 1, 
2012) with the same service area (as defined by the 
Secretary in regulations in effect on such date). 
‘‘(B) A facility obtaining a new provider num-
ber pursuant to a change of ownership. 
‘‘(C) A facility which has a binding written 
agreement with an outside, unrelated party for the 
construction, reconstruction, lease, rental, or financ-
ing of a building as of January 1, 2012. 
‘‘(4) Nothing in this subsection shall be construed as 
prohibiting a critical access hospital from qualifying as a 
rural community hospital if the critical access hospital 
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meets the conditions otherwise applicable to hospitals 
under subsection (e) and section 1866. 
‘‘(5) Nothing in this subsection shall be construed as 
prohibiting a rural community hospital participating in 
the demonstration program under section 410A of the 
Medicare Prescription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108–173; 117 Stat. 
2313) from qualifying as a rural community hospital if 
the rural community hospital meets the conditions other-
wise applicable to hospitals under subsection (e) and sec-
tion 1866.’’. 
(b) PAYMENT.— 
(1) INPATIENT
HOSPITAL
SERVICES.—Section 
1814 of the Social Security Act (42 U.S.C. 1395f) 
is amended by adding at the end the following new 
subsection: 
‘‘Payment for Inpatient Services Furnished in Rural 
Community Hospitals 
‘‘(m) The amount of payment under this part for in-
patient hospital services furnished in a rural community 
hospital, other than such services furnished in a psy-
chiatric or rehabilitation unit of the hospital which is a 
distinct part, is, at the election of the hospital in the appli-
cation referred to in section 1861(jjj)(1)(E)— 
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(A) CONSULTATION
WITH
STATE
AGEN-
CIES.—Section 1863 of such Act (42 U.S.C. 
1395z) is amended by striking ‘‘and (dd)(2)’’ 
and inserting ‘‘(dd)(2), (mm)(1), and (jjj)(1)’’. 
(B) 
PROVIDER
AGREEMENTS.—Section 
1866(a)(2)(A) 
of 
such 
Act 
(42 
U.S.C. 
1395cc(a)(2)(A)) is amended by inserting ‘‘sec-
tion 1834(p)(2),’’ after ‘‘section 1833(b),’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to items and services furnished on 
or after October 1, 2016. 
SEC. 
434. 
MEDICARE 
REMOTE 
MONITORING 
PILOT 
PROJECTS. 
(a) PILOT PROJECTS.— 
(1) IN
GENERAL.—Not later than 9 months 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’) shall conduct 
pilot projects under title XVIII of the Social Secu-
rity Act for the purpose of providing incentives to 
home health agencies to utilize home monitoring and 
communications technologies that— 
(A) enhance health outcomes for Medicare 
beneficiaries; and 
(B) reduce expenditures under such title. 
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(2) SITE REQUIREMENTS.— 
(A) URBAN AND RURAL.—The Secretary 
shall conduct the pilot projects under this sec-
tion in both urban and rural areas. 
(B) SITE IN A SMALL STATE.—The Sec-
retary shall conduct at least 3 of the pilot 
projects in a State with a population of less 
than 1,000,000. 
(3) DEFINITION OF HOME HEALTH AGENCY.— 
In this section, the term ‘‘home health agency’’ has 
the meaning given that term in section 1861(o) of 
the Social Security Act (42 U.S.C. 1395x(o)). 
(b) MEDICARE BENEFICIARIES WITHIN THE SCOPE 
OF PROJECTS.—The Secretary shall specify the criteria 
for identifying those Medicare beneficiaries who shall be 
considered within the scope of the pilot projects under this 
section for purposes of the application of subsection (c) 
and for the assessment of the effectiveness of the home 
health agency in achieving the objectives of this section. 
Such criteria may provide for the inclusion in the projects 
of Medicare beneficiaries who begin receiving home health 
services under title XVIII of the Social Security Act after 
the date of the implementation of the projects. 
(c) INCENTIVES.— 
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(1) PERFORMANCE
TARGETS.—The Secretary 
shall establish for each home health agency partici-
pating in a pilot project under this section a per-
formance target using one of the following meth-
odologies, as determined appropriate by the Sec-
retary: 
(A) ADJUSTED HISTORICAL PERFORMANCE 
TARGET.—The Secretary shall establish for the 
agency— 
(i) a base expenditure amount equal 
to the average total payments made to the 
agency under parts A and B of title XVIII 
of the Social Security Act for Medicare 
beneficiaries determined to be within the 
scope of the pilot project in a base period 
determined by the Secretary; and 
(ii) an annual per capita expenditure 
target for such beneficiaries, reflecting the 
base expenditure amount adjusted for risk 
and adjusted growth rates. 
(B) COMPARATIVE
PERFORMANCE
TAR-
GET.—The Secretary shall establish for the 
agency a comparative performance target equal 
to the average total payments under such parts 
A and B during the pilot project for comparable 
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individuals in the same geographic area that 
are not determined to be within the scope of the 
pilot project. 
(2) INCENTIVE.—Subject to paragraph (3), the 
Secretary shall pay to each participating home care 
agency an incentive payment for each year under the 
pilot project equal to a portion of the Medicare sav-
ings realized for such year relative to the perform-
ance target under paragraph (1). 
(3) LIMITATION ON EXPENDITURES.—The Sec-
retary shall limit incentive payments under this sec-
tion in order to ensure that the aggregate expendi-
tures under title XVIII of the Social Security Act 
(including incentive payments under this subsection) 
do not exceed the amount that the Secretary esti-
mates would have been expended if the pilot projects 
under this section had not been implemented. 
(d) WAIVER AUTHORITY.—The Secretary may waive 
such provisions of titles XI and XVIII of the Social Secu-
rity Act as the Secretary determines to be appropriate for 
the conduct of the pilot projects under this section. 
(e) REPORT TO CONGRESS.—Not later than 5 years 
after the date that the first pilot project under this section 
is implemented, the Secretary shall submit to Congress a 
report on the pilot projects. Such report shall contain a 
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detailed description of issues related to the expansion of 
the projects under subsection (f) and recommendations for 
such legislation and administrative actions as the Sec-
retary considers appropriate. 
(f) EXPANSION.—If the Secretary determines that 
any of the pilot projects under this section enhance health 
outcomes for Medicare beneficiaries and reduce expendi-
tures under title XVIII of the Social Security Act, the Sec-
retary may initiate comparable projects in additional 
areas. 
(g) INCENTIVE PAYMENTS HAVE NO EFFECT ON 
OTHER MEDICARE PAYMENTS TO AGENCIES.—An incen-
tive payment under this section— 
(1) shall be in addition to the payments that a 
home health agency would otherwise receive under 
title XVIII of the Social Security Act for the provi-
sion of home health services; and 
(2) shall have no effect on the amount of such 
payments. 
SEC. 435. RURAL HEALTH QUALITY ADVISORY COMMISSION 
AND DEMONSTRATION PROJECTS. 
(a) RURAL HEALTH QUALITY ADVISORY COMMIS-
SION.— 
(1) 
ESTABLISHMENT.—Not 
later 
than 
months after the date of the enactment of this sec-
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tion, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall 
establish a commission to be known as the Rural 
Health Quality Advisory Commission (in this section 
referred to as the ‘‘Commission’’). 
(2) DUTIES OF COMMISSION.— 
(A) NATIONAL
PLAN.—The Commission 
shall develop, coordinate, and facilitate imple-
mentation of a national plan for rural health 
quality improvement. The national plan shall— 
(i) identify objectives for rural health 
quality improvement; 
(ii) identify strategies to eliminate 
known gaps in rural health system capacity 
and improve rural health quality; and 
(iii) provide for Federal programs to 
identify opportunities for strengthening 
and aligning policies and programs to im-
prove rural health quality. 
(B) 
DEMONSTRATION
PROJECTS.—The 
Commission shall design demonstration projects 
to test alternative models for rural health qual-
ity improvement, including with respect to both 
personal and population health. 
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(C) MONITORING.—The Commission shall 
monitor progress toward the objectives identi-
fied pursuant to paragraph (1)(A). 
(3) MEMBERSHIP.— 
(A) NUMBER.—The Commission shall be 
composed of 11 members appointed by the Sec-
retary. 
(B) SELECTION.—The Secretary shall se-
lect the members of the Commission from 
among individuals with significant rural health 
care and health care quality expertise, including 
expertise in clinical health care, health care 
quality research, population or public health, or 
purchaser organizations. 
(4) CONTRACTING AUTHORITY.—Subject to the 
availability of funds, the Commission may enter into 
contracts and make other arrangements, as may be 
necessary to carry out the duties described in para-
graph (2). 
(5) STAFF.—Upon the request of the Commis-
sion, the Secretary may detail, on a reimbursable 
basis, any of the personnel of the Office of Rural 
Health Policy of the Health Resources and Services 
Administration, the Agency for Healthcare Quality 
and Research, or the Centers for Medicare & Med-
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icaid Services to the Commission to assist in car-
rying out this subsection. 
(6) REPORTS TO CONGRESS.—Not later than 1 
year after the establishment of the Commission, and 
annually thereafter, the Commission shall submit a 
report to the Congress on rural health quality. Each 
such report shall include the following: 
(A) An inventory of relevant programs and 
recommendations for improved coordination and 
integration of policy and programs. 
(B) An assessment of achievement of the 
objectives identified in the national plan devel-
oped under paragraph (2) and recommenda-
tions for realizing such objectives. 
(C) Recommendations on Federal legisla-
tion, regulations, or administrative policies to 
enhance rural health quality and outcomes. 
(b) RURAL
HEALTH
QUALITY
DEMONSTRATION 
PROJECTS.— 
(1) IN
GENERAL.—Not later than 270 days 
after the date of the enactment of this section, the 
Secretary, in consultation with the Rural Health 
Quality Advisory Commission, the Office of Rural 
Health Policy of the Health Resources and Services 
Administration, the Agency for Healthcare Research 
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and Quality, and the Centers for Medicare & Med-
icaid Services, shall make grants to eligible entities 
for 5 demonstration projects to implement and 
evaluate methods for improving the quality of health 
care in rural communities. Each such demonstration 
project shall include— 
(A) alternative community models that— 
(i) will achieve greater integration of 
personal and population health services; 
and 
(ii) 
address 
safety, 
effectiveness, 
patient- or community-centeredness, timeli-
ness, efficiency, and equity (the 6 aims 
identified by the Institute of Medicine of 
the National Academies in its report enti-
tled ‘‘Crossing the Quality Chasm: A New 
Health System for the 21st Century’’ re-
leased on March 1, 2001); 
(B) innovative approaches to the financing 
and delivery of health services to achieve rural 
health quality goals; and 
(C) development of quality improvement 
support structures to assist rural health sys-
tems and professionals (such as workforce sup-
port structures, quality monitoring and report-
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ing, clinical care protocols, and information 
technology applications). 
(2) ELIGIBLE
ENTITIES.—In this subsection, 
the term ‘‘eligible entity’’ means a consortium 
that— 
(A) shall include— 
(i) at least one health care provider or 
health care delivery system located in a 
rural area; and 
(ii) at least one organization rep-
resenting multiple community stakeholders; 
and 
(B) may include other partners such as 
rural research centers. 
(3) CONSULTATION.—In developing the pro-
gram for awarding grants under this subsection, the 
Secretary shall consult with the Administrator of the 
Agency for Healthcare Research and Quality, rural 
health care providers, rural health care researchers, 
and private and nonprofit groups (including national 
associations) which are undertaking similar efforts. 
(4) EXPEDITED WAIVERS.—The Secretary shall 
expedite the processing of any waiver that— 
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(A) is authorized under title XVIII or XIX 
of the Social Security Act (42 U.S.C. 1395 et 
seq.); and 
(B) is necessary to carry out a demonstra-
tion project under this subsection. 
(5) DEMONSTRATION
PROJECT
SITES.—The 
Secretary shall ensure that the 5 demonstration 
projects funded under this subsection are conducted 
at a variety of sites representing the diversity of 
rural communities in the Nation. 
(6) DURATION.—Each demonstration project 
under this subsection shall be for a period of 4 
years. 
(7) INDEPENDENT
EVALUATION.—The Sec-
retary shall enter into an arrangement with an enti-
ty that has experience working directly with rural 
health systems for the conduct of an independent 
evaluation of the program carried out under this 
subsection. 
(8) REPORT.—Not later than 1 year after the 
conclusion of all of the demonstration projects fund-
ed under this subsection, the Secretary shall submit 
a report to the Congress on the results of such 
projects. The report shall include— 
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(A) an evaluation of patient access to care, 
patient outcomes, and an analysis of the cost 
effectiveness of each such project; and 
(B) recommendations on Federal legisla-
tion, regulations, or administrative policies to 
enhance rural health quality and outcomes. 
(c) APPROPRIATION.— 
(1) IN GENERAL.—Out of funds in the Treas-
ury not otherwise appropriated, there are appro-
priated to the Secretary to carry out this section 
$30,000,000 for the period of fiscal years 2017 
through 2021. 
(2) AVAILABILITY.— 
(A) IN
GENERAL.—Funds appropriated 
under paragraph (1) shall remain available for 
expenditure through fiscal year 2021. 
(B) REPORT.—For purposes of carrying 
out subsection (b)(8), funds appropriated under 
paragraph (1) shall remain available for ex-
penditure through fiscal year 2022. 
(3) RESERVATION.—Of the amount appro-
priated under paragraph (1), the Secretary shall re-
serve— 
(A) $5,000,000 to carry out subsection (a); 
and 
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(B) $25,000,000 to carry out subsection 
(b), of which— 
(i) 2 percent shall be for the provision 
of technical assistance to grant recipients; 
and 
(ii) 5 percent shall be for independent 
evaluation under subsection (b)(7). 
SEC. 436. RURAL HEALTH CARE SERVICES. 
Section 330A of the Public Health Service Act (42 
U.S.C. 254c) is amended to read as follows: 
‘‘SEC. 330A. RURAL HEALTH CARE SERVICES OUTREACH, 
RURAL HEALTH NETWORK DEVELOPMENT, 
DELTA RURAL DISPARITIES AND HEALTH 
SYSTEMS DEVELOPMENT, AND SMALL RURAL 
HEALTH CARE PROVIDER QUALITY IMPROVE-
MENT GRANT PROGRAMS. 
‘‘(a) PURPOSE.—The purpose of this section is to 
provide for grants— 
‘‘(1) under subsection (b), to promote rural 
health care services outreach; 
‘‘(2) under subsection (c), to provide for the 
planning and implementation of integrated health 
care networks in rural areas; 
‘‘(3) under subsection (d), to assist rural com-
munities in the Delta Region to reduce health dis-
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parities and to promote and enhance health system 
development; and 
‘‘(4) under subsection (e), to provide for the 
planning and implementation of small rural health 
care provider quality improvement activities. 
‘‘(b) RURAL HEALTH CARE SERVICES OUTREACH 
GRANTS.— 
‘‘(1) GRANTS.—The Director of the Office of 
Rural Health Policy of the Health Resources and 
Services Administration may award grants to eligible 
entities to promote rural health care services out-
reach by expanding the delivery of health care serv-
ices to include new and enhanced services in rural 
areas. The Director may award the grants for peri-
ods of not more than 3 years. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection for a project, an enti-
ty— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
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tivities will be conducted within federally recog-
nized tribal areas; 
‘‘(B) shall represent a consortium com-
posed of members— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
‘‘(ii) that may be nonprofit or for- 
profit entities; and 
‘‘(C) shall not previously have received a 
grant under this subsection for the same or a 
similar project, unless the entity is proposing to 
expand the scope of the project or the area that 
will be served through the project. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) a description of the manner in which 
the project funded under the grant will meet 
the health care needs of rural populations in 
the local community or region to be served; 
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‘‘(C) a plan for quantifying how health 
care needs will be met through identification of 
the target population and benchmarks of service 
delivery or health status, such as— 
‘‘(i) quantifiable measurements of 
health status improvement for projects fo-
cusing on health promotion; or 
‘‘(ii) benchmarks of increased access 
to primary care, including tracking factors 
such as the number and type of primary 
care visits, identification of a medical 
home, or other general measures of such 
access; 
‘‘(D) a description of how the local com-
munity or region to be served will be involved 
in the development and ongoing operations of 
the project; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
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‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(c) RURAL
HEALTH
NETWORK
DEVELOPMENT 
GRANTS.— 
‘‘(1) GRANTS.— 
‘‘(A) IN
GENERAL.—The Director may 
award rural health network development grants 
to eligible entities to promote, through planning 
and implementation, the development of inte-
grated health care networks that have combined 
the functions of the entities participating in the 
networks in order to— 
‘‘(i) achieve efficiencies and economies 
of scale; 
‘‘(ii) expand access to, coordinate, and 
improve the quality of the health care de-
livery system through development of orga-
nizational efficiencies; 
‘‘(iii) implement health information 
technology to achieve efficiencies, reduce 
medical errors, and improve quality; 
‘‘(iv) coordinate care and manage 
chronic illness; and 
‘‘(v) strengthen the rural health care 
system as a whole in such a manner as to 
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show a quantifiable return on investment 
to the participants in the network. 
‘‘(B) GRANT PERIODS.—The Director may 
award such a rural health network development 
grant— 
‘‘(i) for a period of 3 years for imple-
mentation activities; or 
‘‘(ii) for a period of 1 year for plan-
ning activities to assist in the initial devel-
opment of an integrated health care net-
work, if the proposed participants in the 
network do not have a history of collabo-
rative efforts and a 3-year grant would be 
inappropriate. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity— 
‘‘(A) shall be a rural public or rural non-
profit private entity, a facility that qualifies as 
a rural health clinic under title XVIII of the 
Social Security Act, a public or nonprofit entity 
existing exclusively to provide services to mi-
grant and seasonal farm workers in rural areas, 
or a tribal government whose grant-funded ac-
tivities will be conducted within federally recog-
nized tribal areas; 
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‘‘(B) shall represent a network composed 
of participants— 
‘‘(i) that include 3 or more independ-
ently owned health care entities; and 
‘‘(ii) that may be nonprofit or for- 
profit entities; and 
‘‘(C) shall not previously have received a 
grant under this subsection (other than a 1- 
year grant for planning activities) for the same 
or a similar project. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity, in 
consultation with the appropriate State office of 
rural health or another appropriate State entity, 
shall prepare and submit to the Director an applica-
tion at such time, in such manner, and containing 
such information as the Director may require, in-
cluding— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of— 
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‘‘(i) the history of collaborative activi-
ties carried out by the participants in the 
network; 
‘‘(ii) the degree to which the partici-
pants are ready to integrate their func-
tions; and 
‘‘(iii) how the local community or re-
gion to be served will benefit from and be 
involved in the activities carried out by the 
network; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services 
across the continuum of care as a result of the 
integration activities carried out by the net-
work, including a description of— 
‘‘(i) return on investment for the com-
munity and the network members; and 
‘‘(ii) other quantifiable performance 
measures that show the benefit of the net-
work activities; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated; 
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‘‘(G) the administrative capacity to submit 
annual performance data electronically as speci-
fied by the Director; and 
‘‘(H) other such information as the Direc-
tor determines to be appropriate. 
‘‘(d) DELTA RURAL DISPARITIES AND HEALTH SYS-
TEMS DEVELOPMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to eligible entities to support reduction of health dis-
parities, improve access to health care, and enhance 
rural health system development in the Delta Re-
gion. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under this subsection, an entity shall be a 
rural public or rural nonprofit private entity, a facil-
ity that qualifies as a rural health clinic under title 
XVIII of the Social Security Act, a public or non-
profit entity existing exclusively to provide services 
to migrant and seasonal farm workers in rural 
areas, or a tribal government whose grant-funded 
activities will be conducted within federally recog-
nized tribal areas. 
‘‘(3) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
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such time, in such manner, and containing such in-
formation as the Director may require, including— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of the manner in which 
the project funded under the grant will meet 
the health care needs of the Delta Region; 
‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
a result of the activities carried out by the enti-
ty; 
‘‘(E) a description of how health dispari-
ties will be reduced or the health system will be 
improved; 
‘‘(F) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(G) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care provided 
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or how the health care system improves its per-
formance; 
‘‘(H) a description of how the grantee will 
develop an advisory group made up of rep-
resentatives of the communities to be served to 
provide guidance to the grantee to best meet 
community need; and 
‘‘(I) other such information as the Director 
determines to be appropriate. 
‘‘(e) SMALL RURAL HEALTH CARE PROVIDER QUAL-
ITY IMPROVEMENT GRANTS.— 
‘‘(1) GRANTS.—The Director may award grants 
to provide for the planning and implementation of 
small rural health care provider quality improvement 
activities. The Director may award the grants for 
periods of 1 to 3 years. 
‘‘(2) ELIGIBILITY.—To be eligible for a grant 
under this subsection, an entity— 
‘‘(A) shall be— 
‘‘(i) a rural public or rural nonprofit 
private health care provider or provider of 
health care services, such as a rural health 
clinic; or 
‘‘(ii) another rural provider or net-
work of small rural providers identified by 
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the Director as a key source of local care; 
and 
‘‘(B) shall not previously have received a 
grant under this subsection for the same or a 
similar project. 
‘‘(3) PREFERENCE.—In awarding grants under 
this subsection, the Director shall give preference to 
facilities that qualify as rural health clinics under 
title XVIII of the Social Security Act. 
‘‘(4) APPLICATIONS.—To be eligible to receive a 
grant under this subsection, an eligible entity shall 
prepare and submit to the Director an application at 
such time, in such manner, and containing such in-
formation as the Director may require, including— 
‘‘(A) a description of the project that the 
eligible entity will carry out using the funds 
provided under the grant; 
‘‘(B) an explanation of the reasons why 
Federal assistance is required to carry out the 
project; 
‘‘(C) a description of the manner in which 
the project funded under the grant will assure 
continuous quality improvement in the provision 
of services by the entity; 
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‘‘(D) a description of how the local com-
munity or region to be served will experience in-
creased access to quality health care services as 
a result of the activities carried out by the enti-
ty; 
‘‘(E) a plan for sustaining the project after 
Federal support for the project has ended; 
‘‘(F) a description of how the project will 
be evaluated including process and outcome 
measures related to the quality of care pro-
vided; and 
‘‘(G) other such information as the Direc-
tor determines to be appropriate. 
‘‘(f) GENERAL REQUIREMENTS.— 
‘‘(1) PROHIBITED USES OF FUNDS.—An entity 
that receives a grant under this section may not use 
funds provided through the grant— 
‘‘(A) to build or acquire real property; or 
‘‘(B) for construction. 
‘‘(2) COORDINATION WITH OTHER AGENCIES.— 
The Director shall coordinate activities carried out 
under grant programs described in this section, to 
the extent practicable, with Federal and State agen-
cies and nonprofit organizations that are operating 
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similar grant programs, to maximize the effect of 
public dollars in funding meritorious proposals. 
‘‘(g) REPORT.—Not later than September 30, 2018, 
the Secretary shall prepare and submit to the appropriate 
committees of Congress a report on the progress and ac-
complishments of the grant programs described in sub-
sections (b), (c), (d), and (e). 
‘‘(h) DEFINITIONS.—In this section: 
‘‘(1) The term ‘Delta Region’ has the meaning 
given to the term ‘region’ in section 382A of the 
Consolidated Farm and Rural Development Act (7 
U.S.C. 2009aa). 
‘‘(2) The term ‘Director’ means the Director of 
the Office of Rural Health Policy of the Health Re-
sources and Services Administration. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$40,000,000 for fiscal year 2017, and such sums as may 
be necessary for each of fiscal years 2018 through 2021.’’. 
SEC. 437. COMMUNITY HEALTH CENTER COLLABORATIVE 
ACCESS EXPANSION. 
Section 330 of the Public Health Service Act (42 
U.S.C. 254b) is amended by adding at the end the fol-
lowing: 
‘‘(t) MISCELLANEOUS PROVISIONS.— 
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‘‘(1) RULE OF CONSTRUCTION WITH RESPECT 
TO RURAL HEALTH CLINICS.—Nothing in this sec-
tion shall be construed to prevent a community 
health center from contracting with a federally cer-
tified rural health clinic (as defined by section 
1861(aa)(2) of the Social Security Act) for the deliv-
ery of primary health care and other mental, dental, 
and physical health services that are available at the 
rural health clinic to individuals who would other-
wise be eligible for free or reduced cost care if that 
individual were able to obtain that care at the com-
munity health center. Such services may be limited 
in scope to those primary health care and other 
mental, dental, and physical health services available 
in that rural health clinic. 
‘‘(2) ENABLING SERVICES.—To the extent pos-
sible, enabling services such as transportation and 
translation assistance shall be provided by rural 
health clinics described in paragraph (1). 
‘‘(3) ASSURANCES.—In order for a rural health 
clinic to receive funds under this section through a 
contract with a community health center for the de-
livery of primary health care and other services de-
scribed in paragraph (1), such rural health clinic 
shall establish policies to ensure— 
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‘‘(A) nondiscrimination based upon the 
ability of a patient to pay; 
‘‘(B) the establishment of a sliding fee 
scale for low-income patients; and 
‘‘(C) any such services should be subject to 
full reimbursement according to the Prospective 
Payment System scale.’’. 
SEC. 438. FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES. 
(a) IN GENERAL.—For purposes of expediting the 
provision of telehealth services, for which payment is made 
under the Medicare Program, across State lines, the Sec-
retary of Health and Human Services shall, in consulta-
tion with representatives of States, physicians, health care 
practitioners, and patient advocates, encourage and facili-
tate the adoption of provisions allowing for multistate 
practitioner practice across State lines. 
(b) DEFINITIONS.—In subsection (a): 
(1) TELEHEALTH
SERVICE.—The term ‘‘tele-
health service’’ has the meaning given that term in 
subparagraph (F) of section 1834(m)(4) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)). 
(2) PHYSICIAN, 
PRACTITIONER.—The terms 
‘‘physician’’ and ‘‘practitioner’’ have the meaning 
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given those terms in subparagraphs (D) and (E), re-
spectively, of such section. 
(3) MEDICARE PROGRAM.—The term ‘‘Medicare 
Program’’ means the program of health insurance 
administered by the Secretary of Health and Human 
Services under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). 
SEC. 439. SCORING OF PREVENTIVE HEALTH SAVINGS. 
Section 202 of the Congressional Budget and Im-
poundment Control Act of 1974 (2 U.S.C. 602) is amend-
ed by adding at the end the following new subsection: 
‘‘(h) SCORING OF PREVENTIVE HEALTH SAVINGS.— 
‘‘(1) DETERMINATION
BY
THE
DIRECTOR.— 
Upon a request by the chairman or ranking minority 
member of the Committee on the Budget of the Sen-
ate, or by the chairman or ranking minority member 
of the Committee on the Budget of the House of 
Representatives, the Director shall determine if a 
proposed measure would result in reductions in 
budget outlays in budgetary outyears through the 
use of preventive health and preventive health serv-
ices. 
‘‘(2) PROJECTIONS.—If the Director determines 
that a measure would result in substantial reduc-
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tions in budget outlays as described in paragraph 
(1), the Director— 
‘‘(A) shall include, in any projection pre-
pared by the Director, a description and esti-
mate of the reductions in budget outlays in the 
budgetary outyears and a description of the 
basis for such conclusions; and 
‘‘(B) may prepare a budget projection that 
includes some or all of the budgetary outyears, 
notwithstanding the time periods for projections 
described in subsection (e) and sections 308, 
402, and 424. 
‘‘(3) DEFINITIONS.—As used in this sub-
section— 
‘‘(A) the term ‘preventive health’ means an 
action that focuses on the health of the public, 
individuals, and defined populations in order to 
protect, promote, and maintain health, wellness, 
and functional ability, and prevent disease, dis-
ability, and premature death that is dem-
onstrated by credible and publicly available epi-
demiological projection models, incorporating 
clinical trials or observational studies in hu-
mans, to avoid future health care costs; and 
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‘‘(B) the term ‘budgetary outyears’ means 
the 2 consecutive 10-year periods beginning 
with the first fiscal year that is 10 years after 
the budget year provided for in the most re-
cently agreed to concurrent resolution on the 
budget.’’. 
SEC. 440. SENSE OF CONGRESS. 
It is the sense of the Congress that— 
(1) the maintenance of effort provisions added 
to sections 1902 and 2105(d) of the Social Security 
Act by sections 2001(b) and 2101(b) of the Patient 
Protection and Affordable Care Act were written to 
maintain the eligibility standards for the Medicaid 
program under title XIX of the Social Security Act 
and Children’s Health Insurance Program under 
title XXI of such Act until the American Health 
Benefit Exchanges in the States are fully oper-
ational; 
(2) it is imperative that the maintenance of ef-
fort provisions are enforced to the strict standard in-
tended by the Congress; 
(3) waiving the maintenance of effort provisions 
should not be permitted, except in the case of a re-
quest for a waiver that meets the explicit non-
application requirements; 
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(4) the maintenance of effort provisions ensure 
the continued success of the Medicaid program and 
Children’s Health Insurance Program and were writ-
ten deliberately to specifically protect vulnerable and 
disabled individuals, children, and senior citizens, 
many of whom are also members of communities of 
color; and 
(5) the maintenance of effort provisions must 
be strictly enforced and proposals to weaken the 
maintenance of effort provisions must not be consid-
ered. 
SEC. 441. REPEAL OF REQUIREMENT FOR DOCUMENTA-
TION EVIDENCING CITIZENSHIP OR NATION-
ALITY UNDER THE MEDICAID PROGRAM. 
(a) REPEAL.—Subsections (i)(22) and (x) of section 
1903 of the Social Security Act (42 U.S.C. 1396b) are 
each repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) Section 1902 of the Social Security Act (42 
U.S.C. 1396a) is amended— 
(A) by amending paragraph (46) of sub-
section (a) to read as follows: 
‘‘(46) provide that information is requested and 
exchanged for purposes of income and eligibility 
verification in accordance with a State system which 
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meets the requirements of section 1137 of this 
Act;’’; 
(B) in subsection (e)(13)(A)(i)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘sections 1902(a)(46)(B) 
and 1137(d)’’ and inserting ‘‘section 
1137(d)’’; and 
(ii) in subclause (IV), by striking 
‘‘1902(a)(46)(B) or’’; and 
(C) by striking subsection (ee). 
(2) Section 1903 of the Social Security Act (42 
U.S.C. 1396b) is amended— 
(A) in subsection (i), by redesignating 
paragraphs (23) through (26) as paragraphs 
(22) through (25), respectively; and 
(B) by redesignating subsections (y) and 
(z) as subsections (x) and (y), respectively. 
(3) Subsection (c) of section 6036 of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396b note) is re-
pealed. 
(c) EFFECTIVE DATE.—The repeals and amend-
ments made by this section shall take effect as if included 
in the enactment of the Deficit Reduction Act of 2005. 
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SEC. 442. OFFICE OF MINORITY HEALTH IN VETERANS 
HEALTH ADMINISTRATION OF DEPARTMENT 
OF VETERANS AFFAIRS. 
(a) ESTABLISHMENT AND FUNCTIONS.—Subchapter 
I of chapter 73 of title 38, United States Code, is amended 
by adding at the end the following new section: 
‘‘§ 7310. Office of Minority Health 
‘‘(a) ESTABLISHMENT.—There is established in the 
Department within the Office of the Under Secretary for 
Health an office to be known as the ‘Office of Minority 
Health’ (in this section referred to as the ‘Office’). 
‘‘(b) HEAD.—The Director of the Office of Minority 
Health shall be the head of the Office. The Director of 
the Office of Minority Health shall be appointed by the 
Under Secretary of Health from among individuals quali-
fied to perform the duties of the position. 
‘‘(c) FUNCTIONS.—The functions of the Office are as 
follows: 
‘‘(1) To establish short-range and long-range 
goals and objectives and coordinate all other activi-
ties within the Veterans Health Administration that 
relate to disease prevention, health promotion, health 
care services delivery, and health care research con-
cerning veterans who are members of a racial or eth-
nic minority group. 
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‘‘(2) To support research, demonstrations, and 
evaluations to test new and innovative models for 
the discharge of activities described in paragraph 
(1). 
‘‘(3) To increase knowledge and understanding 
of health risk factors for veterans who are members 
of a racial or ethnic minority group. 
‘‘(4) To develop mechanisms that support bet-
ter health care information dissemination, education, 
prevention, and services delivery to veterans from 
disadvantaged backgrounds, including veterans who 
are members of a racial or ethnic minority group. 
‘‘(5) To enter into contracts or agreements with 
appropriate public and nonprofit private entities to 
develop and carry out programs to provide bilingual 
or interpretive services to assist veterans who are 
members of a racial or ethnic minority group and 
who lack proficiency in speaking the English lan-
guage in accessing and receiving health care services 
through the Veterans Health Administration. 
‘‘(6) To carry out programs to improve access 
to health care services through the Veterans Health 
Administration for veterans with limited proficiency 
in speaking the English language, including the de-
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velopment and evaluation of demonstration and pilot 
projects for that purpose. 
‘‘(7) To advise the Under Secretary of Health 
on matters relating to the development, implementa-
tion, and evaluation of health professions education 
in decreasing disparities in health care outcomes be-
tween veterans who are members of a racial or eth-
nic minority group and other veterans, including cul-
tural competency as a method of eliminating such 
health disparities. 
‘‘(8) To perform such other functions and du-
ties as the Secretary or the Under Secretary for 
Health considers appropriate. 
‘‘(d) DEFINITIONS.—In this section: 
‘‘(1) The term ‘racial or ethnic minority group’ 
means the following: 
‘‘(A) American Indians (including Alaska 
Natives, Eskimos, and Aleuts). 
‘‘(B) Asian-Americans. 
‘‘(C) Native Hawaiians and other Pacific 
Islanders. 
‘‘(D) Blacks. 
‘‘(E) Hispanics. 
‘‘(2) The term ‘Hispanic’ means individuals 
whose origin is Mexican, Puerto Rican, Cuban, Cen-
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tral or South American, or any other Spanish-speak-
ing country.’’. 
(b) CLERICAL AMENDMENT.—The table of sections 
at the beginning of such chapter is amended by inserting 
after the item relating to section 7309 the following new 
item: 
‘‘7310. Office of Minority Health.’’. 
SEC. 443. INDIAN DEFINED IN PPACA. 
(a) DEFINITION OF INDIAN.—Section 1304 of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18024) is amended by adding at the end the following: 
‘‘(f) INDIAN.— 
‘‘(1) IN GENERAL.—In this title, the term ‘In-
dian’ means any individual— 
‘‘(A) described in paragraph (13) or (28) 
of section 4 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1603); 
‘‘(B) who is eligible for health services pro-
vided by the Indian Health Service under sec-
tion 809 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1679); 
‘‘(C) who is of Indian descent and belongs 
to the Indian community served by the local fa-
cilities and program of the Indian Health Serv-
ice; or 
‘‘(D) who is described in paragraph (2). 
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‘‘(2) INCLUDED
INDIVIDUALS.—The following 
individuals shall be considered to be an ‘Indian’: 
‘‘(A) A member of a federally recognized 
Indian tribe. 
‘‘(B) A resident of an urban center who 
meets 1 or more of the following 4 criteria: 
‘‘(i) Membership in a tribe, band, or 
other organized group of Indians, including 
those tribes, bands, or groups terminated 
since 1940 and those recognized as of the 
date of enactment of the Health Equity 
and Accountability Act of 2016 or later by 
the State in which they reside, or being a 
descendant, in the first or second degree, 
of any such member. 
‘‘(ii) Is an Eskimo or Aleut or other 
Alaska Native. 
‘‘(iii) Is considered by the Secretary of 
the Interior to be an Indian for any pur-
pose. 
‘‘(iv) Is determined to be an Indian 
under regulations promulgated by the Sec-
retary. 
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‘‘(C) An individual who is considered by 
the Secretary of the Interior to be an Indian for 
any purpose. 
‘‘(D) An individual who is considered by 
the Secretary to be an Indian for purposes of 
eligibility for Indian health care services, includ-
ing as a California Indian, Eskimo, Aleut, or 
other Alaska Native.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) AFFORDABLE
CHOICES
HEALTH
BENEFIT 
PLANS.—Section 1311(c)(6)(D) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 
18031(c)(6)(D)) is amended by striking ‘‘section 4 
of the Indian Health Care Improvement Act’’ and 
inserting ‘‘section 1304(f)’’. 
(2) REDUCED COST-SHARING FOR INDIVIDUALS 
ENROLLING IN QUALIFIED HEALTH PLANS.—Section 
1402(d) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18071(d)) is amended— 
(A) in paragraph (1), in the matter pre-
ceding subparagraph (A), by striking ‘‘section 
4(d) of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450b(d))’’ and 
inserting ‘‘section 1304(f)’’; and 
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(B) in paragraph (2), in the matter pre-
ceding subparagraph (A), by striking ‘‘(as so 
defined)’’ and inserting ‘‘(as defined in section 
1304(f))’’. 
(3) EXEMPTION
FROM
PENALTY
FOR
NOT 
MAINTAINING
MINIMUM
ESSENTIAL
COVERAGE.— 
Section 5000A(e) of the Internal Revenue Code of 
1986 is amended by striking paragraph (3) and in-
serting the following: 
‘‘(3) INDIANS.—Any applicable individual who 
is an Indian (as defined in section 1304(f) of the 
Patient Protection and Affordable Care Act).’’. 
SEC. 444. STUDY OF DSH PAYMENTS TO ENSURE HOSPITAL 
ACCESS FOR LOW-INCOME PATIENTS. 
(a) IN GENERAL.—Not later than January 1, 2016, 
the Comptroller General of the United States shall con-
duct a study on how certain amendments made by the Pa-
tient Protection and Affordable Care Act (Public Law 
111–148) to titles XVIII and XIX of the Social Security 
Act affect the timely access to health care services for low- 
income patients. Such study shall— 
(1) evaluate and examine whether States elect-
ing to make medical assistance available under sec-
tion 1902(a)(10)(A)(i)(VIII) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) (including 
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States making such an election through a waiver of 
the State plan) to individuals described in such sec-
tion mitigates the need for payments to dispropor-
tionate share hospitals under section 1886(d)(5)(F) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(5)(F)) and section 1923 of such Act (42 
U.S.C. 1396r–4), including the impact of such 
States electing to make medical assistance available 
to such individuals on— 
(A) the number of individuals in the 
United States who are without health insurance 
and the distribution of such individuals in rela-
tion to areas primarily served by dispropor-
tionate share hospitals; and 
(B) the low-income utilization rate of such 
hospitals and the resulting fiscal sustainability 
of such hospitals; 
(2) evaluate the appropriate level and distribu-
tion of such payments among disproportionate hos-
pitals for purposes of— 
(A) sufficiently accounting for the level of 
uncompensated care provided by such hospitals 
to low-income patients; and 
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(B) providing timely access to health serv-
ices for individuals in medically underserved 
areas; and 
(3) assess, with respect to disproportionate hos-
pitals— 
(A) the role played by such hospitals in 
providing critical access to emergency, inpa-
tient, and outpatient health services, as well as 
the location of such hospitals in relation to 
medically underserved areas; and 
(B) the extent to which such hospitals sat-
isfy the requirements established for charitable 
hospital organizations under section 501(r) of 
the Internal Revenue Code of 1986 with respect 
to community health needs assessments, finan-
cial assistance policy requirements, limitations 
on charges, and billing and collection require-
ments. 
(b) REPORTS.— 
(1) REPORT
TO
CONGRESS.—Not later than 
180 days after the date on which the study under 
subsection (a) is completed, the Comptroller General 
of the United States shall submit to the Committee 
on Energy and Commerce of the House of Rep-
resentatives and the Committee on Health, Edu-
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cation, Labor, and Pensions of the Senate a report 
that contains— 
(A) the results of the study; 
(B) recommendations to Congress for any 
legislative changes to the payments to dis-
proportionate share hospitals under section 
1886(d)(5)(F) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)) and section 1923 of 
such Act (42 U.S.C. 1396r–4) that are needed 
to ensure access to health services for low-in-
come patients that— 
(i) are based on the number of indi-
viduals without health insurance, the 
amount of uncompensated care provided by 
such hospitals, and the impact of reduced 
payments levels on low-income commu-
nities; and 
(ii) takes into account any reports 
submitted by the Secretary of the Treas-
ury, in consultation with the Secretary of 
Health and Human Services, to Congres-
sional committees regarding the costs in-
curred by charitable hospital organizations 
for charity care, bad debt, nonreimbursed 
expenses for services provided to individ-
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uals under the Medicare Program under 
title XVIII of the Social Security Act and 
the Medicaid Program under title XIX of 
such Act, and any community benefit ac-
tivities provided by such organizations. 
(2) REPORT TO THE SECRETARY OF HEALTH 
AND HUMAN SERVICES.—Not later than 180 days 
after the date on which the study under subsection 
(a) is completed, the Comptroller General of the 
United States shall submit to the Secretary of 
Health and Human Services a report that con-
tains— 
(A) the results of the study; and 
(B) any recommendations for purposes of 
assisting in the development of the methodology 
for the adjustment of payments to dispropor-
tionate share hospitals, as required under sec-
tion 1886(r) of the Social Security Act (42 
U.S.C. 1395ww(r)) and the reduction of such 
payments section 1923(f)(7) of such Act (42 
U.S.C. 1396r–4(f)(7)), taking into account the 
reports referred to in paragraph (1)(B)(ii). 
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SEC. 445. ASSISTANT SECRETARY OF THE INDIAN HEALTH 
SERVICE. 
(a) REFERENCES.—Any reference in a law, regula-
tion, document, paper, or other record of the United 
States to the Director of the Indian Health Service shall 
be deemed to be a reference to the Assistant Secretary 
of the Indian Health Service. 
(b) EXECUTIVE SCHEDULE.—Section 5315 of title 5, 
United States Code, is amended in the matter relating to 
the Assistant Secretaries of Health and Human Services 
by striking ‘‘(6)’’ and inserting ‘‘(7), 1 of whom shall be 
the Assistant Secretary of the Indian Health Service’’. 
(c) CONFORMING AMENDMENT.—Section 5316 of 
title 5, United States Code, is amended by striking ‘‘Direc-
tor, Indian Health Service, Department of Health and 
Human Services.’’. 
SEC. 446. REAUTHORIZATION OF THE NATIVE HAWAIIAN 
HEALTH CARE IMPROVEMENT ACT. 
(a) NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— 
Section 6(h)(1) of the Native Hawaiian Health Care Im-
provement Act (42 U.S.C. 11705(h)(1)) is amended by 
striking ‘‘may be necessary for fiscal years 1993 through 
2019’’ and inserting ‘‘are necessary’’. 
(b) ADMINISTRATIVE
GRANT
FOR
PAPA
OLA 
LOKAHI.—Section 7(b) of the Native Hawaiian Health 
Care Improvement Act (42 U.S.C. 11706(b)) is amended 
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by striking ‘‘may be necessary for fiscal years 1993 
through 2019’’ and inserting ‘‘are necessary’’. 
(c) NATIVE HAWAIIAN HEALTH SCHOLARSHIPS.— 
Section 10(c) of the Native Hawaiian Health Care Im-
provement Act (42 U.S.C. 11709(c)) is amended by strik-
ing ‘‘may be necessary for fiscal years 1993 through 
2019’’ and inserting ‘‘are necessary’’. 
SEC. 447. AVAILABILITY OF NON-ENGLISH LANGUAGE 
SPEAKING PROVIDERS. 
(a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18031(c)(1)(B)) is amended by inserting before the semi-
colon the following: ‘‘and, with respect to such providers, 
a provider’s ability to provide care in a language other 
than English either through the provider speaking such 
language or by the provider having a training medical in-
terpreter who speaks such language available during office 
hours’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply for plan years beginning more 
than 1 year after the date of the enactment of this Act. 
SEC. 448. ACCESS TO ESSENTIAL COMMUNITY PROVIDERS. 
(a) ESSENTIAL COMMUNITY PROVIDERS.—Section 
1311(c)(1)(C) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18031(c)(1)(C)) is amended— 
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(1) by inserting ‘‘(i)’’ after ‘‘(C)’’; and 
(2) by adding at the end the following new 
clauses: 
‘‘(ii) not later than 2018, increase the per-
centage of essential community providers in-
cluded in its network by 10 percent annually 
(based on the level in the plan for 2016) until 
90 percent of all federally qualified health cen-
ters and 75 percent of all other essential com-
munity providers in the contract service area 
are in-network; and 
‘‘(iii) include one of each type of essential 
community provider in network in each county 
in their service area, where available;’’. 
(b) 
REPORTING
REQUIREMENTS.—Section 
1311(e)(3) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 18031(e)(3)(A)) is amended by adding at 
the end the following new subparagraph: 
‘‘(E) DATA
ON
ESSENTIAL
COMMUNITY 
PROVIDERS.—The Secretary shall require quali-
fied health plans to submit annually to the Sec-
retary data on the percentage of essential com-
munity providers, by county, that contract with 
each qualified health plan offered in that county 
and the percentage of essential community pro-
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viders, by type, that contract with each quali-
fied health plan offered in that county. Data so 
submitted shall be made available to the general 
public’’. 
(c) ESSENTIAL COMMUNITY PROVIDER PROVISIONS 
APPLIED UNDER MEDICARE AND MEDICAID.— 
(1) MEDICARE.—Section 1852(d)(1) of the So-
cial Security Act (42 U.S.C.1395w–22(d)(1)) is 
amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (D); 
(B) by striking the period at the end of 
subparagraph (E) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) the plan meets the requirements of 
clauses (ii) and (iii) of section 1311(c)(1)(C) of 
the Patient Protection and Affordable Care Act 
(relating to inclusion in networks of essential 
community providers).’’. 
(2) MEDICAID.—Section 1932(b)(5) of the So-
cial Security Act (42 U.S.C. 1396u–2(b)(5)) is 
amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (A); 
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(B) by striking the period at the end of 
subparagraph (B) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) the plan meets the requirements of 
clauses (ii) and (iii) of section 1311(c)(1)(C) of 
the Patient Protection and Affordable Care Act 
(relating to inclusion in networks of essential 
community providers) with respect to services 
offered in the service area involved.’’. 
SEC. 449. PROVIDER NETWORK ADEQUACY IN COMMU-
NITIES OF COLOR. 
(a) IN GENERAL.—Section 1311(c)(1)(B) of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18031(c)(1)(B)) is amended— 
(1) by inserting ‘‘(i)’’ after ‘‘(B)’’; and 
(2) by adding at the end the following the fol-
lowing new clauses: 
‘‘(ii) meet such network adequacy 
standards as the Secretary may establish 
with regard to— 
‘‘(I) appointment wait time; 
‘‘(II) travel time and distance to 
health care provider facilities and pro-
viders by public and private transit; 
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‘‘(III) hours of operation to ac-
commodate individuals who cannot 
come to provider appointments during 
standard business hours; and 
‘‘(IV) other network adequacy 
standards to ensure that care through 
these plans is accessible to diverse 
communities; and. 
‘‘(iii) provide coverage for services for 
enrollees through out-of-network providers 
at no additional cost to the enrollees in 
cases where in-network providers are un-
able to comply with the standards estab-
lished under clause subclause (III) or (IV) 
of clause (ii) for such services and the out- 
of-network providers can deliver such serv-
ices in compliance with such standards.. 
‘‘(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to plan years beginning more 
than 1 year after the date of the enactment of this Act..’’. 
SEC. 450. IMPROVING ACCESS TO DENTAL CARE. 
(a) REPORTS TO CONGRESS.— 
(1) GAO REPORT ON DENTAL THERAPIST PRO-
GRAMS.—Not later than 1 year after the date of the 
enactment of this Act, the Comptroller General of 
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the United States shall submit to Congress a report 
on the Alaska Dental Health Aide Therapists Pro-
gram and the Dental Therapist and Advanced Den-
tal Therapist programs in Minnesota, to assess den-
tal therapists’ effectiveness in— 
(A) improving access to timely dental care 
among communities of color; 
(B) providing high quality care; and 
(C) providing culturally competent care. 
(2) HRSA REPORT
ON
DENTAL
SHORTAGE 
AREAS.—Not later than 1 year after the date of the 
enactment of this Act, the Secretary, acting through 
the Administrator of the Health Resources Service 
Administration, shall submit to Congress a report 
which details geographic dental access shortages and 
the preparedness of dental providers to offer cul-
turally and linguistically appropriate, affordable, ac-
cessible, and timely services. 
(b) EXPANSION OF DENTAL HEALTH AID THERA-
PISTS IN TRIBAL COMMUNITIES.—Section 119(d) of the 
Indian Health Care Improvement Act ( U.S.C. 1616l(d)) 
is amended— 
(1) in paragraph (2), by striking ‘‘Subject to’’ 
and all that follows and inserting ‘‘Subject to para-
graph (3), in establishing a national program under 
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paragraph (1), the Secretary shall not reduce the 
amounts provided for the Community Health Aide 
Program described in subsections (a) and (b).’’; 
(2) by striking paragraph (3); and 
(3) by redesignating paragraph (4) as para-
graph (3). 
(c) COVERAGE OF DENTAL SERVICES UNDER THE 
MEDICARE PROGRAM.— 
(1) COVERAGE.—Section 1861(s)(2) of the So-
cial Security Act (42 U.S.C. 1395x(s)(2)) is amend-
ed— 
(A) in subparagraph (EE), by striking 
‘‘and’’ after the semicolon at the end; 
(B) in subparagraph (FF), by adding 
‘‘and’’ after the semicolon at the end; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(GG) oral health services (as defined in 
subsection (kkk);’’. 
(2) ORAL HEALTH SERVICES DEFINED.—Sec-
tion 1861 of the Social Security Act (42 U.S.C. 
1395x), as amended by sections 205(b) and 433(a), 
is amended by adding at the end the following new 
subsection: 
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‘‘Oral Health Services 
‘‘(kkk)(1) The term ‘oral health services’ means serv-
ices (as defined by the Secretary) that are necessary to 
prevent disease and promote oral health, restore oral 
structures to health and function, and treat emergency 
conditions. 
‘‘(2) For purposes of paragraph (1), such term shall 
include mobile and portable oral health services (as de-
fined by the Secretary) that— 
‘‘(A) are provided for the purpose of over-
coming mobility, transportation, and access barriers 
for individuals; and 
‘‘(B) satisfy the standards and certification re-
quirements established under section 1902(a)(82)(B) 
for the State in which the services are provided.’’. 
(3) PAYMENT
AND
COINSURANCE.—Section 
1833(a)(1) of the Social Security Act (42 U.S.C. 
1395l(a)(1)) is amended— 
(A) by striking ‘‘and’’ before ‘‘(Z)’’; and 
(B) by inserting before the semicolon at 
the end the following: ‘‘, and (AA) with respect 
to oral health services (as defined in section 
1861(kkk)), the amount paid shall be (i) in the 
case of such services that are preventive, 100 
percent of the lesser of the actual charge for 
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the services or the amount determined under 
the payment basis determined under section 
1848, and (ii) in the case of all other such serv-
ices, 80 percent of the lesser of the actual 
charge for the services or the amount deter-
mined under the payment basis determined 
under section 1848’’. 
(4) PAYMENT UNDER PHYSICIAN FEE SCHED-
ULE.—Section 1848(j)(3) of the Social Security Act 
(42 U.S.C. 1395w–4(j)(3)) is amended by inserting 
‘‘(2)(GG),’’ after ‘‘risk assessment),’’. 
(5) DENTURES.—Section 1861(s)(8) of the So-
cial Security Act (42 U.S.C. 1395x(s)(8)) is amend-
ed— 
(A) by striking ‘‘(other than dental)’’ and 
inserting ‘‘(including dentures)’’; and 
(B) by striking ‘‘internal body’’. 
(6) REPEAL
OF
GROUND
FOR
EXCLUSION.— 
Section 1862(a) of the Social Security Act (42 
U.S.C. 1395y) is amended by striking paragraph 
(12). 
(7) EFFECTIVE DATE.—The amendments made 
by this section shall apply to services furnished on 
or after January 1, 2017. 
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(d) COVERAGE OF DENTAL SERVICES UNDER THE 
MEDICAID PROGRAM.— 
(1) IN GENERAL.—Section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended— 
(A) in subsection (a)(10), by striking ‘‘den-
tal services’’ and inserting ‘‘oral health services 
(as defined in subsection (ee)(1))’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(ee)(1) Subject to paragraphs (2) and (3), for pur-
poses of this title, the term ‘oral health services’ means 
services (as defined by the Secretary) that are necessary 
to prevent disease and promote oral health, restore oral 
structures to health and function, and treat emergency 
conditions. These services shall include, in the case of 
pregnant or postpartum women, such services as are nec-
essary to address oral health conditions that exist or are 
exacerbated by pregnancy or childbirth or which, if left 
untreated, could adversely affect fetal or child develop-
ment. 
‘‘(2) For purposes of paragraph (1), such term shall 
include— 
‘‘(A) dentures; and 
‘‘(B) mobile and portable oral health services 
(as defined by the Secretary) that— 
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‘‘(i) are provided for the purpose of over-
coming mobility, transportation, and access bar-
riers for individuals; and 
‘‘(ii) satisfy the standards and certification 
requirements 
established 
under 
section 
1902(a)(82)(C) for the State in which the serv-
ices are provided. 
‘‘(3) For purposes of paragraph (1), such term shall 
not apply to dental care or services provided to individuals 
under the age of 21 under subsection (r)(3).’’. 
(2) CONFORMING AMENDMENTS.— 
(A) STATE PLAN REQUIREMENTS.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended— 
(i) in paragraph (10)(A), in the mat-
ter preceding clause (i), by inserting 
‘‘(10),’’ after ‘‘(5),’’; 
(ii) in paragraph (80), by striking 
‘‘and’’ at the end; 
(iii) in paragraph (81), by striking the 
period at the end and inserting ‘‘; and’’; 
and 
(iv) by inserting after paragraph (81) 
the following: 
‘‘(82) provide for— 
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‘‘(A) informing, in writing, all individuals 
who have been determined to be eligible for 
medical assistance of the availability of oral 
health services (as defined in section 1905(ee)); 
‘‘(B) conducting targeted outreach to preg-
nant women who have been determined to be el-
igible for medical assistance about the avail-
ability of medical assistance for such dental 
services and the importance of receiving dental 
care while pregnant; and 
‘‘(C) establishing and maintaining stand-
ards for and certification of mobile and portable 
oral health services (as described in subsections 
(r)(3)(C) and (ee)(2)(B) of section 1905).’’. 
(B) DEFINITION
OF
MEDICAL
ASSIST-
ANCE.—Section 1905(a)(12) of the Social Secu-
rity Act (42 U.S.C. 1396d(a)(12)) is amended 
by striking ‘‘, dentures,’’. 
(3) MOBILE
AND
PORTABLE
ORAL
HEALTH 
SERVICES UNDER EPSDT.—Section 1905(r)(3) of the 
Social Security Act (42 U.S.C. 1396d(r)(3)) is 
amended— 
(A) in subparagraph (A)(ii), by striking ‘‘; 
and’’ and inserting a semicolon; 
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(B) in subparagraph (B), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) which shall include mobile and port-
able oral health services (as defined by the Sec-
retary) that— 
‘‘(i) are provided for the purpose of 
overcoming mobility, transportation, or ac-
cess barriers for children; and 
‘‘(ii) satisfy the standards and certifi-
cation requirements established under sec-
tion 1902(a)(82)(C) for the State in which 
the services are provided.’’. 
(e) ORAL HEALTH SERVICES
AS
AN ESSENTIAL 
HEALTH BENEFIT.—Section 1302(b) of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 18022(b)) is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (J), by striking ‘‘oral 
and’’; and 
(B) by adding at the end the following: 
‘‘(K) Oral health services for children and 
adults.’’; and 
(2) by adding at the end the following: 
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‘‘(6) ORAL HEALTH SERVICES.—For purposes 
of paragraph (1)(K), the term ‘oral health services’ 
means services (as defined by the Secretary), that 
are necessary to prevent disease and promote oral 
health, restore oral structures to health and func-
tion, and treat emergency conditions.’’. 
(f) DEMONSTRATION PROGRAM ON TRAINING AND 
EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 
PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 
VETERANS IN RURAL AND OTHER UNDERSERVED COM-
MUNITIES.— 
(1) DEMONSTRATION PROGRAM AUTHORIZED.— 
The Secretary of Veterans Affairs may carry out a 
demonstration program to establish programs to 
train and employ alternative dental health care pro-
viders in order to increase access to dental health 
care services for veterans who are entitled to such 
services from the Department of Veterans Affairs 
and reside in rural and other underserved commu-
nities. 
(2) TELEHEALTH.—For purposes of alternative 
dental health care providers and other dental care 
providers who are licensed to provide clinical care, 
dental services provided under the demonstration 
program under this section may be administered by 
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such providers through telehealth-enabled collabora-
tion and supervision when appropriate and feasible. 
(3) ALTERNATIVE DENTAL HEALTH CARE PRO-
VIDERS DEFINED.—In this section, the term ‘‘alter-
native dental health care providers’’ has the meaning 
given that term in section 340G–1(a)(2) of the Pub-
lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as are necessary to carry out the demonstration pro-
gram under this subsection. 
(g) DEMONSTRATION PROGRAM ON TRAINING AND 
EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 
PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 
MEMBERS OF THE ARMED FORCES AND DEPENDENTS 
LACKING READY ACCESS TO SUCH SERVICES.— 
(1) DEMONSTRATION PROGRAM AUTHORIZED.— 
The Secretary of Defense may carry out a dem-
onstration program to establish programs to train 
and employ alternative dental health care providers 
in order to increase access to dental health care 
services for members of the Armed Forces and their 
dependents who lack ready access to such services, 
including the following: 
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(A) Members and dependents who reside in 
rural areas or areas otherwise underserved by 
dental health care providers. 
(B) Members of the National Guard and 
Reserves in active status who are potentially 
deployable. 
(2) TELEHEALTH.—For purposes of alternative 
dental health care providers and other dental care 
providers who are licensed to provide clinical care, 
dental services provided under the demonstration 
program under this section may be administered by 
such providers through telehealth-enabled collabora-
tion and supervision when appropriate and feasible. 
(3) ALTERNATIVE DENTAL HEALTH CARE PRO-
VIDERS DEFINED.—In this section, the term ‘‘alter-
native dental health care providers’’ has the meaning 
given that term in section 340G–1(a)(2) of the Pub-
lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as are necessary to carry out the demonstration pro-
gram under this subsection. 
(h) DEMONSTRATION PROGRAM ON TRAINING AND 
EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 
PROVIDERS FOR DENTAL HEALTH CARE SERVICES FOR 
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PRISONERS WITHIN THE CUSTODY OF THE BUREAU OF 
PRISONS.— 
(1) DEMONSTRATION PROGRAM AUTHORIZED.— 
The Attorney General, acting through the Director 
of the Bureau of Prisons, may carry out a dem-
onstration program to establish programs to train 
and employ alternative dental health care providers 
in order to increase access to dental health services 
for prisoners within the custody of the Bureau of 
Prisons. 
(2) TELEHEALTH.—For purposes of alternative 
dental health care providers and any other dental 
care providers who are licensed to provide clinical 
care, dental services provided under the demonstra-
tion program under this section may be administered 
by such providers through telehealth-enabled collabo-
ration and supervision when deemed appropriate and 
feasible. 
(3) ALTERNATIVE DENTAL HEALTH CARE PRO-
VIDERS DEFINED.—In this section, the term ‘‘alter-
native dental health care providers’’ has the meaning 
given that term in section 340G–1(a)(2) of the Pub-
lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
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as are necessary to carry out the demonstration pro-
gram under this subsection. 
(i) DEMONSTRATION PROGRAM ON TRAINING AND 
EMPLOYMENT OF ALTERNATIVE DENTAL HEALTH CARE 
PROVIDERS
FOR
DENTAL
HEALTH
CARE
SERVICES 
UNDER THE INDIAN HEALTH SERVICE.— 
(1) DEMONSTRATION PROGRAM AUTHORIZED.— 
The Secretary of Health and Human Services, act-
ing through the Indian Health Service, may carry 
out a demonstration program to establish programs 
to train and employ alternative dental health care 
providers in order to help eliminate oral health dis-
parities and increase access to dental services 
through health programs operated by the Indian 
Health Service, Indian tribes, tribal organizations, 
and urban Indian organizations (as those terms are 
defined in section 4 of the Indian Health Care Im-
provement Act (25 U.S.C. 1603)). 
(2) TELEHEALTH.—For purposes of alternative 
dental health care providers and any other dental 
care providers who are licensed to provide clinical 
care, dental services provided under the demonstra-
tion program under this section may be administered 
by such providers through telehealth-enabled collabo-
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ration and supervision when deemed appropriate and 
feasible. 
(3) ALTERNATIVE DENTAL HEALTH CARE PRO-
VIDERS DEFINED.—In this section, the term ‘‘alter-
native dental health care providers’’ has the meaning 
given that term in section 340G–1(a)(2) of the Pub-
lic Health Service Act (42 U.S.C. 256g–1(a)(2)). 
(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated such sums 
as are necessary to carry out the demonstration pro-
gram under this subsection. 
TITLE V—IMPROVING HEALTH 
OUTCOMES 
FOR 
WOMEN, 
CHILDREN, AND FAMILIES 
SEC. 501. GRANTS TO PROMOTE POSITIVE HEALTH OUT-
COMES FOR WOMEN AND CHILDREN. 
Part Q of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399Z–2. GRANTS TO PROMOTE POSITIVE HEALTH 
OUTCOMES FOR WOMEN AND CHILDREN. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, in col-
laboration with the Administrator of the Health Resources 
and Services Administration and other Federal officials 
determined appropriate by the Secretary, is authorized to 
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award grants to eligible entities to promote positive health 
outcomes for women and children in target populations, 
especially racial and ethnic minority women and children 
in medically underserved communities. 
‘‘(b) USE OF FUNDS.—Grants awarded pursuant to 
subsection (a) may be used to support the activities of 
community health workers, including such activities— 
‘‘(1) to educate and provide outreach regarding 
enrollment in health insurance including the State 
Children’s Health Insurance Program under title 
XXI of the Social Security Act, Medicare under title 
XVIII of such Act, and Medicaid under title XIX of 
such Act; 
‘‘(2) to educate, guide, and provide outreach in 
a community setting regarding health problems prev-
alent among women and children and especially 
among racial and ethnic minority women and chil-
dren; 
‘‘(3) to educate, guide, and provide experiential 
learning opportunities and target risk factors and 
healthy behaviors that impede or contribute to 
achieving positive health outcomes, including— 
‘‘(A) healthy nutrition; 
‘‘(B) physical activity; 
‘‘(C) overweight or obesity; 
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‘‘(D) tobacco use; 
‘‘(E) alcohol and substance use; 
‘‘(F) injury and violence; 
‘‘(G) sexual health; 
‘‘(H) mental health; 
‘‘(I) musculoskeletal health and arthritis; 
‘‘(J) dental and oral health; 
‘‘(K) understanding informed consent; and 
‘‘(L) stigma; 
‘‘(4) to educate and guide regarding effective 
strategies to promote positive health outcomes for 
women and children; 
‘‘(5) to promote community wellness and aware-
ness; and 
‘‘(6) to educate and refer target populations to 
appropriate health care agencies and community- 
based programs and organizations in order to in-
crease access to quality health care services, includ-
ing preventive health services. 
‘‘(c) APPLICATION.— 
‘‘(1) IN
GENERAL.—Each eligible entity that 
desires to receive a grant under subsection (a) shall 
submit an application to the Secretary, at such time, 
in such manner, and accompanied by such additional 
information as the Secretary may require. 
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‘‘(2) CONTENTS.—Each application submitted 
pursuant to paragraph (1) shall— 
‘‘(A) describe the activities for which as-
sistance under this section is sought; 
‘‘(B) contain an assurance that, with re-
spect to each community health worker pro-
gram receiving funds under the grant awarded, 
such program provides in-language training and 
supervision to community health workers to en-
able such workers to provide authorized pro-
gram activities in (at least) the most commonly 
used languages within a particular geographic 
region; 
‘‘(C) contain an assurance that the appli-
cant will evaluate the effectiveness of commu-
nity health worker programs receiving funds 
under the grant; 
‘‘(D) contain an assurance that each com-
munity health worker program receiving funds 
under the grant will provide culturally com-
petent services in the linguistic context most 
appropriate for the individuals served by the 
program; 
‘‘(E) contain a plan to document and dis-
seminate project descriptions and results to 
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other States and organizations as identified by 
the Secretary; and 
‘‘(F) describe plans to enhance the capac-
ity of individuals to utilize health services and 
health-related social services under Federal, 
State, and local programs by— 
‘‘(i) assisting individuals in estab-
lishing eligibility under the programs and 
in receiving the services or other benefits 
of the programs; and 
‘‘(ii) providing other services, as the 
Secretary determines to be appropriate, 
which may include transportation and 
translation services. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to those appli-
cants— 
‘‘(1) who propose to target geographic areas 
that— 
‘‘(A)(i) have a high percentage of residents 
who are uninsured or underinsured (if the tar-
geted geographic area is located in a State that 
has elected to make medical assistance available 
under section 1902(a)(10)(A)(i)(VIII) of the 
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Social Security Act to individuals described in 
such section); 
‘‘(ii) have a high percentage of under-
insured residents in a particular geographic 
area (if the targeted geographic area is located 
in a State that has not so elected); or 
‘‘(iii) have a high number of households ex-
periencing extreme poverty; and 
‘‘(B) have a high percentage of families for 
whom English is not their primary language or 
including 
smaller 
limited-English-proficient 
communities within the region that are not oth-
erwise reached by linguistically appropriate 
health services; 
‘‘(2) with experience in providing health or 
health-related social services to individuals who are 
underserved with respect to such services; and 
‘‘(3) with documented community activity and 
experience with community health workers. 
‘‘(e) COLLABORATION WITH ACADEMIC INSTITU-
TIONS.—The Secretary shall encourage community health 
worker programs receiving funds under this section to col-
laborate with academic institutions, including minority- 
serving institutions. Nothing in this section shall be con-
strued to require such collaboration. 
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‘‘(f) QUALITY ASSURANCE AND COST EFFECTIVE-
NESS.—The Secretary shall establish guidelines for ensur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for ensuring the cost effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (f). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project. 
‘‘(2) CONTENTS.—The report required under 
paragraph (1) shall include the following: 
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‘‘(A) A description of the programs for 
which grant funds were used. 
‘‘(B) The number of individuals served. 
‘‘(C) An evaluation of— 
‘‘(i) the effectiveness of these pro-
grams; 
‘‘(ii) the cost of these programs; and 
‘‘(iii) the impact of the project on the 
health outcomes of the community resi-
dents. 
‘‘(D) Recommendations for sustaining the 
community health worker programs developed 
or assisted under this section. 
‘‘(E) Recommendations regarding training 
to enhance career opportunities for community 
health workers. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means an individual who 
promotes health or nutrition within the community 
in which the individual resides— 
‘‘(A) by serving as a liaison between com-
munities and health care agencies; 
‘‘(B) by providing guidance and social as-
sistance to community residents; 
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‘‘(C) by enhancing community residents’ 
ability to effectively communicate with health 
care providers; 
‘‘(D) by providing culturally and linguis-
tically appropriate health or nutrition edu-
cation; 
‘‘(E) by advocating for individual and com-
munity health, including dental, oral, mental, 
and environmental health, or nutrition needs; 
‘‘(F) by taking into consideration the 
needs of the communities served, including the 
prevalence rates of risk factors that impede 
achieving positive healthy outcomes among 
women and children, especially among racial 
and ethnic minority women and children; and 
‘‘(G) by providing referral and followup 
services. 
‘‘(2) COMMUNITY SETTING.—The term ‘commu-
nity setting’ means a home or a community organi-
zation that serves a population. 
‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en-
tity’ means— 
‘‘(A) a unit of State, territorial, local, or 
tribal government (including a federally recog-
nized tribe or Alaska Native village); or 
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‘‘(B) a community-based organization. 
‘‘(4) MEDICALLY UNDERSERVED COMMUNITY.— 
The term ‘medically underserved community’ means 
a community— 
‘‘(A) that has a substantial number of in-
dividuals who are members of a medically un-
derserved population, as defined by section 
330(b)(3); 
‘‘(B) a significant portion of which is a 
health professional shortage area as designated 
under section 332; and 
‘‘(C) that includes populations that are lin-
guistically isolated, such as geographic areas 
with a shortage of health professionals able to 
provide linguistically appropriate services. 
‘‘(5) SUPPORT.—The term ‘support’ means the 
provision of training, supervision, and materials 
needed to effectively deliver the services described in 
subsection (b), reimbursement for services, and 
other benefits. 
‘‘(6) TARGET POPULATION.—The term ‘target 
population’ means women of reproductive age, re-
gardless of their current childbearing status and 
children under 21 years of age. 
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‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$15,000,000 for each of fiscal years 2017 through 2021.’’. 
SEC. 502. REMOVING BARRIERS TO HEALTH CARE AND NU-
TRITION ASSISTANCE FOR CHILDREN, PREG-
NANT WOMEN, AND LAWFULLY PRESENT IN-
DIVIDUALS. 
(a) MEDICAID.—Section 1903(v) of the Social Secu-
rity Act (42 U.S.C. 1396b(v)) is amended by striking 
paragraph (4) and inserting the following new paragraph: 
‘‘(4)(A) Notwithstanding sections 401(a), 402(b), 
403, and 421 of the Personal Responsibility and Work Op-
portunity Reconciliation Act of 1996 and paragraph (1), 
payment shall be made to a State under this section for 
medical assistance furnished to an alien under this title 
(including an alien described in such paragraph) who 
meets any of the following conditions: 
‘‘(i) The alien is otherwise eligible for such as-
sistance under the State plan approved under this 
title (other than the requirement of the receipt of 
aid or assistance under title IV, supplemental secu-
rity income benefits under title XVI, or a State sup-
plementary payment) within either or both of the 
following eligibility categories: 
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‘‘(I) Children under 21 years of age, in-
cluding any optional targeted low-income child 
(as 
such 
term 
is 
defined 
in 
section 
1905(u)(2)(B)). 
‘‘(II) Pregnant women during pregnancy 
and during the 60-day period beginning on the 
last day of the pregnancy. 
‘‘(ii) The alien is lawfully present in the United 
States. 
‘‘(B) No debt shall accrue under an affidavit of sup-
port against any sponsor of an alien who meets the condi-
tions specified in subparagraph (A) on the basis of the 
provision of medical assistance to such alien under this 
paragraph and the cost of such assistance shall not be con-
sidered as an unreimbursed cost.’’. 
(b) 
SCHIP.—Subparagraph 
(J) 
of 
section 
2107(e)(1) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(J) Paragraph (4) of section 1903(v) (re-
lating to coverage of categories of children, 
pregnant women, and other lawfully present in-
dividuals).’’. 
(c) SUPPLEMENTAL NUTRITION ASSISTANCE.—Not-
withstanding sections 401(a), 402(a), and 403(a) of the 
Personal Responsibility and Work Opportunity Reconcili-
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ation Act of 1996 (8 U.S.C. 1611(a); 1612(a); 1613(a)) 
and section 6(f) of the Food and Nutrition Act of 2008 
(7 U.S.C. 2015(f)), persons who are lawfully present in 
the United States shall be not be ineligible for benefits 
under the supplemental nutrition assistance program on 
the basis of their immigration status or date of entry into 
the United States. 
(d) ELIGIBILITY FOR FAMILIES WITH CHILDREN.— 
Section 421(d)(3) of the Personal Responsibility and 
Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 
1631(d)(3)) is amended by striking ‘‘to the extent that 
a qualified alien is eligible under section 402(a)(2)(J)’’ 
and inserting, ‘‘to the extent that a child is a member of 
a household under the supplemental nutrition assistance 
program’’. 
(e) 
ENSURING
PROPER
SCREENING.—Section 
11(e)(2)(B) of the Food and Nutrition Act of 2008 (7 
U.S.C. 2020(e)(2)(B)) is amended— 
(1) by redesignating clauses (vi) and (vii) as 
clauses (vii) and (viii); and 
(2) by inserting after clause (v) the following: 
‘‘(vi) shall provide a method for imple-
menting section 421 of the Personal Re-
sponsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631) 
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that does not require any unnecessary in-
formation from persons who may be ex-
empt from that provision;’’. 
SEC. 503. REPEAL OF DENIAL OF BENEFITS. 
Section 115 of the Personal Responsibility and Work 
Opportunity Reconciliation Act of 1996 (21 U.S.C. 862a) 
is amended— 
(1) in subsection (a), by striking paragraph (2); 
(2) in subsection (b), by striking paragraph (2); 
and 
(3) in subsection (e), by striking paragraph (2). 
SEC. 504. BIRTH DEFECTS PREVENTION, RISK REDUCTION, 
AND AWARENESS. 
(a) IN GENERAL.—The Secretary shall establish and 
implement a birth defects prevention and public awareness 
program, consisting of the activities described in sub-
sections (c) and (d). 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘pregnancy and breastfeeding in-
formation services’’ includes only— 
(A) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during pregnancy 
that may be associated with birth defects or 
other health risks, such as exposures to medica-
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tions, chemicals, infections, foodborne patho-
gens, illnesses, nutrition, or lifestyle factors; 
(B) information services to provide accu-
rate, evidence-based, clinical information re-
garding maternal exposures during breast-
feeding that may be associated with health risks 
to a breast-fed infant, such as exposures to 
medications, chemicals, infections, foodborne 
pathogens, illnesses, nutrition, or lifestyle fac-
tors; 
(C) the provision of accurate, evidence- 
based information weighing risks of exposures 
during breastfeeding against the benefits of 
breastfeeding; and 
(D) the provision of information described 
in subparagraph (A), (B), or (C) through coun-
selors, Web sites, fact sheets, telephonic or elec-
tronic communication, community outreach ef-
forts, or other appropriate means. 
(2) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services, acting through the 
Director of the Centers for Disease Control and Pre-
vention. 
(c) NATIONWIDE MEDIA CAMPAIGN.—In carrying out 
subsection (a), the Secretary shall conduct or support a 
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nationwide media campaign to increase awareness among 
health care providers and at-risk populations about preg-
nancy and breastfeeding information services. 
(d) GRANTS FOR PREGNANCY AND BREASTFEEDING 
INFORMATION SERVICES.— 
(1) IN GENERAL.—In carrying out subsection 
(a), the Secretary shall award grants to State or re-
gional agencies or organizations for any of the fol-
lowing: 
(A) INFORMATION SERVICES.—The provi-
sion of, or campaigns to increase awareness 
about, pregnancy and breastfeeding information 
services. 
(B) SURVEILLANCE AND RESEARCH.—The 
conduct or support of— 
(i) surveillance of or research on— 
(I) maternal exposures and ma-
ternal health conditions that may in-
fluence the risk of birth defects, pre-
maturity, or other adverse pregnancy 
outcomes; and 
(II) maternal exposures that may 
influence health risks to a breastfed 
infant; or 
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(ii) networking to facilitate surveil-
lance or research described in this sub-
paragraph. 
(2) PREFERENCE FOR CERTAIN STATES.—The 
Secretary, in making any grant under this sub-
section, shall give preference to States, otherwise 
equally qualified, that have a pregnancy and 
breastfeeding information service in place. 
(3) MATCHING
FUNDS.—The Secretary may 
only award a grant under this subsection to a State 
or regional agency or organization that agrees, with 
respect to the costs to be incurred in carrying out 
the grant activities, to make available (directly or 
through donations from public or private entities) 
non-Federal funds toward such costs in an amount 
equal to not less than 25 percent of the amount of 
the grant. 
(4) COORDINATION.—The Secretary shall en-
sure that activities funded through a grant under 
this subsection are coordinated, to the maximum ex-
tent practicable, with other birth defects prevention 
and environmental health activities of the Federal 
Government, including with respect to pediatric envi-
ronmental health specialty units and children’s envi-
ronmental health centers. 
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(e) EVALUATION.—In furtherance of the program 
under subsection (a), the Secretary shall provide for an 
evaluation of pregnancy and breastfeeding information 
services to identify efficient and effective models of— 
(1) providing information; 
(2) raising awareness and increasing knowledge 
about birth defects prevention measures and tar-
geting education to at-risk groups; 
(3) modifying risk behaviors; or 
(4) other outcome measures as determined ap-
propriate by the Secretary. 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
$5,000,000 for fiscal year 2017, $6,000,000 for fiscal year 
2018, $7,000,000 for fiscal year 2019, $8,000,000 for fis-
cal year 2020, and $9,000,000 for fiscal year 2021. 
SEC. 505. UNIFORM STATE MATERNAL MORTALITY REVIEW 
COMMITTEES 
ON 
PREGNANCY-RELATED 
DEATHS. 
(a) IN GENERAL.—Title V of the Social Security Act 
(42 U.S.C. 701 et seq.) is amended by adding at the end 
the following new section: 
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‘‘SEC. 514. UNIFORM STATE MATERNAL MORTALITY RE-
VIEW 
COMMITTEES 
ON 
PREGNANCY-RE-
LATED DEATHS. 
‘‘(a) GRANTS.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of this title, for each of fiscal years 2017 
through 2023, in addition to payments from allot-
ments for States under section 502 for such year, 
the Secretary shall, subject to paragraph (3) and in 
accordance with the criteria established under para-
graph (2), award grants to States to— 
‘‘(A) carry out the activities described in 
subsection (b)(1); 
‘‘(B) establish a State maternal mortality 
review committee, in accordance with subsection 
(b)(2), to carry out the activities described in 
subsection (b)(2)(A), and to establish the proc-
esses described in subsection (b)(1); 
‘‘(C) ensure the State department of 
health carries out the applicable activities de-
scribed in subsection (b)(3), with respect to 
pregnancy-related deaths occurring within the 
State during such fiscal year; 
‘‘(D) implement and use the comprehensive 
case abstraction form developed under sub-
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section (c), in accordance with such subsection; 
and 
‘‘(E) provide for public disclosure of infor-
mation, in accordance with subsection (e). 
‘‘(2) CRITERIA.—The Secretary shall establish 
criteria for determining eligibility for and the 
amount of a grant awarded to a State under para-
graph (1). Such criteria shall provide that in the 
case of a State that receives such a grant for a fiscal 
year and is determined by the Secretary to have not 
used such grant in accordance with this section, 
such State shall not be eligible for such a grant for 
any subsequent fiscal year. 
‘‘(3) AUTHORIZATION
OF
APPROPRIATIONS.— 
For purposes of carrying out the grant program 
under this section, including for administrative pur-
poses, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2017 through 
2023. 
‘‘(b) PREGNANCY-RELATED DEATH REVIEW.— 
‘‘(1) REVIEW OF PREGNANCY-RELATED DEATH 
AND PREGNANCY-ASSOCIATED DEATH CASES.—For 
purposes of subsection (a), with respect to a State 
that receives a grant under subsection (a), the fol-
lowing shall apply: 
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‘‘(A) MANDATORY
REPORTING
OF
PREG-
NANCY-RELATED DEATHS.— 
‘‘(i) IN GENERAL.—The State shall, 
through the State maternal mortality re-
view committee, develop a process, sepa-
rate from any reporting process established 
by the State department of health prior to 
the date of the enactment of this section, 
that provides for mandatory and confiden-
tial case reporting by individuals and enti-
ties described in clause (ii) of pregnancy- 
related deaths to the State department of 
health. 
‘‘(ii) INDIVIDUALS AND ENTITIES DE-
SCRIBED.—Individuals and entities de-
scribed in this clause include each of the 
following: 
‘‘(I) Health care providers. 
‘‘(II) Medical examiners. 
‘‘(III) Medical coroners. 
‘‘(IV) Hospitals. 
‘‘(V) Free-standing birth centers. 
‘‘(VI) Federally qualified health 
centers. 
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‘‘(VII) Other health care facili-
ties. 
‘‘(VIII) Any other individuals re-
sponsible for completing death certifi-
cates. 
‘‘(IX) Any other appropriate in-
dividuals or entities specified by the 
Secretary. 
‘‘(B) VOLUNTARY
REPORTING
OF
PREG-
NANCY-RELATED AND PREGNANCY-ASSOCIATED 
DEATHS.— 
‘‘(i) The State shall, through the 
State maternal mortality review committee, 
develop a process for and encourage, sepa-
rate from any reporting process established 
by the State department of health prior to 
the date of the enactment of this section, 
voluntary and confidential case reporting 
by individuals described in clause (ii) of 
pregnancy-associated deaths to the State 
department of health. 
‘‘(ii) The State shall, through the 
State maternal mortality review committee, 
develop a process for voluntary and con-
fidential reporting by family members of 
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the deceased and by other individuals on 
possible pregnancy-related and pregnancy- 
associated deaths to the State department 
of health. Such process shall include— 
‘‘(I) making publicly available on 
the Internet Web site of the State de-
partment of health a telephone num-
ber, Internet Web link, and email ad-
dress for such reporting; and 
‘‘(II) publicizing to local profes-
sional organizations, community orga-
nizations, and social services agencies 
the availability of the telephone num-
ber, Internet Web link, and email ad-
dress made available under subclause 
(I). 
‘‘(C) DEVELOPMENT OF CASE-FINDING.— 
The State, through the vital statistics unit of 
the State, shall annually identify pregnancy-re-
lated and pregnancy-associated deaths occur-
ring in such State during the year involved 
by— 
‘‘(i) matching all death records, with 
respect to such year, for women of child-
bearing age to live birth certificates and in-
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fant death certificates to identify deaths of 
women that occurred during pregnancy 
and within one year after the end of a 
pregnancy; 
‘‘(ii) identifying deaths reported dur-
ing such year as having an underlying or 
contributing cause of death related to 
pregnancy, regardless of the time that has 
passed between the end of the pregnancy 
and the death; 
‘‘(iii) collecting data from medical ex-
aminer and coroner reports; and 
‘‘(iv) any other methods the States 
may devise to identify maternal deaths, 
such as through review of a random sam-
ple of reported deaths of women of child-
bearing age to ascertain cases of preg-
nancy-related 
and 
pregnancy-associated 
deaths that are not discernable from a re-
view of death certificates alone. 
When feasible and for purposes of effectively 
collecting and obtaining data on pregnancy-re-
lated and pregnancy-associated deaths, the 
State shall adopt the most recent standardized 
birth and death certificates, as issued by the 
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National Center for Vital Health Statistics, in-
cluding the recommended checkbox section for 
pregnancy on the death certificates. 
‘‘(D) CASE INVESTIGATION AND DEVELOP-
MENT OF CASE SUMMARIES.—Following receipt 
of reports by the State department of health 
pursuant to subparagraph (A) or (B) and col-
lection by the vital statistics unit of the State 
of possible cases of pregnancy-related and preg-
nancy-associated deaths pursuant to subpara-
graph (C), the State, through the State mater-
nal mortality review committee established 
under subsection (a), shall investigate each 
case, utilizing the case abstraction form de-
scribed in subsection (c), and prepare de-identi-
fied case summaries, which shall be reviewed by 
the committee and included in applicable re-
ports. For purposes of subsection (a), under the 
processes established under subparagraphs (A), 
(B), and (C), a State department of health or 
vital statistics unit of a State shall provide to 
the State maternal mortality review committee 
access to information collected pursuant to such 
subparagraphs as necessary to carry out this 
subparagraph. Data and information collected 
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for the case summary and review are for pur-
poses of public health activities, in accordance 
with HIPAA privacy and security law (as de-
fined in section 3009(a)(2) of the Public Health 
Service Act). Such case investigations shall in-
clude data and information obtained through— 
‘‘(i) medical examiner and autopsy re-
ports of the woman involved; 
‘‘(ii) medical records of the woman, 
including such records related to health 
care prior to pregnancy, prenatal and post-
natal care, labor and delivery care, emer-
gency 
room 
care, 
hospital 
discharge 
records including immunization status and 
screening status for prevalent diseases, and 
any care delivered up until the time of 
death of the woman for purposes of public 
health 
activities, 
in 
accordance 
with 
HIPAA privacy and security law (as de-
fined in section 3009(a)(2) of the Public 
Health Service Act); 
‘‘(iii) oral and written interviews of in-
dividuals directly involved in the maternal 
care of the woman during and immediately 
following the pregnancy of the woman, in-
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cluding health care, mental health, and so-
cial service providers in-language when 
possible, as applicable; 
‘‘(iv) optional oral or written inter-
views of the family of the woman; 
‘‘(v) socioeconomic and other relevant 
background information about the woman; 
‘‘(vi) information collected in subpara-
graph (C)(i); and 
‘‘(vii) other information on the cause 
of death of the woman, such as social serv-
ices and child welfare reports, including ex-
periences with intimate partner violence. 
‘‘(2) STATE
MATERNAL
MORTALITY
REVIEW 
COMMITTEES.— 
‘‘(A) DUTIES.— 
‘‘(i) REQUIRED
COMMITTEE
ACTIVI-
TIES.—For purposes of subsection (a), a 
maternal mortality review committee estab-
lished by a State pursuant to a grant 
under such subsection shall carry out the 
following 
pregnancy-related 
death 
and 
pregnancy-associated death review activi-
ties and shall include all information rel-
evant to the death involved on the case ab-
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straction form developed under subsection 
(d): 
‘‘(I) With respect to a case of 
pregnancy-related or pregnancy-asso-
ciated death of a woman, review the 
case summaries prepared under sub-
paragraphs (A), (B), (C), and (D) of 
paragraph (1). 
‘‘(II) Review aggregate statistical 
reports developed by the vital statis-
tics unit of the State under paragraph 
(1)(C) 
regarding 
pregnancy-related 
and pregnancy-associated deaths to 
identify trends, patterns, and dispari-
ties in adverse outcomes and address 
medical, nonmedical, and system-re-
lated factors that may have contrib-
uted to such pregnancy-related and 
pregnancy-associated deaths and dis-
parities. 
‘‘(III) Develop recommendations, 
based on the review of the case sum-
maries under paragraph (1)(D) and 
aggregate statistical reports under 
subclause (II), to improve maternal 
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care, social and health services, and 
public health policy and institutions, 
including with respect to improving 
access to maternal care, improving the 
availability of social services, and 
eliminating disparities in maternal 
care and outcomes. 
‘‘(ii) OPTIONAL
COMMITTEE
ACTIVI-
TIES.—For purposes of subsection (a), a 
maternal mortality review committee estab-
lished by a State under such subsection 
may present findings and recommendations 
regarding a specific case or set of cir-
cumstances directly to a health care facil-
ity or its local or State professional organi-
zation for the purpose of instituting policy 
changes, educational activities, or other-
wise improving the quality of care provided 
by the facilities. 
‘‘(B) COMPOSITION
OF
MATERNAL
MOR-
TALITY REVIEW COMMITTEES.— 
‘‘(i) IN GENERAL.—Each State mater-
nal mortality review committee established 
pursuant to a grant under subsection (a) 
shall be multidisciplinary, consisting of 
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health care, behavioral health, and social 
service providers, public health officials, 
other persons with professional expertise 
on maternal health and mortality, and pa-
tient and community advocates who rep-
resent those communities within such State 
that are the most affected by maternal 
mortality. Membership on such a com-
mittee of a State shall be reviewed annu-
ally by the State department of health to 
ensure that membership representation re-
quirements are being fulfilled in accord-
ance with this paragraph. 
‘‘(ii) REQUIRED MEMBERSHIP.—Each 
such review committee shall include— 
‘‘(I) representatives from medical 
specialties providing care to pregnant 
and postpartum patients, including 
obstetricians 
(including 
generalists 
and maternal fetal medicine special-
ists), and family practice physicians; 
‘‘(II) representatives from mid-
wifery specialties (including certified 
professional midwives and certified 
midwives); 
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‘‘(III) advanced practice nurses; 
‘‘(IV) hospital-based nurses; 
‘‘(V) representatives of the State 
department of health maternal and 
child health department; 
‘‘(VI) social service providers or 
social workers; 
‘‘(VII) the chief medical exam-
iners or designees; 
‘‘(VIII) facility representatives, 
such as from hospitals or free-stand-
ing birth centers; and 
‘‘(IX) community or patient ad-
vocates who represent those commu-
nities within the State that are the 
most affected by maternal mortality. 
‘‘(iii) ADDITIONAL
MEMBERS.—Each 
such review committee may also include 
representatives from other relevant aca-
demic, health, social service, or policy pro-
fessions, or community organizations, on 
an ongoing basis, or as needed, as deter-
mined beneficial by the review committee, 
including— 
‘‘(I) anesthesiologists; 
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‘‘(II) emergency physicians; 
‘‘(III) pathologists; 
‘‘(IV) epidemiologists or biostat-
isticians; 
‘‘(V) intensivists; 
‘‘(VI) orthopedic surgeons and/or 
orthopedic physicians; 
‘‘(VII) vital statistics officers; 
‘‘(VIII) nutritionists; 
‘‘(IX) 
mental 
health 
profes-
sionals; 
‘‘(X) substance abuse treatment 
specialists; 
‘‘(XI) representatives of relevant 
advocacy groups; 
‘‘(XII) academics; 
‘‘(XIII) representatives of bene-
ficiaries of the State plan under the 
Medicaid Program under title XIX; 
‘‘(XIV) paramedics; 
‘‘(XV) lawyers; 
‘‘(XVI) risk management special-
ists; 
‘‘(XVII) representatives of the 
departments of health or public health 
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of major cities in the State involved; 
and 
‘‘(XVIII) policymakers. 
‘‘(iv) DIVERSE COMMUNITY MEMBER-
SHIP.—The composition of such a com-
mittee, with respect to a State, shall in-
clude— 
‘‘(I) representatives from diverse 
communities, particularly those com-
munities within such State most se-
verely affected by pregnancy-related 
deaths or pregnancy-associated deaths 
and by a lack of access to relevant 
maternal care services, from commu-
nity maternal child health organiza-
tions, and from minority advocacy 
groups; 
‘‘(II) members, including health 
care providers, from different geo-
graphic regions in the State, including 
any rural, urban, and tribal areas; 
and 
‘‘(III) health care and social serv-
ice providers who work in commu-
nities that are diverse with regard to 
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race, ethnicity, immigration status, in-
digenous status, and English pro-
ficiency. 
‘‘(v) MATERNAL MORTALITY REVIEW 
STAFF.—Staff of each such review com-
mittee shall include— 
‘‘(I) vital health statisticians, ma-
ternal child health statisticians, or 
epidemiologists; 
‘‘(II) a coordinator of the State 
maternal mortality review committee, 
to be designated by the State; and 
‘‘(III) administrative staff. 
‘‘(C) OPTION FOR STATES TO FORM RE-
GIONAL
MATERNAL
MORTALITY
REVIEWS.— 
States with a low rate of occurrence of preg-
nancy-associated or pregnancy-related deaths 
may choose to partner with one or more neigh-
boring States to fulfill the activities described in 
paragraph (1)(C). In such a case, with respect 
to States in such a partnership, any require-
ment under this section relating to the report-
ing of information related to such activities 
shall be deemed to be fulfilled by each such 
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State if a single such report is submitted for 
the partnership. 
‘‘(3) STATE DEPARTMENT OF HEALTH ACTIVI-
TIES.—For purposes of subsection (a), a State de-
partment of health of a State receiving a grant 
under such subsection shall— 
‘‘(A) in consultation with the maternal 
mortality review committee of the State and in 
conjunction with relevant professional organiza-
tions, develop a plan for ongoing health care 
provider education, based on the findings and 
recommendations of the committee, in order to 
improve the quality of maternal care; and 
‘‘(B) take steps to widely disseminate the 
findings and recommendations of the State ma-
ternal mortality review committees of the State 
and to implement the recommendations of such 
committee. 
‘‘(c) CASE ABSTRACTION FORM.— 
‘‘(1) DEVELOPMENT.—The Director of the Cen-
ters for Disease Control and Prevention shall de-
velop a uniform, comprehensive case abstraction 
form and make such form available to States for 
State maternal mortality review committees for use 
by such committees in order to— 
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‘‘(A) ensure that the cases and information 
collected and reviewed by such committees can 
be pooled for review by the Department of 
Health and Human Services and its agencies; 
and 
‘‘(B) preserve the uniformity of the infor-
mation and its use for Federal public health 
purposes. 
‘‘(2) PERMISSIBLE
STATE
MODIFICATION.— 
Each State may modify the form developed under 
paragraph (1) for implementation and use by such 
State or by the State maternal mortality review com-
mittee of such State by including on such form addi-
tional information to be collected, but may not alter 
the standard questions on such form, in order to en-
sure that the information can be collected and re-
viewed centrally at the Federal level. 
‘‘(d) TREATMENT AS PUBLIC HEALTH AUTHORITY 
FOR PURPOSES OF HIPAA.—For purposes of applying 
HIPAA privacy and security law (as defined in section 
3009(a)(2) of the Public Health Service Act), a State ma-
ternal mortality review committee of a State established 
pursuant to this section to carry out activities described 
in subsection (b)(2)(A) shall be deemed to be a public 
health authority described in section 164.501 (and ref-
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erenced in section 164.512(b)(1)(i)) of title 45, Code of 
Federal Regulations (or any successor regulation), car-
rying out public health activities and purposes described 
in such section 164.512(b)(1)(i) (or any such successor 
regulation). 
‘‘(e) PUBLIC DISCLOSURE OF INFORMATION.— 
‘‘(1) IN GENERAL.—For fiscal year 2017 or a 
subsequent fiscal year, each State receiving a grant 
under this section for such year shall, subject to 
paragraph (3), provide for the public disclosure, and 
submission to the information clearinghouse estab-
lished under paragraph (2), of the information in-
cluded in the report of the State under section 
506(a)(2)(F) for such year (relating to the findings 
for such year of the State maternal mortality review 
committee established by the State under this sec-
tion). 
‘‘(2) 
INFORMATION
CLEARINGHOUSE.—The 
Secretary of Health and Human Services shall es-
tablish an information clearinghouse, that shall be 
administered by the Director of the Centers for Dis-
ease Control and Prevention, that will maintain find-
ings and recommendations submitted pursuant to 
paragraph (1) and provide such findings and rec-
ommendations for public review and research pur-
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poses by State health departments, maternal mor-
tality review committees, and health providers and 
institutions. 
‘‘(3) CONFIDENTIALITY OF INFORMATION.—In 
no case shall any individually identifiable health in-
formation be provided to the public, or submitted to 
the information clearinghouse, under paragraph (1). 
‘‘(f) CONFIDENTIALITY
OF
REVIEW
COMMITTEE 
PROCEEDINGS.— 
‘‘(1) IN GENERAL.—All proceedings and activi-
ties of a State maternal mortality review committee 
under this section, opinions of members of such a 
committee formed as a result of such proceedings 
and activities, and records obtained, created, or 
maintained pursuant to this section, including 
records of interviews, written reports, and state-
ments procured by the Department of Health and 
Human Services or by any other person, agency, or 
organization acting jointly with the Department, in 
connection with morbidity and mortality reviews 
under this section, shall be confidential, and not sub-
ject to discovery, subpoena, or introduction into evi-
dence in any civil, criminal, legislative, or other pro-
ceeding. Such records shall not be open to public in-
spection. 
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‘‘(2) TESTIMONY
OF
MEMBERS
OF
COM-
MITTEE.— 
‘‘(A) IN GENERAL.—Members of a State 
maternal mortality review committee under this 
section may not be questioned in any civil, 
criminal, legislative, or other proceeding regard-
ing information presented in, or opinions 
formed as a result of, a meeting or communica-
tion of the committee. 
‘‘(B) CLARIFICATION.—Nothing in this 
subsection shall be construed to prevent a mem-
ber of such a committee from testifying regard-
ing information that was obtained independent 
of such member’s participation on the com-
mittee, or that is public information. 
‘‘(3) AVAILABILITY OF INFORMATION FOR RE-
SEARCH
PURPOSES.—Nothing in this subsection 
shall prohibit the publishing by such a committee or 
the Department of Health and Human Services of 
statistical compilations and research reports that— 
‘‘(A) are based on confidential information, 
relating to morbidity and mortality review; and 
‘‘(B) do not contain identifying informa-
tion or any other information that could be 
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used to ultimately identify the individuals con-
cerned. 
‘‘(g) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘pregnancy-associated death’ 
means the death of a woman while pregnant or dur-
ing the one-year period following the date of the end 
of pregnancy, irrespective of the cause of such death. 
‘‘(2) The term ‘pregnancy-related death’ means 
the death of a woman while pregnant or during the 
one-year period following the date of the end of 
pregnancy, irrespective of the duration or site of the 
pregnancy, from any cause related to or aggravated 
by the pregnancy or its management, but not from 
any accidental or incidental cause. 
‘‘(3) The term ‘woman of childbearing age’ 
means a woman who is at least 10 years of age and 
not more than 54 years of age.’’. 
(b) INCLUSION OF FINDINGS OF REVIEW COMMIT-
TEES IN REQUIRED REPORTS.— 
(1) STATE
TRIENNIAL
REPORTS.—Paragraph 
(2) of section 506(a) of the Social Security Act (42 
U.S.C. 706(a)) is amended by inserting after sub-
paragraph (E) the following new subparagraph: 
‘‘(F) In the case of a State receiving a 
grant under section 514, beginning for the first 
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fiscal year beginning after 3 years after the 
date of establishment of the State maternal 
mortality review committee established by the 
State pursuant to such grant and once every 3 
years thereafter, information containing the 
findings and recommendations of such com-
mittee and information on the implementation 
of such recommendations during the period in-
volved.’’. 
(2) ANNUAL
REPORTS
TO
CONGRESS.—Para-
graph (3) of such section is amended— 
(A) in subparagraph (D) by striking ‘‘and’’ 
at the end; 
(B) in subparagraph (E) by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) For fiscal year 2017 and each subsequent 
fiscal year, taking into account the findings, rec-
ommendations, and implementation information sub-
mitted by States pursuant to paragraph (2)(F), on 
the status of pregnancy-related deaths and preg-
nancy-associated deaths in the United States and in-
cluding recommendations on methods to prevent 
such deaths in the United States.’’. 
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SEC. 
506. 
ELIMINATING 
DISPARITIES 
IN 
MATERNITY 
HEALTH OUTCOMES. 
Part B of title III of the Public Health Service Act 
is amended by inserting after section 317V, as added, the 
following new section: 
‘‘SEC. 317W. ELIMINATING DISPARITIES IN MATERNITY 
HEALTH OUTCOMES. 
‘‘(a) IN GENERAL.—The Secretary (in consultation 
with the Deputy Assistant Secretary for Minority Health, 
the Director of the National Institutes of Health, the Di-
rector of the Centers for Disease Control and Prevention, 
the Administrator of the Centers for Medicare & Medicaid 
Services, and the Administrator of the Agency for 
Healthcare Research & Quality, and in consultation with 
relevant national stakeholder organizations such as na-
tional medical specialty organizations, national maternal 
child health organizations, national groups that represent 
minority populations, and national health disparity organi-
zations) shall carry out the following activities to eliminate 
disparities in maternal health outcomes: 
‘‘(1) Conduct research into the determinants 
and the distribution of disparities in maternal care, 
health risks, and health outcomes, and improve the 
capacity of the performance measurement infrastruc-
ture to measure such disparities. 
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‘‘(2) Expand access to services that have been 
demonstrated to improve the quality and outcomes 
of maternity care for vulnerable populations. 
‘‘(3) Establish a demonstration project to com-
pare the effectiveness of interventions to reduce dis-
parities in maternity services and outcomes, and im-
plement and assess effective interventions. 
‘‘(b) SCOPE AND SELECTION OF STATES FOR DEM-
ONSTRATION
PROJECT.—The 
demonstration 
project 
under subsection (a)(3) shall be conducted in no more 
than 8 States, which shall be selected by the Secretary 
based on— 
‘‘(1) applications submitted by States, which 
specify which regions and populations the State in-
volved will serve under the demonstration project; 
‘‘(2) criteria designed by the Secretary to en-
sure that, as a whole, the demonstration project is, 
to the greatest extent possible, representative of the 
demographic and geographic composition of commu-
nities most affected by disparities; 
‘‘(3) criteria designed by the Secretary to en-
sure that a variety of types of models are tested 
through the demonstration project and that such 
models include interventions that have an existing 
evidence base for effectiveness; and 
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‘‘(4) criteria designed by the Secretary to as-
sure that the demonstration projects and models will 
be carried out in consultation with local and regional 
provider organizations, such as community health 
centers, hospital systems, and medical societies rep-
resenting providers of maternity services. 
‘‘(c) DURATION
OF DEMONSTRATION PROJECT.— 
The demonstration project under subsection (a)(3) shall 
begin on January 1, 2017, and end on December 31, 
2021. 
‘‘(d) GRANTS FOR EVALUATION AND MONITORING.— 
The Secretary may make grants to States and health care 
providers participating in the demonstration project under 
subsection (a)(3) for the purpose of collecting data nec-
essary for the evaluation and monitoring of such project. 
‘‘(e) REPORTS.— 
‘‘(1) STATE REPORTS.—Each State that par-
ticipates in the demonstration project under sub-
section (a)(3) shall report to the Secretary, in a 
time, form, and manner specified by the Secretary, 
the data necessary to— 
‘‘(A) monitor the— 
‘‘(i) outcomes of the project; 
‘‘(ii) costs of the project; and 
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‘‘(iii) quality of maternity care pro-
vided under the project; and 
‘‘(B) evaluate the rationale for the selec-
tion of the items and services included in any 
bundled payment made by the State under the 
project. 
‘‘(2) FINAL REPORT.—Not later than December 
31, 2022, the Secretary shall submit to Congress a 
report on the results of the demonstration project 
under subsection (a)(3).’’. 
SEC. 507. DECREASING THE RISK FACTORS FOR SUDDEN 
UNEXPECTED INFANT DEATH AND SUDDEN 
UNEXPLAINED DEATH IN CHILDHOOD. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration and in con-
sultation with the Director of the Centers for Disease Con-
trol and Prevention and the Director of the National Insti-
tutes of Health (in this section referred to as the ‘‘Sec-
retary’’), shall establish and implement a culturally com-
petent public health awareness and education campaign 
to provide information that is focused on decreasing the 
risk factors for sudden unexpected infant death and sud-
den unexplained death in childhood, including educating 
individuals about safe sleep environments, sleep positions, 
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and reducing exposure to smoking during pregnancy and 
after birth. 
(b) TARGETED POPULATIONS.—The campaign under 
subsection (a) shall be designed to reduce health dispari-
ties through the targeting of populations with high rates 
of sudden unexpected infant death and sudden unex-
plained death in childhood. 
(c) CONSULTATION.—In establishing and imple-
menting the campaign under subsection (a), the Secretary 
shall consult with national organizations representing 
health care providers, including nurses and physicians, 
parents, child care providers, children’s advocacy and safe-
ty organizations, maternal and child health programs, nu-
trition professionals focusing on women, infants, and chil-
dren, and other individuals and groups determined nec-
essary by the Secretary for such establishment and imple-
mentation. 
(d) GRANTS.— 
(1) IN
GENERAL.—In carrying out the cam-
paign under subsection (a), the Secretary shall 
award grants to national organizations, State and 
local health departments, and community-based or-
ganizations for the conduct of education and out-
reach programs for nurses, parents, child care pro-
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viders, public health agencies, and community orga-
nizations. 
(2) APPLICATION.—To be eligible to receive a 
grant under paragraph (1), an entity shall submit to 
the Secretary an application at such time, in such 
manner, and containing such information as the Sec-
retary may require. 
(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 
2017 through 2021. 
SEC. 
508. 
REDUCING 
UNINTENDED 
TEENAGE 
PREG-
NANCIES. 
Title III of the Public Health Service Act (42 U.S.C. 
241 et seq.) is amended by adding at the end the following 
new part: 
‘‘PART W—YOUTH PREGNANCY PREVENTION 
PROGRAMS 
‘‘SEC. 399OO. PURPOSE. 
‘‘It is the purpose of this part to develop and carry 
out research and multimedia campaigns on new and exist-
ing program interventions to provide youth in communities 
at disproportionate risk for unintended teen pregnancy 
(particularly young people of color, immigrant commu-
nities, youth in the foster care system, youth in the juve-
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nile justice system, rural youth, and LGBTQ youth) the 
information and skills needed to prevent unintended teen-
age pregnancies, build healthy relationships, and improve 
overall health and well-being. 
‘‘SEC. 399OO–1. LIMITATION. 
‘‘No Federal funds provided under this Act may be 
used for media awareness campaigns that— 
‘‘(1) withhold health-promoting or life-saving 
information about sexuality-related topics; 
‘‘(2) undermine young people’s confidence in 
the effectiveness of contraception; 
‘‘(3) are medically inaccurate or have been sci-
entifically shown to be ineffective; 
‘‘(4) promote gender, racial, or ethnic stereo-
types; 
‘‘(5) are insensitive and unresponsive to the 
needs of sexually active youth, LGBTQ youth, or 
youth survivors of sexual violence; 
‘‘(6) are inconsistent with the ethical impera-
tives of medicine and public health; or 
‘‘(7) stigmatize and shame youth who are par-
enting or choose to parent. 
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SEC. 515. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
(a) IN GENERAL.—Part A of title II of the Public 
Health Service Act (42 U.S.C. 202 et seq.) is amended 
by adding at the end the following new section: 
‘‘SEC. 229A. INTERAGENCY COORDINATING COMMITTEE ON 
THE PROMOTION OF OPTIMAL MATERNITY 
OUTCOMES. 
‘‘(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Deputy Assistant 
Secretary for Women’s Health under section 229 and in 
collaboration with the Federal officials specified in sub-
section (b), shall establish the Interagency Coordinating 
Committee on the Promotion of Optimal Maternity Out-
comes (referred to in this subsection as the ‘ICCPOM’). 
‘‘(b) OTHER AGENCIES.—The officials specified in 
this subsection are the Secretary of Labor, the Secretary 
of Defense, the Secretary of Veterans Affairs, the Surgeon 
General, the Director of the Centers for Disease Control 
and Prevention, the Administrator of the Health Re-
sources and Services Agency, the Administrator of the 
Centers for Medicare & Medicaid Services, the Director 
of the Indian Health Service, the Administrator of the 
Substance Abuse and Mental Health Services Administra-
tion, the Director of the National Institute on Child 
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