543 
Subtitle 
B—Modifications 
to 
Achieve Parity in Existing Pro-
grams 
SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 
HEALTH IT INFRASTRUCTURE IN RACIAL 
AND ETHNIC MINORITY COMMUNITIES. 
Section 3011 of the Public Health Service Act (42 
U.S.C. 300jj–31) is amended— 
(1) in subsection (a), by adding at the end the 
following new paragraph: 
‘‘(8) Activities described in the previous para-
graphs of this subsection with respect to commu-
nities with a high proportion of individuals from ra-
cial and ethnic minority groups (as defined in sec-
tion 1707(g)).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) ANNUAL REPORT
ON EXPENDITURES.—The 
National Coordinator shall report annually to the Con-
gress on activities and expenditures under this section.’’. 
SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS-
SISTANCE TO RACIAL AND ETHNIC MINORITY 
GROUPS. 
(a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub-
lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 
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amended by inserting ‘‘or individuals from racial and eth-
nic minority groups (as defined in section 1707(g))’’ after 
‘‘medically underserved individuals’’. 
(b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 
such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 
(1) by inserting: ‘‘Each evaluation panel shall 
include at least one consumer advocate from a racial 
and ethnic minority community served by the center 
involved and at least one representative of a minor-
ity-serving institution.’’ after ‘‘ ‘and of Federal offi-
cials.’’; and 
(2) by inserting ‘‘and shall determine the de-
gree to which such center provides outreach and as-
sistance to providers predominantly serving racial 
and ethnic minority groups (as defined in section 
1707(g))’’ after ‘‘specified in paragraph (3)’’. 
SEC. 813. EXTENDING COMPETITIVE GRANTS FOR THE DE-
VELOPMENT OF LOAN PROGRAMS TO FACILI-
TATE ADOPTION OF CERTIFIED EHR TECH-
NOLOGY BY PROVIDERS SERVING RACIAL 
AND ETHNIC MINORITY GROUPS. 
Section 3014(e) of the Public Health Service Act (42 
U.S.C. 300jj–34(e)) is amended— 
(1) in paragraph (3), by striking at the end 
‘‘or’’; 
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(2) in paragraph (4), by striking the period at 
the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(5) carry out any of the activities described in 
a previous paragraph of this subsection with respect 
to communities with a high proportion of individuals 
from racial and ethnic minority groups (as defined 
in section 1707(g)).’’. 
Subtitle C—Additional Research 
and Studies 
SEC. 831. DATA COLLECTION AND ASSESSMENTS CON-
DUCTED IN COORDINATION WITH MINORITY- 
SERVING INSTITUTIONS. 
Section 3001(c)(6) of the Public Health Service Act 
(42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 
end the following new subparagraph: 
‘‘(F) DATA
COLLECTION
AND
ASSESS-
MENTS
CONDUCTED
IN
COORDINATION
WITH 
MINORITY-SERVING INSTITUTIONS.— 
‘‘(i) IN
GENERAL.—In carrying out 
subparagraph (C) with respect to commu-
nities with a high proportion of individuals 
from racial and ethnic minority groups (as 
defined in section 1707(g)), the National 
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Coordinator shall, to the greatest extent 
possible, coordinate with an entity de-
scribed in clause (ii). 
‘‘(ii) 
MINORITY-SERVING
INSTITU-
TIONS.—For purposes of clause (i), an en-
tity described in this clause is a historically 
Black college or university, an Hispanic- 
serving institution, a tribal college or uni-
versity, or an Asian-American-, Native 
American-, and Pacific Islander-serving in-
stitution with an accredited public health, 
health policy, or health services research 
program.’’. 
SEC. 832. IOM STUDY AND REPORT ON PRIVACY CONCERNS 
OF CERTAIN MINORITY POPULATIONS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall seek to enter into an agreement 
with the Institute of Medicine of the National Academies 
to— 
(1) complete a study— 
(A) on the privacy concerns, relating to the 
exchange of health information, of individuals 
described in subsection (b); 
(B) on how such concerns may create bar-
riers for such individuals to access health care 
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or participate in the exchange of health infor-
mation; and 
(C) including recommendations for over-
coming such barriers for such individuals; and 
(2) not later than 24 months after the date of 
the enactment of this Act, submit to Congress a re-
port on the results of such study. 
If such Institute declines to conduct the study and submit 
the report, the Secretary shall enter into an agreement 
with another appropriate public or nonprofit private entity 
to conduct the study and submit the report. 
(b) INDIVIDUALS DESCRIBED.—For purposes of sub-
section (a), the individuals described in this subsection are 
individuals from racial and ethnic minority groups (as de-
fined in section 1707(g)), including such individuals 
who— 
(1) are immigrants, as well as citizens living 
within immigrant households (‘‘mixed-status’’ house-
holds) in the United States; 
(2) are lesbian, gay, bisexual, or transgender; or 
(3) have a mental health disability or a record 
of a mental health disability or treatment for a men-
tal health disability. 
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SEC. 833. STUDY OF HEALTH INFORMATION TECHNOLOGY 
IN 
MEDICALLY 
UNDERSERVED 
COMMU-
NITIES. 
(a) STUDY.—The Secretary of Health and Human 
Services shall seek to enter into an agreement with the 
Institute of Medicine of the National Academies to con-
duct a study on the development and implementation of 
health information technology in communities with a high 
proportion of individuals from racial and ethnic minority 
groups (as defined in section 1707(g)) and submit the re-
port under subsection (b). The study shall— 
(1) identify barriers to successful implementa-
tion of health information technology in these com-
munities; 
(2) examine the impact of health information 
technology on providing quality care and reducing 
the cost of care to these communities; 
(3) examine urban and rural community health 
systems and determine the impact that health infor-
mation technology may have on the capacity of pri-
mary health providers; 
(4) identify specific best practices for using 
health information technology to foster the con-
sistent provision of physical accessibility and reason-
able policy accommodations in health care to individ-
uals with disabilities in these communities; and 
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(5) assess the feasibility and the costs of associ-
ated with the use of health information technology 
in these communities. 
If such Institute declines to conduct the study, the Sec-
retary shall enter into an agreement with another appro-
priate public or nonprofit private entity to conduct the 
study. 
(b) REPORT.—The Secretary shall ensure that, not 
later than 24 months after the date of the enactment of 
this Act, the study required under subsection (a) is com-
pleted and a report on the study is submitted to Congress, 
including any recommendations for legislation or adminis-
trative action. 
Subtitle D—Closing Gaps in 
Funding To Adopt Certified EHRs 
SEC. 841. APPLICATION OF MEDICARE HITECH PAYMENTS 
TO HOSPITALS IN PUERTO RICO. 
(a) IN GENERAL.—Subsection (n)(6)(B) of section 
1886 of the Social Security Act (42 U.S.C. 1395ww) is 
amended by striking ‘‘subsection (d) hospital’’ and insert-
ing ‘‘hospital that is a subsection (d) hospital or a sub-
section (d) Puerto Rico hospital’’. 
(b) OFFSETTING REDUCTION.—Subsection (n)(2) of 
such section is amended by adding at the end the following 
new subparagraph: 
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‘‘(H) 
BUDGET
NEUTRALITY
ADJUST-
MENT.—The Secretary shall reduce the applica-
ble amounts that would otherwise be deter-
mined under this subsection with respect to— 
‘‘(i) the first fiscal year to which this 
subparagraph applies by an amount that 
the Secretary estimates would ensure that 
estimated aggregate payments under this 
subsection for such fiscal year are not in-
creased as a result of the amendments 
made by subsection (a) of section 841 of 
the Health Equity and Accountability Act 
of 2011; or 
‘‘(ii) a succeeding fiscal year by an 
amount that the Secretary estimates would 
ensure that estimated aggregate payments 
under this subsection for such fiscal year 
are not increased as a result of the amend-
ments made by subsections (a) and (c) of 
such section.’’. 
(c) CONFORMING
AMENDMENTS.—(1) Subsection 
(b)(3)(B)(ix) of such section is amended— 
(A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 
and inserting ‘‘(n)(6)(B)’’; and 
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(B) in subclause (II), by striking ‘‘subsection 
(d) hospital’’ and inserting ‘‘an eligible hospital’’. 
(2) Paragraphs (2) and (4)(A) of section 1853(m) of 
the Social Security Act (42 U.S.C. 1395w–23(m)) are 
each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 
‘‘1886(n)(6)(B)’’. 
(d) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by sub-
sections (a), (b) and (c) by program instruction or other-
wise. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payments for payment years for 
fiscal years beginning after the date of the enactment of 
this Act. 
SEC. 842. EXTENDING MEDICAID EHR INCENTIVE PAY-
MENTS TO LONG-TERM CARE FACILITIES AND 
HOME HEALTH AGENCIES. 
Section 1903(t)(2)(B) of the Social Security Act (42 
U.S.C. 1396b(t)(2)(B)) is amended— 
(1) in clause (i), by striking ‘‘, or’’ and insert-
ing a semicolon; 
(2) in clause (ii), by striking the period at the 
end and inserting a semicolon; and 
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(3) by adding at the end the following new 
clauses: 
‘‘(iii) a long-term care facility; or 
‘‘(iv) a home health agency (as defined in 
section 1861(o)).’’. 
SEC. 843. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 
FOR 
MEDICAID 
ELECTRONIC 
HEALTH 
RECORD INCENTIVE PAYMENTS. 
(a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 
Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 
amended by striking ‘‘insofar as the assistant is prac-
ticing’’ and all that follows through ‘‘so led’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to amounts ex-
pended under 1903(a)(3)(F) of the Social Security Act 
(42 U.S.C. 1396b(a)(3)(F)) for calendar quarters begin-
ning on or after the date of the enactment of this Act. 
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TITLE IX—ACCOUNTABILITY 
AND EVALUATION 
SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 
ASSISTED HEALTH CARE SERVICES AND RE-
SEARCH PROGRAMS ON THE BASIS OF SEX, 
RACE, COLOR, NATIONAL ORIGIN, SEXUAL 
ORIENTATION, GENDER IDENTITY, OR DIS-
ABILITY STATUS. 
No person in the United States shall, on the basis 
of sex, race, color, national origin, sexual orientation, gen-
der identity, or disability status, be excluded from partici-
pation in, be denied the benefits of, or be subjected to dis-
crimination under any health care service or research pro-
gram or activity receiving Federal financial assistance. 
SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 
A payment to a provider of services, physician, or 
other supplier under part B, C, or D of title XVIII of 
the Social Security Act shall be deemed a grant, and not 
a contract of insurance or guaranty, for the purposes of 
title VI of the Civil Rights Act of 1964. 
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SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 
THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES. 
Title XXXIV of the Public Health Service Act, as 
amended by titles I, II, and III of this Act, is further 
amended by inserting after subtitle B the following: 
‘‘Subtitle C—Strengthening 
Accountability 
‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
within the Office for Civil Rights an Office of Health Dis-
parities, which shall be headed by a director to be ap-
pointed by the Secretary. 
‘‘(b) PURPOSE.—The Office of Health Disparities 
shall ensure that the health programs, activities, and oper-
ations of health entities which receive Federal financial as-
sistance are in compliance with title VI of the Civil Rights 
Act, which prohibits discrimination on the basis of race, 
color, or national origin. The activities of the Office shall 
include the following: 
‘‘(1) The development and implementation of 
an action plan to address racial and ethnic health 
care disparities, which shall address concerns relat-
ing to the Office for Civil Rights as released by the 
United States Commission on Civil Rights in the re-
port entitled ‘Health Care Challenge: Acknowledging 
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Disparity, Confronting Discrimination, and Ensur-
ing Equity’ (September 1999) in conjunction with 
the reports by the Institute of Medicine entitled ‘Un-
equal Treatment: Confronting Racial and Ethnic 
Disparities in Health Care’, ‘Crossing the Quality 
Chasm: A New Health System for the 21st Cen-
tury’, and ‘In the Nation’s Compelling Interest: En-
suring Diversity in the Health Care Workforce’, and 
‘The National Partnership for Action to End Health 
Disparities’, and other related reports by the Insti-
tute of Medicine. This plan shall be publicly dis-
closed for review and comment and the final plan 
shall address any comments or concerns that are re-
ceived by the Office. 
‘‘(2) Investigative and enforcement actions 
against intentional discrimination and policies and 
practices that have a disparate impact on minorities. 
‘‘(3) The review of racial, ethnic, and primary 
language health data collected by Federal health 
agencies to assess health care disparities related to 
intentional discrimination and policies and practices 
that have a disparate impact on minorities. 
‘‘(4) Outreach and education activities relating 
to compliance with title VI of the Civil Rights Act. 
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‘‘(5) The provision of technical assistance for 
health entities to facilitate compliance with title VI 
of the Civil Rights Act. 
‘‘(6) Coordination and oversight of activities of 
the civil rights compliance offices established under 
section 3442. 
‘‘(7) Ensuring compliance with the 1997 Office 
of Management and Budget Standards for Maintain-
ing, Collecting, and Presenting Federal Data on 
Race, Ethnicity and the available language stand-
ards. 
‘‘(c) FUNDING AND STAFF.—The Secretary shall en-
sure the effectiveness of the Office of Health Disparities 
by ensuring that the Office is provided with— 
‘‘(1) adequate funding to enable the Office to 
carry out its duties under this section; and 
‘‘(2) staff with expertise in— 
‘‘(A) epidemiology; 
‘‘(B) statistics; 
‘‘(C) health quality assurance; 
‘‘(D) minority health and health dispari-
ties; 
‘‘(E) cultural and linguistic competency; 
and 
‘‘(F) civil rights. 
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‘‘(d) REPORT.—Not later than December 31, 2012, 
and annually thereafter, the Secretary, in collaboration 
with the Director of the Office for Civil Rights and the 
Deputy Assistant Secretary for Minority Health, shall 
submit a report to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives 
that includes— 
‘‘(1) the number of cases filed, broken down by 
category; 
‘‘(2) the number of cases investigated and 
closed by the office; 
‘‘(3) the outcomes of cases investigated; 
‘‘(4) the staffing levels of the office including 
staff credentials; 
‘‘(5) the number of other lingering and emerg-
ing cases in which civil rights inequities can be dem-
onstrated; and 
‘‘(6) the number of cases remaining open and 
an explanation for their open status. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2012 through 2017. 
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‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF-
FICES FOR CIVIL RIGHTS WITHIN FEDERAL 
HEALTH AND HUMAN SERVICES AGENCIES. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
civil rights compliance offices in each agency within the 
Department of Health and Human Services that admin-
isters health programs. 
‘‘(b) PURPOSE OF OFFICES.—Each office established 
under subsection (a) shall ensure that recipients of Fed-
eral financial assistance under Federal health programs 
administer their programs, services, and activities in a 
manner that— 
‘‘(1) does not discriminate, either intentionally 
or in effect, on the basis of race, national origin, lan-
guage, ethnicity, sex, age, disability, sexual orienta-
tion, and gender identity; and 
‘‘(2) promotes the reduction and elimination of 
disparities in health and health care based on race, 
national origin, language, ethnicity, sex, age, dis-
ability, sexual orientation, and gender identity. 
‘‘(c) POWERS AND DUTIES.—The offices established 
in subsection (a) shall have the following powers and du-
ties: 
‘‘(1) The establishment of compliance and pro-
gram participation standards for recipients of Fed-
eral financial assistance under each program admin-
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‘‘(v) require an investment of public 
funding to move forward and be competi-
tive; 
‘‘(vi) operate on a self-service basis; 
‘‘(vii) in accordance with subpara-
graph (C), expand or preserve the avail-
ability of healthy, fresh, high quality un-
prepared and unprocessed foods, particu-
larly fresh fruits and vegetables, in under-
served areas; and 
‘‘(viii) agree to accept benefits under 
the supplemental nutrition assistance pro-
gram established under the Food and Nu-
trition Act of 2008 (7 U.S.C. 2011 et 
seq.). 
‘‘(C) REQUIREMENTS.— 
‘‘(i) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) PERISHABLE FOOD.— 
‘‘(aa) IN
GENERAL.—The 
term ‘perishable food’ means food 
that is fresh, refrigerated, or fro-
zen. 
‘‘(bb) 
EXCLUSION.—The 
term ‘perishable food’ does not 
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