(I) the Director of the Agency for 
Healthcare Research and Quality; 
(J) the Surgeon General; 
(K) the Administrator of the Health Re-
sources and Services Administration; 
(L) the Director of the Office of Minority 
Health; 
(M) the Director of the Office of Women’s 
Health; 
(N) the Chairperson of the National Coun-
cil on Disability; 
(O) the National Coordinator for Health 
Information Technology; 
(P) at least 4 State, local, territorial, and 
Tribal public health officials representing de-
partments of public health, or an Urban Indian 
health representative, who shall represent juris-
dictions from different regions of the United 
States with relatively high concentrations of 
historically marginalized populations, to be ap-
pointed by the Secretary; 
(Q) at least 3 independent individuals with 
expertise on racially and ethnically diverse rep-
resentation with knowledge or field experience 
with community-based participatory research on 
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racial and ethnic disparities in public health, to 
be appointed by the Secretary; and 
(R) at least 4 individuals with expertise on 
health equity and demographic data disparities 
with knowledge of, or field experience in, lan-
guage, ability, sex, sexual orientation, gender 
identity, or socioeconomic status. 
(2) CHAIRPERSON.—The Chief Information Of-
ficer of the Department of Health and Human Serv-
ices (or the Chief Information Officer’s designee) 
shall serve as the Chairperson of the Task Force. 
(c) DUTIES.—The Task Force shall— 
(1) examine where to place artificial intelligence 
and algorithms in the health care service delivery 
process relative to the use of autonomous human de-
cision-makers; 
(2) identify the risks of health care system utili-
zation of artificial intelligence and algorithms in 
terms of civil rights, civil liberties, and discrimina-
tory bias in health care access, quality, and out-
comes; and 
(3) prepare and submit the report under sub-
section (d). 
(d) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Task Force shall— 
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(1) submit a written report of the findings of 
the examination under paragraph (1) and rec-
ommendations to Congress with respect to imple-
mentation of artificial intelligence and algorithms in 
health care delivery and mitigation of the risks asso-
ciated with that implementation; and 
(2) publish such report on the website of the 
Department of Health and Human Services. 
(e) PUBLIC COMMENT.—Not later than 60 days after 
the date of the date of the enactment of this Act, the Task 
Force shall publish in the Federal Register a notice pro-
viding for a public comment period on the duties and ac-
tivities of the Task Force of not less than 90 days, begin-
ning on the date of that publication. 
(f) STAFF OF COMMISSION.— 
(1) ADDITIONAL STAFF.—The Chairperson of 
the Task Force may appoint and fix the pay of addi-
tional staff to the Task Force as the Chairperson 
considers appropriate. 
(2) APPLICABILITY OF CERTAIN CIVIL SERVICE 
LAWS.—The staff of the Task Force may be ap-
pointed without regard to the provisions of title 5, 
United States Code, governing appointments in the 
competitive service, and may be paid without regard 
to the provisions of chapter 51 and subchapter III 
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of chapter 53 of that title relating to classification 
and General Schedule pay rates. 
(3) DETAILEES.—Any Federal Government em-
ployee may be detailed to the Task Force without re-
imbursement from the Task Force, and the detailee 
shall retain the rights, status, and privileges of his 
or her regular employment without interruption. 
TITLE II—CULTURALLY AND LIN-
GUISTICALLY 
APPROPRIATE 
HEALTH AND HEALTH CARE 
SEC. 2001. DEFINITIONS; FINDINGS. 
(a) DEFINITIONS.—In this title, the definitions in 
section 3400 of the Public Health Service Act, as added 
by section 2004, shall apply. 
(b) FINDINGS.—Congress finds the following: 
(1) Effective communication is essential to 
meaningful access to quality physical and mental 
health care. 
(2) Research indicates that the lack of appro-
priate language services creates language barriers 
that result in increased risk of misdiagnosis, ineffec-
tive treatment plans, and poor health outcomes for 
individuals with limited English proficiency and indi-
viduals with communication disabilities such as cog-
nitive, hearing, vision, or print impairments. 
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(3) The number of limited English speaking 
residents in the United States who speak English 
less than very well and, therefore, cannot effectively 
communicate with health and social service providers 
continues to increase significantly. 
(4) The responsibility to fund language services 
in the provision of health care and health care-re-
lated services to individuals with limited English 
proficiency and individuals with communication dis-
abilities such as cognitive hearing, vision, or print 
impairments is a societal one that cannot fairly be 
placed solely upon the health care, public health, or 
social services community. 
(5) Title VI of the Civil Rights Act of 1964 (42 
U.S.C. 2000d et seq.) prohibits discrimination based 
on the grounds of race, color, or national origin by 
any entity receiving Federal financial assistance. In 
order to avoid discrimination on the grounds of na-
tional origin, all programs or activities administered 
by the Federal Government must take adequate 
steps to ensure that their policies and procedures do 
not deny or have the effect of denying individuals 
with limited English proficiency with equal access to 
benefits and services for which such persons qualify. 
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(6) Both the Americans with Disabilities Act of 
1990 (42 U.S.C. 12101 et seq.) and the Rehabilita-
tion Act of 1973 (29 U.S.C. 701 et seq.) prohibit 
discrimination on the basis of disability and require 
the provision of appropriate auxiliary aids and serv-
ices necessary to ensure effective communication 
with individuals with disabilities. The type of auxil-
iary aid or service necessary to ensure effective com-
munication will vary in accordance with the method 
of communication used by the individual; the nature, 
length, and complexity of the communication in-
volved; and the context in which the communication 
is taking place. A public accommodation should con-
sult with individuals with disabilities whenever pos-
sible to determine what type of auxiliary aid is need-
ed to ensure effective communication. The public ac-
commodation should use the individual’s preferred 
method of communication whenever possible, unless 
it would be an undue burden to the public accommo-
dation and an alternative would provide an equally 
effective means of communication. The ultimate de-
cision as to what measures to take rests with the 
public accommodation, provided that the method 
chosen results in effective communication. 
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(7) Section 1557 of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18116) builds on 
title VI of the Civil Rights Act of 1964 (42 U.S.C. 
2000d et seq.) and section 504 of the Rehabilitation 
Act of 1973 (29 U.S.C. 794), prohibits discrimina-
tion on the basis of race, color, national origin, dis-
ability, sex, and age, requires the provision of lan-
guage services to ensure effective communication 
with individuals with limited English proficiency, 
and requires the provision of appropriate auxiliary 
aids and services necessary to ensure effective com-
munication with individuals with disabilities. 
(8) Linguistic diversity in the health care and 
health care-related services workforce is important 
for providing all patients the environment most con-
ducive to positive health outcomes. 
(9) All members of the health care and health 
care-related services community should continue to 
educate their staff and constituents about limited 
English proficient and disability communication 
issues and help them identify resources to improve 
access to quality care for individuals with limited 
English proficiency and individuals with communica-
tion disabilities such as cognitive, hearing, vision, or 
print impairments. 
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(10) Access to English as a second language, 
foreign language, and sign language interpreters, 
translated and alternative format documents, read-
ers, and other auxiliary aids and services, are essen-
tial to ensure effective communication and eliminate 
the language barriers that impede access to health 
care. 
(11) Culturally competent language services in 
health care settings should be available as a matter 
of course. 
SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID-
UALS WITH LIMITED ENGLISH PROFICIENCY. 
(a) PURPOSE.—Consistent with the goals provided in 
Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 
to improving access to services for persons with limited 
English proficiency), it is the purpose of this section— 
(1) to improve Federal agency performance re-
garding access to federally conducted and federally 
assisted programs and activities for individuals with 
limited English proficiency; 
(2) to require each Federal agency to examine 
the services it provides and develop and implement 
a system by which individuals with limited English 
proficiency can obtain culturally competent services 
and meaningful access to those services consistent 
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with, and without substantially burdening, the fun-
damental mission of the agency; 
(3) to require each Federal agency to translate 
any English language written material prepared for 
the general public relating to a public health emer-
gency, including vaccine distribution and education, 
into the top 15 non-English languages in the United 
States (according to the most recent data from the 
American Community Survey or its replacement) not 
later than 7 days after any such material is made 
available in English; 
(4) to require each Federal agency to ensure 
that recipients of Federal financial assistance pro-
vide culturally competent services and meaningful 
access to applicants and beneficiaries who are indi-
viduals with limited English proficiency; 
(5) to ensure that recipients of Federal finan-
cial assistance take reasonable steps, consistent with 
the guidelines set forth in the ‘‘Guidance to Federal 
Financial Assistance Recipients Regarding Title VI 
Prohibition Against National Origin Discrimination 
Affecting Limited English Proficient Persons (67 
Fed. Reg. 41455 (June 18, 2002))’’, to ensure cul-
turally and linguistically appropriate access to their 
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programs and activities by individuals with limited 
English proficiency; and 
(6) to ensure compliance with title VI of the 
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 
and section 1557 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18116) (prohibiting 
health care providers and organizations from dis-
criminating in the provision of services). 
(b) FEDERALLY CONDUCTED PROGRAMS AND AC-
TIVITIES.— 
(1) IN
GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency providing financial assistance to, or admin-
istering, a health program or activity described in 
section 2003(a) shall prepare a plan or update a 
plan to improve culturally and linguistically appro-
priate access to such program or activity with re-
spect to individuals with limited English proficiency. 
Not later than 1 year after the date of enactment 
of this title, each such Federal agency shall ensure 
that such plan is fully implemented. 
(2) PLAN
REQUIREMENT.—Each plan under 
paragraph (1) shall include— 
(A) the steps the agency will take to en-
sure that individuals with limited English pro-
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ficiency have access to each health program or 
activity supported or administered by the agen-
cy; 
(B) the policies and procedures for identi-
fying, assessing, and meeting the culturally and 
linguistically appropriate language needs of its 
beneficiaries that are individuals with limited 
English proficiency served by such program or 
activity; 
(C) the steps the agency will take for such 
program or activity to be culturally and linguis-
tically appropriate by— 
(i) providing a range of language as-
sistance options; 
(ii) giving notice to individuals with 
limited English proficiency of the right to 
competent language services; 
(iii) training staff (at least annually); 
and 
(iv) monitoring and assessing the 
quality of the language services (at least 
annually); 
(D) the steps the agency will take for such 
program or activity to provide reasonable ac-
commodations necessary for individuals with 
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limited English proficiency, including those in-
dividuals with a communication disability, to 
understand communications from the agency; 
(E) the steps the agency will take to en-
sure that applications, forms, and other signifi-
cant documents for such program or activity 
are competently translated into the primary 
language of a client that is an individual with 
limited English proficiency where such mate-
rials are needed to improve access of such client 
to such program or activity; 
(F) the resources the agency will provide 
to improve cultural and linguistic appropriate-
ness to assist recipients of Federal funds to im-
prove access to health care-related programs 
and activities for individuals with limited 
English proficiency; 
(G) the resources the agency will provide 
to ensure that competent language assistance is 
provided to patients that are individuals with 
limited English proficiency by interpreters or 
trained bilingual staff; 
(H) the resources the agency will provide 
to ensure that family, particularly minor chil-
dren, and friends are not used to provide inter-
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pretation services, except as permitted under 
section 1557 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18116); and 
(I) the steps the agency will take and re-
sources the agency will provide to ensure that 
individuals know their rights, including the abil-
ity to file a complaint. 
(3) SUBMISSION OF PLAN TO DOJ.—Each agen-
cy that is required to prepare a plan under para-
graph (1) shall— 
(A) consult with populations who are di-
rectly impacted by policies in the plan and their 
representatives in the development of the plan; 
and 
(B) when the plan is finalized, send a copy 
of such plan to the Attorney General, to serve 
as the central repository of all such plans. 
SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTH CARE. 
(a) APPLICABILITY.—This section shall apply to any 
health program or activity— 
(1) of which any part is receiving Federal fi-
nancial assistance, including credits, subsidies, or 
contracts of insurance; or 
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(2) that is carried out (including indirectly 
through contracts, subcontracts, or other support) 
by an executive agency or any entity established 
under title I of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18001 et seq.) (or amend-
ments made thereby). 
(b) STANDARDS.—Each program or activity de-
scribed in subsection (a)— 
(1) shall implement strategies to recruit, retain, 
and promote individuals at all levels to maintain a 
diverse staff and leadership that can provide cul-
turally and linguistically appropriate health care to 
patient populations of the service area of the pro-
gram or activity; 
(2) shall educate and train governance, leader-
ship, and workforce at all levels and across all dis-
ciplines of the program or activity in culturally and 
linguistically appropriate policies and practices on an 
ongoing basis at least yearly; 
(3) shall offer and provide language assistance, 
including trained and competent bilingual staff and 
interpreter services, to individuals with limited 
English proficiency or who have other communica-
tion needs, at no cost to the individual at all points 
of contact, and during all hours of operation, to fa-
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cilitate timely access to health care services and 
health care-related services; 
(4) shall for each language group consisting of 
individuals with limited English proficiency that con-
stitutes 5 percent or 500 individuals, whichever is 
less, of the population of persons eligible to be 
served or likely to be affected or encountered in the 
service area of the program or activity, make avail-
able at a fifth grade reading level— 
(A) easily understood patient-related mate-
rials, including print and multimedia materials, 
in the language of such language group; 
(B) information or notices about termi-
nation of benefits in such language; 
(C) signage; and 
(D) any other documents or types of docu-
ments designated by the Secretary; 
(5) shall develop and implement clear goals, 
policies, operational plans, and management, ac-
countability, and oversight mechanisms to provide 
culturally and linguistically appropriate services and 
infuse them throughout the planning and operations 
of the program or activity; 
(6) shall conduct initial and ongoing, at least 
annually, organizational assessments of culturally 
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and linguistically appropriate services-related activi-
ties and integrate valid linguistic, competence-related 
National Standards for Culturally and Linguistically 
Appropriate Services (CLAS) measures into the in-
ternal audits, performance improvement programs, 
patient satisfaction assessments, continuous quality 
improvement activities, and outcomes-based evalua-
tions of the program or activity and develop ways to 
standardize assessments; 
(7) shall ensure that, consistent with the pri-
vacy protections provided for under the regulations 
promulgated under section 264(c) of the Health In-
surance Portability and Accountability Act of 1996 
(42 U.S.C. 1320–2 note), data on an individual re-
quired to be collected pursuant to section 3101, in-
cluding the individual’s alternative format pref-
erences and policy modification needs, are— 
(A) collected in health records; 
(B) integrated into the management infor-
mation systems of the program or activity; 
(C) reported in such a way as to be inter-
operable with health information systems at the 
Federal and State levels; and 
(D) periodically updated; 
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(8) shall maintain a current demographic, cul-
tural, and epidemiological profile of the community, 
conduct regular assessments of community health 
assets and needs, and use the results of such assess-
ments to accurately plan for and implement services 
that respond to the cultural and linguistic character-
istics of the service area of the program or activity; 
(9) shall develop participatory, collaborative 
partnerships with community-based organizations 
and utilize a variety of formal and informal mecha-
nisms to facilitate community and patient involve-
ment in designing, implementing, and evaluating 
policies and practices to ensure culturally and lin-
guistically appropriate service-related activities; 
(10) shall ensure that conflict and grievance 
resolution processes are culturally and linguistically 
appropriate and capable of identifying, preventing, 
and resolving cross-cultural conflicts or complaints 
by patients; 
(11) shall annually make available to the public 
information about their progress and successful in-
novations in implementing the standards under this 
section, translated materials of such information 
that is culturally and linguistically appropriate to 
the communities served under this section, and pro-
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vide public notice in such communities about the 
availability of this information; and 
(12) shall, if requested, regularly make avail-
able to the head of each Federal entity from which 
Federal funds are provided, information about the 
progress and successful innovations of the program 
or activity in implementing the standards under this 
section as required by the head of such entity. 
(c) COMMENTS ACCEPTED THROUGH NOTICE AND 
COMMENT RULEMAKING.—An agency carrying out a pro-
gram or activity described in subsection (a)— 
(1) shall ensure that comments with respect to 
such program or activity that are accepted through 
notice and comment rulemaking are accepted in all 
languages; 
(2) may not require such comments to be sub-
mitted only in English; and 
(3) shall ensure that any such comments that 
are not submitted in English are considered, during 
the agency’s review of such comments, equally as 
such comments that are submitted in English. 
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SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO-
PRIATE 
HEALTH 
CARE 
IN 
THE 
PUBLIC 
HEALTH SERVICE ACT. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE 
XXXIV—CULTURALLY 
AND LINGUISTICALLY APPRO-
PRIATE HEALTH CARE 
‘‘SEC. 3400. DEFINITIONS. 
‘‘(a) IN GENERAL.—In this title: 
‘‘(1) BILINGUAL.—The term ‘bilingual’, with 
respect to an individual, means an individual who 
has a sufficient degree of proficiency in 2 languages. 
‘‘(2) CULTURAL.—The term ‘cultural’ means 
relating to integrated patterns of human behavior 
that include the language, thoughts, communica-
tions, actions, customs, beliefs, values, age, and in-
stitutions of racial, ethnic, religious, or social 
groups, including lesbian, gay, bisexual, transgender, 
queer, and questioning individuals, and individuals 
with physical and mental disabilities. 
‘‘(3) CULTURALLY
AND
LINGUISTICALLY
AP-
PROPRIATE.—The term ‘culturally and linguistically 
appropriate’ means being respectful of and respon-
sive to the cultural and linguistic needs of all indi-
viduals. 
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‘‘(4) EFFECTIVE COMMUNICATION.—The term 
‘effective communication’ means an exchange of in-
formation between the provider of health care or 
health care-related services and the recipient of such 
services who is limited in English proficiency, or has 
a communication impairment such as a hearing, vi-
sion, speaking, or cognitive disability, that enables 
access to, understanding of, and benefit from health 
care or health care-related services, and full partici-
pation in the development of their treatment plan. 
‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 
term ‘grievance resolution process’ means all aspects 
of dispute resolution including filing complaints, 
grievance and appeal procedures, and court action. 
‘‘(6) HEALTH CARE GROUP.—The term ‘health 
care group’ means a group of physicians organized, 
at least in part, for the purposes of providing physi-
cian services under the Medicaid program under title 
XIX of the Social Security Act, the State Children’s 
Health Insurance Program under title XXI of such 
Act, or the Medicare program under title XVIII of 
such Act, including a provider of services under part 
B of such title XVIII, and may include a hospital, 
a hospice provider, a palliative care provider, and 
any other individual or entity furnishing services 
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covered under any such program that is affiliated 
with the health care group. 
‘‘(7) HEALTH CARE.—The term ‘health care’ 
includes all health care needed throughout the life 
cycle and the end of life. 
‘‘(8) HEALTH
CARE
SERVICES.—The term 
‘health care services’ means services that address 
physical and mental health conditions, as well as 
conditions impacted by social determinants of health, 
in all care settings throughout the life cycle and the 
end of life. 
‘‘(9) HEALTH CARE-RELATED SERVICES.—The 
term ‘health care-related services’ means human or 
social services programs or activities that provide ac-
cess, referrals, or links to health care services. 
‘‘(10) HEALTH EDUCATOR.—The term ‘health 
educator’ includes a professional with a bacca-
laureate degree who is responsible for designing, im-
plementing, and evaluating individual and population 
health promotion, health education (including edu-
cation on end-of-life care options), end-of-life care, 
or chronic disease prevention programs. 
‘‘(11) INDIAN; INDIAN TRIBE.—The terms ‘In-
dian’ and ‘Indian Tribe’ have the meanings given 
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such terms in section 4 of the Indian Self-Deter-
mination and Education Assistance Act. 
‘‘(12) INDIVIDUAL
WITH
A
DISABILITY.—The 
term ‘individual with a disability’ means any indi-
vidual who has a disability as defined for the pur-
pose of section 504 of the Rehabilitation Act of 
1973. 
‘‘(13) INDIVIDUAL
WITH
LIMITED
ENGLISH 
PROFICIENCY.—The term ‘individual with limited 
English proficiency’ means an individual who self- 
identifies on the Census as speaking English less 
than ‘very well’. 
‘‘(14) INTEGRATED
HEALTH
CARE
DELIVERY 
SYSTEM.—The term ‘integrated health care delivery 
system’ means an interdisciplinary system that 
brings together providers from the primary health, 
mental health, substance use disorder, hospice and 
palliative care, and related disciplines to improve the 
health outcomes of an individual and the community. 
Such providers may include hospitals, health, mental 
health, or substance use prevention and treatment 
clinics and providers, home health agencies, home- 
and community-based services providers, congregate 
care settings (including any skilled nursing facilities, 
assisted living facilities, prisons and jails, residential 
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behavioral health care and psychiatric facilities, and 
facilities providing services for aging adults and peo-
ple with disabilities), ambulatory surgery centers, re-
habilitation centers, and employed, independent, or 
contracted physicians. 
‘‘(15) INTERPRETING; INTERPRETATION.—The 
terms ‘interpreting’ and ‘interpretation’ mean the 
transmission of a spoken, written, or signed message 
from one language or format into another, faithfully, 
accurately, and objectively. 
‘‘(16) LANGUAGE ACCESS.—The term ‘language 
access’ means the provision of language services to 
an individual with limited English proficiency or an 
individual with communication disabilities designed 
to enhance that individual’s access to, understanding 
of, or benefit from health care services or health 
care-related services. 
‘‘(17) LANGUAGE ASSISTANCE SERVICES.—The 
term ‘language assistance services’ includes— 
‘‘(A) oral language assistance, including in-
terpretation in non-English languages provided 
in-person or remotely by a qualified interpreter 
for an individual with limited English pro-
ficiency, and the use of qualified bilingual or 
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multilingual staff to communicate directly with 
individuals with limited English proficiency; 
‘‘(B) written translation, performed by a 
qualified translator, of written content in paper 
or electronic form into languages other than 
English; and 
‘‘(C) taglines. 
‘‘(18) MINORITY.— 
‘‘(A) IN GENERAL.—The terms ‘minority’ 
and ‘minorities’ refer to individuals from a mi-
nority group. 
‘‘(B) POPULATIONS.—The term ‘minority’, 
with respect to populations, refers to racial and 
ethnic minority groups, members of sexual and 
gender minority groups, and individuals with a 
disability. 
‘‘(19) MINORITY GROUP.—The term ‘minority 
group’ means a racial and ethnic minority group as 
defined in this section. 
‘‘(20) ONSITE
INTERPRETATION.—The term 
‘onsite interpretation’ means a method of inter-
preting or interpretation for which the interpreter is 
in the physical presence of the provider of health 
care services or health care-related services and the 
recipient of such services who is limited in English 
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proficiency or has a communication impairment such 
as an impairment in hearing, vision, or learning. 
‘‘(21) QUALIFIED
INDIVIDUAL
WITH
A
DIS-
ABILITY.—The term ‘qualified individual with a dis-
ability’ means, with respect to a health program or 
activity, an individual with a disability who, with or 
without reasonable modifications to policies, prac-
tices, or procedures, the removal of architectural, 
communication, or transportation barriers, or the 
provision of auxiliary aids and services, meets the es-
sential eligibility requirements for the receipt of aids, 
benefits, or services offered or provided by the health 
program or activity. 
‘‘(22) QUALIFIED INTERPRETER FOR AN INDI-
VIDUAL WITH A DISABILITY.—The term ‘qualified 
interpreter for an individual with a disability’, with 
respect to an individual with a disability— 
‘‘(A) means an interpreter for such indi-
vidual who by means of a remote interpreting 
service or an onsite appearance— 
‘‘(i) adheres to generally accepted in-
terpreter ethics principles, including client 
confidentiality; and 
‘‘(ii) is able to interpret effectively, ac-
curately, and impartially, both receptively 
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and expressively, using any necessary spe-
cialized vocabulary, terminology, and phra-
seology; and 
‘‘(B) may include— 
‘‘(i) sign language interpreters; 
‘‘(ii) oral transliterators, which are in-
dividuals who represent or spell in the 
characters of another alphabet; and 
‘‘(iii) cued language transliterators, 
which are individuals who represent or 
spell 
by 
using 
a 
small 
number 
of 
handshapes. 
‘‘(23) QUALIFIED INTERPRETER FOR AN INDI-
VIDUAL
WITH
LIMITED
ENGLISH
PROFICIENCY.— 
The term ‘qualified interpreter for an individual with 
limited English proficiency’ means an interpreter 
who by means of a remote interpreting service or an 
onsite appearance— 
‘‘(A) adheres to generally accepted inter-
preter ethics principles, including client con-
fidentiality; 
‘‘(B) has demonstrated proficiency in 
speaking 
and 
understanding 
both 
spoken 
English and one or more other spoken lan-
guages; and 
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‘‘(C) is able to interpret effectively, accu-
rately, and impartially, both receptively and ex-
pressly, to and from such languages and 
English, using any necessary specialized vocab-
ulary, terminology, and phraseology. 
‘‘(24) QUALIFIED
TRANSLATOR.—The term 
‘qualified translator’ means a translator who— 
‘‘(A) adheres to generally accepted trans-
lator ethics principles, including client confiden-
tiality; 
‘‘(B) has demonstrated proficiency in writ-
ing and understanding both written English 
and one or more other written non-English lan-
guages; and 
‘‘(C) is able to translate effectively, accu-
rately, and impartially to and from such lan-
guages and English, using any necessary spe-
cialized vocabulary, terminology, and phrase-
ology. 
‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘racial and ethnic minority group’ means 
Indians and Alaska Natives, African Americans (in-
cluding Caribbean Blacks, Africans, and other 
Blacks), Asian Americans, Hispanics (including 
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Latinos), Middle Easterners and North Africans, 
and Native Hawaiians and other Pacific Islanders. 
‘‘(26) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Services, 
acting through the Director of the Agency for 
Healthcare Research and Quality. 
‘‘(27) 
SEXUAL
AND
GENDER
MINORITY 
GROUP.—The term ‘sexual and gender minority 
group’ encompasses lesbian, gay, bisexual, and 
transgender populations, as well as those whose sex-
ual orientation, gender identity and expression, or 
reproductive development varies from traditional, so-
cietal, cultural, or physiological norms. 
‘‘(28) SIGHT TRANSLATION.—The term ‘sight 
translation’ means the transmission of a written 
message in one language into a spoken or signed 
message in another language, or an alternative for-
mat in English or another language. 
‘‘(29) STATE.—Notwithstanding section 2, the 
term ‘State’ means each of the several States, the 
District of Columbia, the Commonwealth of Puerto 
Rico, the United States Virgin Islands, Guam, 
American Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
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‘‘(30) 
TELEPHONIC
INTERPRETATION.—The 
term ‘telephonic interpretation’ (also known as ‘over 
the phone interpretation’ or ‘OPI’) means, with re-
spect to interpretation for an individual with limited 
English proficiency, a method of interpretation in 
which the interpreter is not in the physical presence 
of the provider of health care services or health care- 
related services and such individual receiving such 
services, but the interpreter is connected via tele-
phone. 
‘‘(31) TRANSLATION.—The term ‘translation’ 
means the transmission of a written message in one 
language into a written or signed message in an-
other language, and includes translation into an-
other language or alternative format, such as large 
print font, Braille, audio recording, or CD. 
‘‘(32) 
UNDERSERVED
COMMUNITIES.—The 
term ‘underserved communities’ means populations 
sharing a particular characteristic, as well as geo-
graphic communities, who have been systematically 
denied a full opportunity to participate in aspects of 
economic, social, and civic life, such as— 
‘‘(A) Black, Latino, and Indigenous and 
Native American persons, Asian Americans and 
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Pacific Islanders, Middle Easterners and North 
Africans, and other persons of color; 
‘‘(B) members of religious minorities; 
‘‘(C) lesbian, gay, bisexual, transgender, 
and queer persons; 
‘‘(D) persons with disabilities; 
‘‘(E) persons who live in rural areas; and 
‘‘(F) persons otherwise adversely affected 
by persistent poverty or inequality as defined in 
Executive Order 13985. 
‘‘(33) 
UNDERSERVED
POPULATIONS.—The 
term ‘underserved populations’ means populations 
sharing a particular characteristic, as well as geo-
graphic communities, who have been systematically 
denied a full opportunity to participate in aspects of 
economic, social, and civic life, as defined in Execu-
tive Order 13985. 
‘‘(34) VIDEO
REMOTE
INTERPRETING
SERV-
ICES.—The term ‘video remote interpreting services’ 
means the provision, in health care services or health 
care-related services, through a qualified interpreter 
for an individual with limited English proficiency, of 
video remote interpreting services that are— 
‘‘(A) in real-time, full-motion video, and 
audio over a dedicated high-speed, wide-band-
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width video connection or wireless connection 
that delivers high-quality video images that do 
not produce lags, choppy, blurry, or grainy im-
ages, or irregular pauses in communication; and 
‘‘(B) in a sharply delineated image that is 
large enough to display. 
‘‘(35) VITAL DOCUMENT.—The term ‘vital doc-
ument’ includes applications for government pro-
grams that provide health care services, medical or 
financial consent forms, financial assistance docu-
ments, letters containing important information re-
garding patient instructions (such as prescriptions, 
referrals to other providers, and discharge plans) 
and participation in a program (such as a Medicaid 
managed care program), notices pertaining to the 
reduction, denial, or termination of services or bene-
fits, notices of the right to appeal such actions, and 
notices advising individuals with limited English pro-
ficiency with communication disabilities of the avail-
ability of free language services, alternative formats, 
and other outreach materials. 
‘‘(b) REFERENCE.—In any reference in this title to 
a regulatory provision applicable to a ‘handicapped indi-
vidual’, the term ‘handicapped individual’ in such provi-
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sion shall have the same meaning as the term ‘individual 
with a disability’ as defined in subsection (a). 
‘‘Subtitle A—Resources and Innova-
tion for Culturally and Linguis-
tically Appropriate Health Care 
‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE HEALTH 
CARE. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish and support a center to be known as the ‘Robert T. 
Matsui Center for Culturally and Linguistically Appro-
priate Health Care’ (referred to in this section as the 
‘Center’) to carry out each of the following activities: 
‘‘(1) INTERPRETATION SERVICES.— 
‘‘(A) IN GENERAL.—The Center shall pro-
vide resources via the internet to identify and 
link health care providers to competent and 
qualified interpreter and translation services. 
‘‘(B) TRAINING.—For purposes of pro-
viding the services described in subparagraph 
(A), the Center shall adopt a language access 
plan that includes training requirements for 
Center staff to provide such services. 
‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 
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100 
‘‘(A) VITAL
DOCUMENTS.—The Center 
shall provide, directly or through contract, to 
providers of health care services and health 
care-related services, at no cost to such pro-
viders and in a timely and reasonable manner, 
vital documents— 
‘‘(i) which may be submitted by cov-
ered entities (as defined in section 92.4 of 
title 45, Code of Federal Regulations, as in 
effect on May 18, 2016) for translation 
into non-English languages or alternative 
formats at a fifth-grade reading level; and 
‘‘(ii) from competent translation serv-
ices, the quality of which shall be mon-
itored and reported publicly. 
‘‘(B) FORMS.—For each form developed or 
revised by the Secretary that will be used by in-
dividuals with limited English proficiency in 
health care or health care-related settings, the 
Center shall, not later than 45 calendar days of 
the Secretary receiving final approval of the 
form from the Office of Management and 
Budget— 
‘‘(i) translate the form, at a min-
imum, into the top 15 non-English lan-
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101 
guages in the United States according to 
the most recent data from the American 
Community Survey or its replacement; and 
‘‘(ii) post all translated forms on the 
Center’s website. 
‘‘(3) TOLL-FREE
CUSTOMER
SERVICE
TELE-
PHONE
NUMBER.—The 
Center 
shall 
provide, 
through a toll-free number, a customer service line 
for individuals with limited English proficiency that 
is linked to the toll-free telephone number 1–800– 
MEDICARE and a toll-free telephone hotline pro-
vided for pursuant to section 1311(d)(4)(B) of the 
Patient Protection and Affordable Care Act by an 
Exchange established under title I of such Act— 
‘‘(A) to obtain information about federally 
conducted or funded health programs, including 
the Medicare program under title XVIII of the 
Social Security Act, the Medicaid program 
under title XIX of such Act, and the State Chil-
dren’s Health Insurance Program under title 
XXI of such Act, and coverage available 
through an Exchange established under title I 
of the Patient Protection and Affordable Care 
Act, and other sources of free or reduced care 
including federally qualified health centers, enti-
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102 
ties receiving assistance under title X, and pub-
lic health departments; 
‘‘(B) to obtain assistance with applying for 
or accessing these programs and understanding 
Federal notices written in English; and 
‘‘(C) to learn how to access language serv-
ices. 
‘‘(4) 
HEALTH
INFORMATION
CLEARING-
HOUSE.— 
‘‘(A) IN GENERAL.—The Center shall de-
velop and maintain, and make available on the 
internet and in print, an information clearing-
house that includes the information described in 
subparagraphs (B) through (F)— 
‘‘(i) to facilitate the provision of lan-
guage services by providers of health care 
services and health care-related services to 
reduce medical errors; 
‘‘(ii) to improve medical outcomes, im-
prove cultural competence, reduce health 
care costs caused by miscommunication 
with individuals with limited English pro-
ficiency; and 
‘‘(iii) to reduce or eliminate the dupli-
cation of efforts to translate materials. 
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103 
‘‘(B) DOCUMENT TEMPLATES.—The Cen-
ter shall collect and evaluate for accuracy, de-
velop, and make available templates for stand-
ard documents that are necessary for patients 
and consumers to access and make educated de-
cisions about their health care, including tem-
plates for each of the following: 
‘‘(i) Administrative and legal docu-
ments, including— 
‘‘(I) intake forms; 
‘‘(II) forms related to the Medi-
care program under title XVIII of the 
Social Security Act, the Medicaid pro-
gram under title XIX of such Act, 
and the State Children’s Health In-
surance Program under title XXI of 
such Act, including eligibility informa-
tion for such programs; 
‘‘(III) forms informing patients 
of the compliance and consent re-
quirements pursuant to the regula-
tions under section 264(c) of the 
Health Insurance Portability and Ac-
countability Act of 1996 (42 U.S.C. 
1320–2 note); and 
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104 
‘‘(IV) documents concerning in-
formed consent, advanced directives, 
and waivers of rights. 
‘‘(ii) Clinical information, such as how 
to take medications, how to prevent trans-
mission of a contagious disease, and other 
prevention and treatment instructions. 
‘‘(iii) Public health, patient education, 
and outreach materials, such as immuniza-
tion notices, health warnings, or screening 
notices. 
‘‘(iv) Additional health or health care- 
related materials as determined appro-
priate by the Director of the Center. 
‘‘(C) STRUCTURE
OF
FORMS.—In oper-
ating the clearinghouse, the Center shall— 
‘‘(i) ensure that the documents posted 
in English and non-English languages are 
culturally and linguistically appropriate; 
‘‘(ii) allow public review of the docu-
ments before dissemination in order to en-
sure that the documents are understand-
able and culturally and linguistically ap-
propriate for the target populations; 
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105 
‘‘(iii) allow health care providers to 
customize the documents for their use; 
‘‘(iv) facilitate access to such docu-
ments; 
‘‘(v) provide technical assistance with 
respect to the access and use of such infor-
mation; and 
‘‘(vi) carry out any other activities the 
Secretary determines to be useful to fulfill 
the purposes of the clearinghouse. 
‘‘(D) 
LANGUAGE
ASSISTANCE
PRO-
GRAMS.—The Center shall provide for the col-
lection and dissemination of information on cur-
rent examples of language assistance programs 
and strategies to improve language services for 
individuals with limited English proficiency, in-
cluding case studies using de-identified patient 
information, program summaries, and program 
evaluations. 
‘‘(E) CULTURALLY
AND
LINGUISTICALLY 
APPROPRIATE
MATERIALS.—The Center shall 
provide, at no cost, to all health care providers 
and all providers of health care-related services, 
information relating to culturally and linguis-
tically appropriate health care for minority pop-
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106 
ulations residing in the United States, includ-
ing— 
‘‘(i) tenets of culturally and linguis-
tically appropriate care; 
‘‘(ii) culturally and linguistically ap-
propriate self-assessment tools; 
‘‘(iii) culturally and linguistically ap-
propriate training tools; 
‘‘(iv) strategic plans to increase cul-
tural and linguistic appropriateness in dif-
ferent types of providers of health care 
services and health care-related services, 
including regional collaborations among 
health care organizations for health care 
services and health care-related services; 
and 
‘‘(v) culturally and linguistically ap-
propriate information for educators, practi-
tioners, students, and researchers. 
‘‘(F) 
TRANSLATION
GLOSSARIES.—The 
Center shall— 
‘‘(i) develop and publish on its website 
translation glossaries that provide stand-
ardized translations of commonly used 
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107 
terms and phrases utilized in documents 
translated by the Center; and 
‘‘(ii) make such glossaries available— 
‘‘(I) free of charge; 
‘‘(II) in each language in which 
the Center translates forms under 
paragraph (2)(B); 
‘‘(III) in alternative formats in 
accordance with the Americans with 
Disabilities Act of 1990 (42 U.S.C. 
12101 et seq.); and 
‘‘(IV) in paper format upon re-
quest. 
‘‘(G) INFORMATION
ABOUT
PROGRESS.— 
The Center shall— 
‘‘(i) regularly collect and make pub-
licly 
available 
information 
about 
the 
progress of entities receiving grants under 
section 3402 regarding successful innova-
tions in implementing the requirements of 
this subsection; and 
‘‘(ii) provide public notice in the enti-
ties’ communities about the availability of 
such information. 
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108 
‘‘(b) DIRECTOR.—The Center shall be headed by a 
Director who shall be appointed by, and who shall report 
to, the Director of the Agency for Healthcare Research 
and Quality. 
‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di-
rector of the Center shall collaborate with the Deputy As-
sistant Secretary for Minority Health, the Administrator 
of the Centers for Medicare & Medicaid Services, and the 
Administrator of the Health Resources and Services Ad-
ministration to notify health care providers and health 
care organizations about the availability of language ac-
cess services by the Center. 
‘‘(d) 
EDUCATION.—The 
Secretary, 
directly 
or 
through contract, shall undertake a national education 
campaign to inform providers, individuals with limited 
English proficiency, individuals with hearing or vision im-
pairments, health professionals, graduate schools, commu-
nity health centers, social service providers, and commu-
nity-based organizations about— 
‘‘(1) Federal and State laws and guidelines gov-
erning access to language services; 
‘‘(2) the value of using trained and competent 
interpreters and the risks associated with using fam-
ily members, friends, minors, and untrained bilin-
gual staff; 
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109 
‘‘(3) funding sources for developing and imple-
menting language services; and 
‘‘(4) promising practices to effectively provide 
language services. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2023 through 2027. 
‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS-
TICALLY 
APPROPRIATE 
HEALTH 
CARE 
GRANTS. 
‘‘(a) IN GENERAL.— 
‘‘(1) GRANTS.—The Secretary shall award 
grants to eligible entities to enable such entities to 
design, implement, and evaluate innovative, cost-ef-
fective programs to improve culturally and linguis-
tically appropriate access to health care services for 
individuals with limited English proficiency and com-
munication disabilities. 
‘‘(2) COORDINATION.—In making grants under 
this section, and in the design and implementation 
of the program established under this section, the 
Secretary shall coordinate with, and ensure the par-
ticipation of, other agencies including the Health Re-
sources and Services Administration, the National 
Institute on Minority Health and Health Disparities 
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110 
at the National Institutes of Health, and the Office 
of Minority Health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall be— 
‘‘(1) a city, county, Indian Tribe, State, or sub-
division thereof; 
‘‘(2) an organization described in section 
501(c)(3) of the Internal Revenue Code of 1986 and 
exempt from tax under section 501(a) of such Code; 
‘‘(3) a community health, mental health, or 
substance use disorder center or clinic; 
‘‘(4) a solo or group physician practice; 
‘‘(5) an integrated health care delivery system; 
‘‘(6) a public hospital; 
‘‘(7) a health care group, university, or college; 
or 
‘‘(8) any other entity designated by the Sec-
retary. 
‘‘(c) APPLICATION.—An eligible entity seeking a 
grant under this section shall prepare and submit to the 
Secretary an application, at such time, in such manner, 
and containing such additional information as the Sec-
retary may reasonably require. 
‘‘(d) USE OF FUNDS.—An entity shall use funds re-
ceived through a grant under this section to— 
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111 
‘‘(1) develop, implement, and evaluate models of 
providing competent interpretation services through 
onsite interpretation, telephonic interpretation, or 
video remote interpreting services; 
‘‘(2) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
promote and provide language services to patient 
populations of the service area of the entity; 
‘‘(3) develop and maintain a needs assessment 
that identifies the current demographic, cultural, 
and epidemiological profile of the community to ac-
curately plan for and implement language services 
needed in the service area of the entity; 
‘‘(4) develop a strategic plan to implement lan-
guage services; 
‘‘(5) develop participatory, collaborative part-
nerships with communities encompassing the patient 
populations of individuals with limited English pro-
ficiency served by the grant to gain input in design-
ing and implementing language services; 
‘‘(6) develop and implement grievance resolu-
tion processes that are culturally and linguistically 
appropriate and capable of identifying, preventing, 
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112 
and resolving complaints by individuals with limited 
English proficiency; 
‘‘(7) develop short-term medical and mental 
health interpretation training courses and incentives 
for bilingual health care staff who are asked to pro-
vide interpretation services in the workplace; 
‘‘(8) develop formal training programs, includ-
ing continued professional development and edu-
cation programs as well as supervision, for individ-
uals interested in becoming dedicated health care in-
terpreters and culturally and linguistically appro-
priate providers; 
‘‘(9) provide staff language training instruction, 
which shall include information on the practical limi-
tations of such instruction for nonnative speakers; 
‘‘(10) develop policies that address compensa-
tion in salary for staff who receive training to be-
come either a staff interpreter or bilingual provider; 
‘‘(11) develop other language assistance services 
as determined appropriate by the Secretary; 
‘‘(12) develop, implement, and evaluate models 
of improving cultural competence, including cultural 
competence programs for community health workers; 
‘‘(13) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
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113 
mulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 and 
any applicable State privacy laws, data on the indi-
vidual patient or recipient’s race, ethnicity, and pri-
mary language are collected (and periodically up-
dated) in health records and integrated into the or-
ganization’s information management systems or 
any similar system used to store and retrieve data; 
and 
‘‘(14) ensure that culturally competent care and 
language assistance are available to individuals with 
limited English proficiency. 
‘‘(e) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to entities that pri-
marily engage in providing direct care and that have devel-
oped partnerships with community organizations or with 
agencies with experience in improving language access. 
‘‘(f) EVALUATION.— 
‘‘(1) BY GRANTEES.—An entity that receives a 
grant under this section shall submit to the Sec-
retary an evaluation that describes, in the manner 
and to the extent required by the Secretary, the ac-
tivities carried out with funds received under the 
grant, and how such activities improved access to 
health care services and health care-related services 
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and the quality of health care for individuals with 
limited English proficiency. Such evaluation shall be 
collected and disseminated through the Robert T. 
Matsui Center for Culturally and Linguistically Ap-
propriate Health Care established under section 
3401. The Director of the Agency for Healthcare 
Research and Quality shall notify grantees of the 
availability of technical assistance for the evaluation 
and provide such assistance upon request. 
‘‘(2) BY
SECRETARY.—The Director of the 
Agency for Healthcare Research and Quality shall 
evaluate or arrange with other individuals or organi-
zations to evaluate projects funded under this sec-
tion. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2023 through 2027. 
‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM-
PETENCE. 
‘‘(a) IN GENERAL.—The Secretary shall expand re-
search concerning language access in the provision of 
health care services. 
‘‘(b) ELIGIBILITY.—The Secretary may conduct the 
research described in subsection (a) or enter into contracts 
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115 
with other individuals or organizations to conduct such re-
search. 
‘‘(c) USE
OF FUNDS.—Research conducted under 
this section shall be designed to do one or more of the 
following: 
‘‘(1) To identify the barriers to mental and be-
havioral services that are faced by individuals with 
limited English proficiency. 
‘‘(2) To identify health care providers’ and 
health administrators’ knowledge and awareness of 
the barriers to quality health care services that are 
faced by individuals with limited English proficiency 
and communication disabilities. 
‘‘(3) To identify optimal approaches for deliv-
ering language access. 
‘‘(4) To identify best practices for data collec-
tion, including— 
‘‘(A) the collection by providers of health 
care services and health care-related services of 
data on the race, ethnicity, and primary lan-
guage of recipients of such services, taking into 
account existing research conducted by the Gov-
ernment or private sector; 
‘‘(B) the development and implementation 
of data collection and reporting systems; and 
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116 
‘‘(C) effective privacy safeguards for col-
lected data. 
‘‘(5) To develop a minimum data collection set 
for primary language. 
‘‘(6) To evaluate the most effective ways in 
which the Secretary can create or coordinate, and 
subsidize or otherwise fund, telephonic interpretation 
services for health care providers, taking into consid-
eration, among other factors, the flexibility necessary 
for such a system to accommodate variations in— 
‘‘(A) provider type; 
‘‘(B) languages needed and their frequency 
of use; 
‘‘(C) type of encounter; 
‘‘(D) time of encounter, including whether 
the encounter occurs during regular business 
hours and after hours; and 
‘‘(E) location of encounter. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2023 through 2027.’’. 
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SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE-
VELOPMENT 
OF 
STATE 
MEDICAL 
INTER-
PRETING SERVICES. 
(a) GRANTS AUTHORIZED.—The Secretary of Health 
and Human Services shall award 1 grant in accordance 
with this section to each of 3 States (to be selected by 
the Secretary) to assist each such State in designing, im-
plementing, and evaluating a statewide program to provide 
onsite interpreter services under the State Medicaid plan. 
(b) GRANT PERIOD.—A grant awarded under this 
section is authorized for the period of 3 fiscal years begin-
ning on October 1, 2023, and ending on September 30, 
2026. 
(c) PREFERENCE.—In awarding a grant under this 
section, the Secretary shall give preference to a State— 
(1) that has a high proportion of qualified LEP 
enrollees, as determined by the Secretary; 
(2) that has a large number of qualified LEP 
enrollees, as determined by the Secretary; 
(3) that has a high growth rate of the popu-
lation of individuals with limited English proficiency, 
as determined by the Secretary; and 
(4) that has a population of qualified LEP en-
rollees that is linguistically diverse, requiring inter-
preter services in at least 200 non-English lan-
guages. 
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118 
(d) USE OF FUNDS.—A State receiving a grant under 
this section shall use the grant funds to— 
(1) ensure that all health care providers in the 
State participating in the State Medicaid plan have 
access to onsite interpreter services, for the purpose 
of enabling effective communication between such 
providers and qualified LEP enrollees during the 
furnishing of items and services and administrative 
interactions; 
(2) establish, expand, procure, or contract for— 
(A) a statewide health care information 
technology system that is designed to achieve 
efficiencies and economies of scale with respect 
to onsite interpreter services provided to health 
care providers in the State participating in the 
State Medicaid plan; and 
(B) an entity to administer such system, 
the duties of which shall include— 
(i) procuring and scheduling inter-
preter services for qualified LEP enrollees; 
(ii) procuring and scheduling inter-
preter services for individuals with limited 
English proficiency seeking to enroll in the 
State Medicaid plan; 
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119 
(iii) ensuring that interpreters receive 
payment for interpreter services rendered 
under the system; and 
(iv) consulting regularly with organi-
zations representing LEP consumers, in-
terpreters, and health care providers; and 
(3) develop mechanisms to establish, improve, 
and strengthen the competency of the medical inter-
pretation workforce that serves qualified LEP enroll-
ees in the State, including a national certification 
process that is valid, credible, and vendor-neutral. 
(e) APPLICATION.—To receive a grant under this sec-
tion, a State shall submit an application at such time and 
containing such information as the Secretary may require, 
which shall include the following: 
(1) A description of the language access needs 
of individuals in the State enrolled in the State Med-
icaid plan. 
(2) A description of the extent to which the 
program will— 
(A) use the grant funds for the purposes 
described in subsection (d); 
(B) meet the health care needs of rural 
populations of the State; and 
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120 
(C) collect information that accurately 
tracks the language services requested by con-
sumers as compared to the language services 
provided by health care providers in the State 
participating in the State Medicaid plan. 
(3) A description of how the program will be 
evaluated, including a proposal for collaboration with 
organizations representing interpreters, consumers, 
and individuals with limited English proficiency. 
(f) DEFINITIONS.—In this section: 
(1) QUALIFIED
LEP
ENROLLEE.—The term 
‘‘qualified LEP enrollee’’ means an individual— 
(A) who is limited English proficient; and 
(B) who is enrolled in a State Medicaid 
plan. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given the term in section 1101(a)(1) of the So-
cial Security Act (42 U.S.C. 1301(a)(1)), for pur-
poses of title XIX of such Act (42 U.S.C. 1396 et 
seq.). 
(3) STATE MEDICAID PLAN.—The term ‘‘State 
Medicaid plan’’ means a State plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) 
or a waiver of such a plan. 
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121 
(4) 
UNITED
STATES.—The 
term 
‘‘United 
States’’ has the meaning given the term in section 
1101(a)(2) of the Social Security Act (42 U.S.C. 
1301(a)(2)), for purposes of title XIX of such Act 
(42 U.S.C. 1396 et seq.). 
(g) CONTINUATION PAST DEMONSTRATION.—Any 
State receiving a grant under this section must agree to 
directly pay for language services in Medicaid for all Med-
icaid providers by the end of the grant period. 
(h) FUNDING.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated $5,000,000 
to carry out this section. 
(2) AVAILABILITY OF FUNDS.—Amounts appro-
priated pursuant to the authorization in paragraph 
(1) are authorized to remain available without fiscal 
year limitation. 
(3) INCREASED FEDERAL FINANCIAL PARTICI-
PATION.—Section 1903(a)(2)(E) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 
inserting ‘‘(or, in the case of a State that was 
awarded a grant under section 2003 of the Health 
Equity and Accountability Act of 2022, 100 percent 
for each quarter occurring during the grant period 
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122 
specified in subsection (b) of such section)’’ after 
‘‘75 percent’’. 
(i) LIMITATION.—No Federal funds awarded under 
this section may be used to provide interpreter services 
from a location outside the United States. 
SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE CARE: GRADUATE MEDICAL EDU-
CATION. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h)(4) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(L) TREATMENT
OF
CULTURALLY
AND 
LINGUISTICALLY
APPROPRIATE
TRAINING.—In 
determining a hospital’s number of full-time 
equivalent residents for purposes of this sub-
section, all the time that is spent by an intern 
or resident in an approved medical residency 
training program for education and training in 
culturally and linguistically appropriate service 
delivery, which shall include all medically under-
served populations (as defined in section 
330(b)(3) of the Public Health Service Act).’’. 
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123 
(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended— 
(1) by redesignating the clause (x) added by 
section 5505(b) of the Patient Protection and Af-
fordable Care Act as clause (xi) and moving the left 
margin of such clause and each subclause and item 
therein 2 ems to the left; and 
(2) by adding at the end the following new 
clause: 
‘‘(xii) The provisions of subparagraph (L) of 
subsection (h)(4) shall apply under this subpara-
graph in the same manner as they apply under such 
subsection.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply with respect to pay-
ments made to hospitals on or after the date that is one 
year after the date of the enactment of this Act. 
SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID, AND 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAMS. 
(a) LANGUAGE ACCESS GRANTS
FOR MEDICARE 
PROVIDERS.— 
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(1) ESTABLISHMENT.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices, acting through the Centers for Medicare & 
Medicaid Services and in consultation with the 
Center for Medicare and Medicaid Innovation 
(as referred to in section 1115A of the Social 
Security Act (42 U.S.C. 1315a)), shall establish 
a demonstration program under which the Sec-
retary shall award grants to eligible Medicare 
service providers to provide culturally and lin-
guistically appropriate services to Medicare 
beneficiaries who are limited English proficient, 
including beneficiaries who live in diverse and 
underserved communities. 
(B) 
APPLICATION
OF
INNOVATION 
RULES.—The demonstration project under sub-
paragraph (A) shall be conducted in a manner 
that is consistent with the applicable provisions 
of subsections (b), (c), and (d) of section 1115A 
of the Social Security Act (42 U.S.C. 1315a). 
(C) NUMBER OF GRANTS.—To the extent 
practicable, the Secretary shall award not less 
than 24 grants under this subsection. 
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(D) GRANT PERIOD.—Except as provided 
under paragraph (2)(D), each grant awarded 
under this subsection shall be for a 3-year pe-
riod. 
(2) ELIGIBILITY REQUIREMENTS.—To be eligi-
ble for a grant under this subsection, an entity must 
meet the following requirements: 
(A) MEDICARE
PROVIDER.—The entity 
must be— 
(i) a provider of services under part A 
of title XVIII of the Social Security Act 
(42 U.S.C. 1395c et seq.); 
(ii) a provider of services under part 
B of such title (42 U.S.C. 1395j et seq.); 
(iii) a Medicare Advantage organiza-
tion offering a Medicare Advantage plan 
under part C of such title (42 U.S.C. 
1395w–21 et seq.); or 
(iv) a PDP sponsor offering a pre-
scription drug plan under part D of such 
title (42 U.S.C. 1395w–101 et seq.). 
(B) UNDERSERVED
COMMUNITIES.—The 
entity must serve a community that, with re-
spect to necessary language services for improv-
ing access and utilization of health care among 
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126 
individuals with limited English proficiency, is 
disproportionally underserved. 
(C) APPLICATION.—The entity must pre-
pare and submit to the Secretary an applica-
tion, at such time, in such manner, and accom-
panied by such additional information as the 
Secretary may require. 
(D) REPORTING.—In the case of a grantee 
that received a grant under this subsection in 
a previous year, such grantee is only eligible for 
continued payments under a grant under this 
subsection if the grantee met the reporting re-
quirements under paragraph (9) for such year. 
If a grantee fails to meet the requirement of 
such paragraph for the first year of a grant, the 
Secretary may terminate the grant and solicit 
applications from new grantees to participate in 
the demonstration program. 
(3) DISTRIBUTION.—To the extent feasible, the 
Secretary shall award— 
(A) at least 10 grants to providers of serv-
ices described in paragraph (2)(A)(i); 
(B) at least 10 grants to service providers 
described in paragraph (2)(A)(ii); 
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127 
(C) at least 10 grants to organizations de-
scribed in paragraph (2)(A)(iii); and 
(D) at least 10 grants to sponsors de-
scribed in paragraph (2)(A)(iv). 
(4) CONSIDERATIONS IN AWARDING GRANTS.— 
(A) VARIATION
AMONG
GRANTEES.—In 
awarding grants under this subsection, the Sec-
retary shall select grantees to ensure the fol-
lowing: 
(i) The grantees provide many dif-
ferent types of language services. 
(ii) The grantees serve Medicare bene-
ficiaries who speak different languages, 
and who, as a population, have differing 
needs for language services. 
(iii) The grantees serve Medicare 
beneficiaries in both urban and rural set-
tings. 
(iv) The grantees represent each Cen-
ters for Medicare & Medicaid Services re-
gion, as defined by the Secretary. 
(v) The grantees serve Medicare bene-
ficiaries in at least two large metropolitan 
statistical areas with racial, ethnic, sexual, 
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128 
gender, disability, and economically diverse 
populations. 
(B) PRIORITY
FOR
PARTNERSHIPS
WITH 
COMMUNITY ORGANIZATIONS AND AGENCIES.— 
In awarding grants under this subsection, the 
Secretary shall give priority to eligible entities 
that have a partnership with— 
(i) a community organization; or 
(ii) a consortia of community organi-
zations, State agencies, and local agencies, 
that has experience in providing language serv-
ices. 
(5) USE OF FUNDS FOR COMPETENT LANGUAGE 
SERVICES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (E), a grantee may only use grant funds 
received under this subsection to pay for the 
provision of competent language services to 
Medicare beneficiaries who are individuals with 
limited English proficiency. 
(B) COMPETENT LANGUAGE SERVICES DE-
FINED.—For purposes of this subsection, the 
term ‘‘competent language services’’ means— 
(i) interpreter and translation services 
that— 
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129 
(I) subject to the exceptions 
under subparagraph (C)— 
(aa) if the grantee operates 
in a State that has statewide 
health care interpreter standards, 
meet the State standards cur-
rently in effect; or 
(bb) if the grantee operates 
in a State that does not have 
statewide health care interpreter 
standards, utilizes competent in-
terpreters who follow the Na-
tional Council on Interpreting in 
Health Care’s Code of Ethics and 
Standards of Practice and com-
ply with the requirements of sec-
tion 1557 of the Patient Protec-
tion and Affordable Care Act (42 
U.S.C. 18116) as published in 
the Federal Register on May 18, 
2016; and 
(II) that, in the case of inter-
preter 
services, 
are 
provided 
through— 
(aa) onsite interpretation; 
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130 
(bb) telephonic interpreta-
tion; or 
(cc) 
video 
interpretation; 
and 
(ii) the direct provision of health care 
or health care-related services by a com-
petent bilingual health care provider. 
(C) EXCEPTIONS.—The requirements of 
subparagraph (B)(i)(I) do not apply, with re-
spect to interpreter and translation services and 
a grantee— 
(i) in the case of a Medicare bene-
ficiary who is limited English proficient, 
if— 
(I) such beneficiary has been in-
formed, in the beneficiary’s primary 
language, of the availability of free in-
terpreter and translation services and 
the beneficiary instead requests that a 
family member, friend, or other per-
son provide such services; and 
(II) the grantee documents such 
request in the beneficiary’s medical 
record; or 
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131 
(ii) in the case of a medical emergency 
where the delay directly associated with ob-
taining a competent interpreter or trans-
lation services would jeopardize the health 
of the patient. 
Clause (ii) shall not be construed to exempt 
emergency rooms or similar entities that regu-
larly provide health care services in medical 
emergencies to patients who are individuals 
with limited English proficiency from any appli-
cable legal or regulatory requirements related to 
providing competent interpreter and translation 
services without undue delay. 
(D) MEDICARE
ADVANTAGE
ORGANIZA-
TIONS AND PDP SPONSORS.—A grantee that is 
an MA organization or prescription drug spon-
sor must provide at least 50 percent of the 
grant funds that the grantee receives under this 
subsection directly to the entity’s network pro-
viders (including all health providers and phar-
macists) for the purpose of providing support 
for such providers to provide competent lan-
guage services to Medicare beneficiaries who are 
individuals with limited English proficiency. 
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132 
(E) ADMINISTRATIVE
AND
REPORTING 
COSTS.—A grantee may use up to 10 percent of 
the grant funds to pay for administrative costs 
associated with the provision of competent lan-
guage services and for reporting required under 
paragraph (9). 
(6) DETERMINATION
OF
AMOUNT
OF
GRANT 
PAYMENTS.— 
(A) IN GENERAL.—Payments to grantees 
under this subsection shall be calculated based 
on the estimated numbers of Medicare bene-
ficiaries who are limited English proficiency in 
a grantee’s service area utilizing— 
(i) data on the numbers of English 
learners who speak English less than ‘‘very 
well’’ from the most recently available data 
from the Bureau of the Census or other 
State-based study the Secretary determines 
likely to yield accurate data regarding the 
number of such individuals in such service 
area; or 
(ii) data provided by the grantee, if 
the grantee routinely collects data on the 
primary language of the Medicare bene-
ficiaries that the grantee serves and the 
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133 
Secretary determines that the data is accu-
rate and shows a greater number of indi-
viduals with limited English proficiency 
than would be estimated using the data 
under clause (i). 
(B) DISCRETION OF SECRETARY.—Subject 
to subparagraph (C), the amount of payment 
made to a grantee under this subsection may be 
modified annually at the discretion of the Sec-
retary, based on changes in the data under sub-
paragraph (A) with respect to the service area 
of a grantee for the year. 
(C) 
LIMITATION
ON
AMOUNT.—The 
amount of a grant made under this subsection 
to a grantee may not exceed $500,000 for the 
period under paragraph (1)(D). 
(7) ASSURANCES.—Grantees under this sub-
section shall, as a condition of receiving a grant 
under this subsection— 
(A) ensure that clinical and support staff 
receive appropriate ongoing education and 
training in linguistically appropriate service de-
livery; 
(B) ensure the linguistic competence of bi-
lingual providers; 
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134 
(C) offer and provide appropriate language 
services at no additional charge to each patient 
who is limited English proficient for all points 
of contact between the patient and the grantee, 
in a timely manner during all hours of oper-
ation; 
(D) notify Medicare beneficiaries of their 
right to receive language services in their pri-
mary language at least annually; 
(E) post signage in the primary languages 
commonly used by the patient population in the 
service area of the organization; and 
(F) ensure that— 
(i) primary language data are col-
lected for recipients of language services 
and such data are consistent with stand-
ards developed under title XXXIV of the 
Public Health Service Act, as added by 
section 2002 of this Act, to the extent such 
standards are available upon the initiation 
of the demonstration program; and 
(ii) consistent with the privacy protec-
tions provided under the regulations pro-
mulgated pursuant to section 264(c) of the 
Health Insurance Portability and Account-
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135 
ability Act of 1996 (42 U.S.C. 1320d–2 
note), if the recipient of language services 
is a minor or is incapacitated, primary lan-
guage data must also be collected on the 
parent or legal guardian of such recipient. 
(8) NO COST SHARING.—Medicare beneficiaries 
who are limited English proficient shall not have to 
pay cost sharing or co-payments for competent lan-
guage services provided under this demonstration 
program. 
(9) REPORTING
REQUIREMENTS
FOR
GRANT-
EES.—Not later than the end of each calendar year, 
a grantee that receives funds under this subsection 
in such year shall submit to the Secretary a report 
that includes the following information: 
(A) The number of Medicare beneficiaries 
to whom competent language services are pro-
vided, disaggregated by age and entitlement 
basis (on the basis of age, disability, or deter-
mination of end stage renal disease). 
(B) The primary languages of those Medi-
care beneficiaries. 
(C) The types of language services pro-
vided to such beneficiaries. 
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136 
(D) Whether such language services were 
provided by employees of the grantee or 
through a contract with external contractors or 
agencies. 
(E) The types of interpretation services 
provided to such beneficiaries, and the approxi-
mate length of time such service is provided to 
such beneficiaries. 
(F) The costs of providing competent lan-
guage services. 
(G) An account of the training or accredi-
tation of bilingual staff, interpreters, and trans-
lators providing services funded by the grant 
under this subsection. 
(10) EVALUATION
AND
REPORT
TO
CON-
GRESS.—Not later than 1 year after the completion 
of a 3-year grant under this subsection, the Sec-
retary shall conduct an evaluation of the demonstra-
tion program under this subsection and shall submit 
to the Congress a report that includes the following: 
(A) An analysis of the patient outcomes 
and the costs of furnishing care to the Medicare 
beneficiaries who are individuals with limited 
English proficiency participating in the project 
as compared to such outcomes and costs for 
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137 
such Medicare beneficiaries not participating, 
based on the data provided under paragraph (9) 
and any other information available to the Sec-
retary. 
(B) The effect of delivering language serv-
ices on— 
(i) Medicare beneficiary access to care 
and utilization of services; 
(ii) the efficiency and cost effective-
ness of health care delivery; 
(iii) patient satisfaction with respect 
to both health service delivery and lan-
guage assistance; 
(iv) health outcomes; and 
(v) the provision of culturally appro-
priate services provided to such bene-
ficiaries. 
(C) The extent to which bilingual staff, in-
terpreters, and translators providing services 
under such demonstration were trained or ac-
credited and the nature of accreditation or 
training needed by type of provider, service, or 
other category as determined by the Secretary 
to ensure the provision of high-quality interpre-
tation, translation, or other language services to 
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138 
Medicare beneficiaries if such services are ex-
panded pursuant to section 1115A(c) of the So-
cial Security Act (42 U.S.C. 1315a(c)). 
(D) Recommendations, if any, regarding 
the extension of such project to the entire Medi-
care Program, subject to the provisions of such 
section 1115A(c). 
(11) APPROPRIATIONS.—There is appropriated 
to carry out this subsection, in equal parts from the 
Federal Hospital Insurance Trust Fund under sec-
tion 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical In-
surance Trust Fund under section 1841 of such Act 
(42 U.S.C. 1395t), $16,000,000 for each fiscal year 
of the demonstration program. 
(12) 
LIMITED
ENGLISH
PROFICIENT
DE-
FINED.—In this subsection, the term ‘‘limited 
English proficient’’ refers to individuals who self- 
identify on the Census as speaking English less than 
‘‘very well’’. 
(b) LANGUAGE ASSISTANCE SERVICES UNDER THE 
MEDICARE PROGRAM.— 
(1) INCLUSION
AS
RURAL
HEALTH
CLINIC 
SERVICES.—Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended— 
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139 
(A) in subsection (aa)(1)— 
(i) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(ii) by adding ‘‘and’’ at the end of 
subparagraph (C); and 
(iii) by inserting after subparagraph 
(C) the following new subparagraph: 
‘‘(D) language assistance services as defined in 
subsection (lll),’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Language Assistance Services and Related Terms 
‘‘(lll) The term ‘language assistance services’ means 
‘language access’ or ‘language assistance services’ (as 
those terms are defined in section 3400 of the Public 
Health Service Act) furnished by a ‘qualified interpreter 
for an individual with limited English proficiency’ or a 
‘qualified translator’ (as those terms are defined in such 
section 3400) to an ‘individual with limited English pro-
ficiency’ (as defined in such section 3400).’’. 
(2) COVERAGE.—Section 1832(a)(2) of the So-
cial Security Act (42 U.S.C. 1395k(a)(2)) is amend-
ed— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (I); 
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140 
(B) by striking the period at the end of 
subparagraph (J) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) language assistance services (as de-
fined in section 1861(lll)).’’. 
(3) PAYMENT.—Section 1833(a) of the Social 
Security Act (42 U.S.C. 1395l(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (9); 
(B) by striking the period at the end of 
paragraph (10) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (10) the 
following new paragraph: 
‘‘(11) in the case of language assistance serv-
ices (as defined in section 1861(lll)), 100 percent of 
the reasonable charges for such services, as deter-
mined in consultation with the Medicare Payment 
Advisory Commission.’’. 
(4) WAIVER
OF
BUDGET
NEUTRALITY.—For 
the 3-year period beginning on the date of enact-
ment of this section, the budget neutrality provision 
of section 1848(c)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 
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141 
apply with respect to language assistance services 
(as defined in section 1861(lll) of such Act). 
(c) MEDICARE PARTS C AND D.— 
(1) IN GENERAL.—Medicare Advantage plans 
under part C of title XVIII of the Social Security 
Act (42 U.S.C. 1395w–21 et seq.) and prescription 
drug plans under part D of such title (42 U.S.C. 
1395q–101) shall comply with title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 
section 1557 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18116) to provide effective 
language services to enrollees of such plans. 
(2) MEDICARE
ADVANTAGE
PLANS
AND
PRE-
SCRIPTION
DRUG
PLANS
REPORTING
REQUIRE-
MENT.—Section 1857(e) of the Social Security Act 
(42 U.S.C. 1395w–27(e)) is amended by adding at 
the end the following new paragraph: 
‘‘(6) REPORTING REQUIREMENTS RELATING TO 
EFFECTIVE LANGUAGE SERVICES.—A contract under 
this part shall require a Medicare Advantage organi-
zation (and, through application of section 1860D– 
12(b)(3)(D), a contract under section 1860D–12 
shall require a PDP sponsor) to annually submit 
(for each year of the contract) a report that contains 
information on the internal policies and procedures 
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142 
of the organization (or sponsor) related to recruit-
ment and retention efforts directed to workforce di-
versity and linguistically and culturally appropriate 
provision of services in each of the following con-
texts: 
‘‘(A) The collection of data in a manner 
that meets the requirements of title I of the 
Health Equity and Accountability Act of 2022, 
regarding the enrollee population. 
‘‘(B) Education of staff and contractors 
who have routine contact with enrollees regard-
ing the various needs of the diverse enrollee 
population. 
‘‘(C) Evaluation of the language services 
programs and services offered by the organiza-
tion (or sponsor) with respect to the enrollee 
population, such as through analysis of com-
plaints or satisfaction survey results. 
‘‘(D) Methods by which the plan provides 
to the Secretary information regarding the eth-
nic diversity of the enrollee population. 
‘‘(E) The periodic provision of educational 
information to plan enrollees on the language 
services and programs offered by the organiza-
tion (or sponsor).’’. 
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143 
(d) IMPROVING LANGUAGE SERVICES IN MEDICAID 
AND CHIP.— 
(1) 
PAYMENTS
TO
STATES.—Section 
1903(a)(2)(E) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(E)), as amended by section 2005(h)(3), 
is further amended by— 
(A) striking ‘‘75’’ and inserting ‘‘95’’; 
(B) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language assistance 
services’’; and 
(C) striking ‘‘children of families’’ and in-
serting ‘‘individuals’’. 
(2) STATE
PLAN
REQUIREMENTS.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended by striking 
‘‘and (30)’’ and inserting ‘‘(30), and (31)’’. 
(3) DEFINITION
OF
MEDICAL
ASSISTANCE.— 
Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended— 
(A) in paragraph (29), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (31) as 
paragraph (32); and 
(C) by inserting after paragraph (30) the 
following new paragraph: 
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144 
‘‘(31) language assistance services, as such 
term is defined in section 1861(lll), provided in a 
timely manner to individuals with limited English 
proficiency as defined in section 3400 of the Public 
Health Service Act; and’’. 
(4) USE
OF
DEDUCTIONS
AND
COST
SHAR-
ING.—Section 1916(a)(2) of the Social Security Act 
(42 U.S.C. 1396o(a)(2)) is amended— 
(A) in subparagraph (G), by inserting at 
the end ‘‘, and’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(H) language assistance services de-
scribed in section 1905(a)(31);’’. 
(5) CHIP COVERAGE REQUIREMENTS.—Section 
2103 of the Social Security Act (42 U.S.C. 1397cc) 
is amended— 
(A) in subsection (a), in the matter before 
paragraph (1), by striking ‘‘(7), and (8)’’ and 
inserting ‘‘(7), (8), (9), (10), (11), and (12)’’; 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(12) LANGUAGE ASSISTANCE SERVICES.—The 
child health assistance provided to a targeted low-in-
come child shall include coverage of language assist-
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145 
ance services, as such term is defined in section 
1861(l), provided in a timely manner to individuals 
with limited English proficiency (as defined in sec-
tion 3400 of the Public Health Service Act).’’; and 
(C) in subsection (e)(2)— 
(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
(ii) by inserting ‘‘language assistance 
services described in subsection (c)(12),’’ 
before ‘‘visits described in’’. 
(6) DEFINITION
OF
CHILD
HEALTH
ASSIST-
ANCE.—Section 2110(a)(27) of the Social Security 
Act (42 U.S.C. 1397jj(a)(27)) is amended by strik-
ing ‘‘translation’’ and inserting ‘‘language assistance 
services as described in section 2103(c)(12)’’. 
(7) STATE
DATA
COLLECTION.—Pursuant to 
the reporting requirement described in section 
2107(b)(1) of the Social Security Act (42 U.S.C. 
1397gg(b)(1)), the Secretary of Health and Human 
Services shall require that States collect data on— 
(A) the primary language of individuals re-
ceiving child health assistance under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.); and 
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146 
(B) in the case of such individuals who are 
minors or incapacitated, the primary language 
of the individual’s parent or guardian. 
(8) CHIP PAYMENTS
TO
STATES.—Section 
2105 of the Social Security Act (42 U.S.C. 1397ee) 
is amended— 
(A) in subsection (a)(1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘75’’ and inserting 
‘‘95’’; and 
(ii) in subparagraph (D)(iv), by strik-
ing ‘‘translation or interpretation services’’ 
and inserting ‘‘language assistance serv-
ices’’; and 
(B) in subsection (c)(2)(A), by inserting 
before the period at the end the following: ‘‘, 
except that expenditures pursuant to clause (iv) 
of subparagraph (D) of such paragraph shall 
not count towards this total’’. 
(e) FUNDING
LANGUAGE
ASSISTANCE
SERVICES 
FURNISHED
BY PROVIDERS
OF HEALTH CARE
AND 
HEALTH CARE-RELATED SERVICES THAT SERVE HIGH 
RATES OF UNINSURED LEP INDIVIDUALS.— 
(1) PAYMENT OF COSTS.— 
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147 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services (referred to in this subsection as the 
‘‘Secretary’’) shall make payments (on a quar-
terly basis) directly to eligible entities to sup-
port the provision of language assistance serv-
ices to individuals with limited English pro-
ficiency in an amount equal to an eligible enti-
ty’s eligible costs for providing such services for 
the quarter. 
(B) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there are 
appropriated to the Secretary of Health and 
Human Services such sums as may be nec-
essary for each of fiscal years 2022 through 
2026. 
(C) RELATION TO MEDICAID DSH.—Pay-
ments under this subsection shall not offset or 
reduce payments under section 1923 of the So-
cial Security Act (42 U.S.C. 1396r–4), nor 
shall payments under such section be consid-
ered when determining uncompensated costs as-
sociated with the provision of language assist-
ance services for the purposes of this section. 
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148 
(2) 
METHODOLOGY
FOR
PAYMENT
OF 
CLAIMS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a methodology to determine the average 
per person cost of language assistance services. 
(B) 
DIFFERENT
ENTITIES.—In 
estab-
lishing such methodology, the Secretary may es-
tablish different methodologies for different 
types of eligible entities. 
(C) NO
INDIVIDUAL
CLAIMS.—The Sec-
retary may not require eligible entities to sub-
mit individual claims for language assistance 
services for individual patients as a requirement 
for payment under this subsection. 
(3) DATA COLLECTION INSTRUMENT.—For pur-
poses of this subsection, the Secretary shall create a 
standard data collection instrument that is con-
sistent with any existing reporting requirements by 
the Secretary or relevant accrediting organizations 
regarding the number of individuals to whom lan-
guage access is provided. 
(4) GUIDELINES.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary shall establish and distribute guidelines con-
cerning the implementation of this subsection. 
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149 
(5) REPORTING REQUIREMENTS.— 
(A) REPORT TO SECRETARY.—Entities re-
ceiving payment under this subsection shall pro-
vide the Secretary with a quarterly report on 
how the entity used such funds. Such report 
shall contain aggregate (and may not contain 
individualized) data collected using the instru-
ment under paragraph (3) and shall otherwise 
be in a form and manner determined by the 
Secretary. 
(B) REPORT
TO
CONGRESS.—Not later 
than 2 years after the date of enactment of this 
Act, and every 2 years thereafter, the Secretary 
shall submit a report to Congress concerning 
the implementation of this subsection. 
(6) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE COSTS.—The term ‘‘eligible 
costs’’ means, with respect to an eligible entity 
that provides language assistance services to 
limited English proficient individuals, the prod-
uct of— 
(i) the average per person cost of lan-
guage assistance services, determined ac-
cording to the methodology devised under 
paragraph (2); and 
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150 
(ii) the number individuals with lim-
ited English proficiency who are provided 
language assistance services by the entity 
and for whom no reimbursement is avail-
able for such services under the amend-
ments made by subsection (a), (b), (c), or 
(d) or by private health insurance. 
(B) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means an entity that— 
(i) is a Medicaid provider that is— 
(I) a physician; 
(II) a hospital with a low-income 
utilization rate (as defined in section 
1923(b)(3) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(3))) of greater 
than 25 percent; 
(III) a federally qualified health 
center 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
(IV) a hospice provider; or 
(V) a palliative care provider; 
(ii) not later than 6 months after the 
date of the enactment of this Act, provides 
language assistance services to not less 
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151 
than 8 percent of the entity’s total number 
of patients; and 
(iii) prepares and submits an applica-
tion to the Secretary, at such time, in such 
manner, and accompanied by such infor-
mation as the Secretary may require, to 
ascertain the entity’s eligibility for funding 
under this subsection. 
(C) LANGUAGE
ASSISTANCE
SERVICES.— 
The term ‘‘language assistance services’’ has 
the meaning given such term in section 
1861(kkk)(1) of the Social Security Act, as 
added by subsection (b). 
(f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 
SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 
OTHER LAWS.—Nothing in this section shall be construed 
to limit otherwise existing obligations of recipients of Fed-
eral financial assistance under title VI of the Civil Rights 
Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 
the Affordable Care Act, or other laws that protect the 
civil rights of individuals. 
(g) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided and subject to paragraph (2), the amendments 
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152 
made by this section shall take effect on January 1, 
2023. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) or a State plan for child 
health assistance under title XXI of such Act (42 
U.S.C. 1397aa et seq.) which the Secretary of 
Health and Human Services determines requires 
State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirement imposed by the amendments 
made by this section, such State plan shall not be 
regarded as failing to comply with the requirements 
of such title solely on the basis of its failure to meet 
this additional requirement before the first day of 
the first calendar quarter beginning after the close 
of the first regular session of the State legislature 
that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a 
separate regular session of the State legislature. 
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153 
SEC. 2008. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, in consultation 
with the Director of the National Institute on Minority 
Health and Health Disparities and the Deputy Assistant 
Secretary for Minority Health, shall award grants to eligi-
ble entities to improve health care for patient populations 
that have low health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may rea-
sonably require. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—A grant under subsection (a) that is 
awarded through the Director of the Agency for 
Healthcare Research and Quality shall be used— 
(A) to define and increase the under-
standing of health literacy across all areas of 
health care, including end of life care; 
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154 
(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
(D) for any other activity determined ap-
propriate by the Director. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—A grant under subsection (a) that is 
awarded through the Administrator of the Health 
Resources and Services Administration shall be used 
to conduct demonstration projects for interventions 
for patients with low health literacy that may in-
clude— 
(A) the development of new disease man-
agement and end of life care programs for pa-
tients with low health literacy; 
(B) the tailoring of disease management 
programs and end of life care addressing men-
tal, physical, oral, and behavioral health condi-
tions for patients with low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
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155 
(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; 
(F) the conduct of educational campaigns 
concerning health directed specifically at pa-
tients with mental disabilities, including those 
with cognitive and intellectual disabilities, de-
signed to reduce the incidence of low health lit-
eracy among these populations, which shall 
have instructional materials in the plain lan-
guage standards promulgated under the Plain 
Writing Act of 2010 (5 U.S.C. 301 note) for 
Federal agencies; and 
(G) other activities determined appropriate 
by the Administrator. 
(d) DEFINITIONS.—In this section: 
(1) LOW HEALTH LITERACY.—The term ‘‘low 
health literacy’’ means the inability of an individual 
to obtain, process, and understand basic health in-
formation and services needed to make appropriate 
health decisions. 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services— 
(A) acting through the Director of the 
Agency for Healthcare Research and Quality, 
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156 
with respect to grants under subsection (c)(1); 
and 
(B) acting through the Administrator of 
the Health Resources and Services Administra-
tion with respect to grants under subsection 
(c)(2). 
(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 
2023 through 2027. 
SEC. 2009. REQUIREMENTS FOR HEALTH PROGRAMS OR 
ACTIVITIES RECEIVING FEDERAL FUNDS. 
(a) COVERED ENTITY; COVERED PROGRAM OR AC-
TIVITY.—In this section— 
(1) the term ‘‘covered entity’’ has the meaning 
given such term in section 92.4 of title 45, Code of 
Federal Regulations, as in effect on May 18, 2016 
(81 Fed. Reg. 31466); and 
(2) the term ‘‘health program or activity’’ has 
the meaning given such term in section 92.4 of title 
45, Code of Federal Regulations, as in effect on May 
18, 2016 (81 Fed. Reg. 31466). 
(b) REQUIREMENTS.—A covered entity, in order to 
ensure the right of individuals with limited English pro-
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157 
ficiency to receive access to high-quality health care 
through the covered program or activity, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in cul-
turally and linguistically appropriate service delivery 
at least annually; 
(2) offer and provide appropriate language as-
sistance services at no additional charge to each pa-
tient that is an individual with limited English pro-
ficiency at all points of contact, in a timely manner 
during all hours of operation; 
(3) notify patients of their right to receive lan-
guage services in their primary language; and 
(4) utilize only qualified interpreters for an in-
dividual with limited English proficiency or qualified 
translators, except as provided in subsection (c). 
(c) EXEMPTIONS.—The requirements of subsection 
(b)(4) shall not apply as follows: 
(1) When a patient requests the use of family, 
friends, or other persons untrained in interpretation 
or translation if each of the following conditions are 
met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
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158 
(B) The covered entity informs the patient 
in the primary language of the patient that he 
or she has the option of having the entity pro-
vide to the patient an interpreter and trans-
lation services without charge. 
(C) The covered entity informs the patient 
that the entity may not require an individual 
with a limited English proficiency to use a fam-
ily member or friend as an interpreter. 
(D) The covered entity evaluates whether 
the person the patient wishes to use as an in-
terpreter is competent. If the covered entity has 
reason to believe that such person is not com-
petent as an interpreter, the entity provides its 
own interpreter to protect the covered entity 
from liability if the patient’s interpreter is later 
found not competent. 
(E) If the covered entity has reason to be-
lieve that there is a conflict of interest between 
the interpreter and patient, the covered entity 
may not use the patient’s interpreter. 
(F) The covered entity has the patient sign 
a waiver, witnessed by at least 1 individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
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159 
(E) and is translated into the patient’s primary 
language. 
(2) When a medical emergency exists and the 
delay directly associated with obtaining competent 
interpreter or translation services would jeopardize 
the health of the patient, but only until a competent 
interpreter or translation service is available. 
(d) RULE
OF CONSTRUCTION.—Subsection (c)(2) 
shall not be construed to mean that emergency rooms or 
similar entities that regularly provide health care services 
in medical emergencies are exempt from legal or regu-
latory requirements related to competent interpreter serv-
ices. 
SEC. 2010. REPORT ON FEDERAL EFFORTS TO PROVIDE 
CULTURALLY AND LINGUISTICALLY APPRO-
PRIATE HEALTH CARE SERVICES. 
(a) REPORT.—Not later than 1 year after the date 
of enactment of this Act, and annually thereafter, the Sec-
retary of Health and Human Services shall enter into a 
contract with the National Academy of Medicine for the 
preparation and publication of a report that describes 
Federal efforts to ensure that all individuals with limited 
English proficiency have meaningful access to health care 
services and health care-related services that are culturally 
and linguistically appropriate. Such report shall include— 
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(1) a description and evaluation of the activities 
carried out under this Act; 
(2) a description and analysis of best practices, 
model programs, guidelines, and other effective 
strategies for providing access to culturally and lin-
guistically appropriate health care services; 
(3) recommendations on the development and 
implementation of policies and practices by providers 
of health care services and health care-related serv-
ices for individuals with limited English proficiency, 
including people with cognitive, hearing, vision, or 
print impairments; 
(4) recommend guidelines or standards for 
health literacy and plain language, informed consent, 
discharge instructions, and written communications, 
and for improvement of health care access; 
(5) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(6) a description of the costs associated with or 
savings related to the provision of language services. 
(b) 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 
2023 through 2027. 
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161 
SEC. 2011. ENGLISH INSTRUCTION FOR INDIVIDUALS WITH 
LIMITED ENGLISH PROFICIENCY. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to eligible entities 
for the provision of English as a second language (in this 
section referred to as ‘‘ESL’’) instruction to individuals 
with limited English proficiency, including health care-re-
lated English instruction, and shall determine, after con-
sultation with appropriate stakeholders, the mechanism 
for administering and distributing such grants. 
(b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
igible entity’’ means— 
(1) a State; or 
(2) a community-based organization that pre-
dominantly employs and serves racial and ethnic mi-
nority groups (as defined in section 1707(g) of the 
Public Health Service Act (42 U.S.C. 300u–6(g)). 
(c) APPLICATION.—An eligible entity that desires to 
receive a grant under this section shall apply by submit-
ting to the Secretary of Education an application at such 
time, in such manner, and containing such information as 
the Secretary may require. 
(d) USE OF GRANT.—An eligible entity shall use 
grant funds provided under this section to— 
(1) develop and implement a plan for assuring 
the availability of ESL instruction, free of charge, to 
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162 
the community served by the eligible entity, that ef-
fectively integrates information about the nature of 
the United States health care system, how to access 
care, and any special language skills that may be re-
quired for individuals with limited English pro-
ficiency to access and regularly negotiate the health 
care system effectively; 
(2) develop a plan for making ESL instruction 
available free to charge to individuals with limited 
English proficiency in the community served by the 
eligible entity who are seeking instruction, including, 
where appropriate, through the use of public-private 
partnerships; and 
(3) provide ESL instruction to individuals with 
limited English proficiency in the community served 
by the eligible entity. 
(e) SUPPLEMENT, NOT SUPPLANT.—An eligible enti-
ty awarded a grant under this section shall use funds 
made available under this section to supplement, and not 
supplant, other Federal, State, and local funds that would 
otherwise be expended to carry out activities under this 
section. 
(f) DUTIES OF THE SECRETARY.—The Secretary of 
Education shall— 
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163 
(1) collect and make publicly available annual 
data on how much Federal, State, and local govern-
ments spend annually on ESL instruction; 
(2) collect data from eligible entities awarded a 
grant under this section to identify the unmet needs 
of individuals with limited English proficiency for 
appropriate ESL instruction, including— 
(A) the preferred written and spoken lan-
guage of such individuals; 
(B) the availability of enrollment in ESL 
instruction programs in the communities served 
by each eligible entity awarded a grant under 
this section, including the extent of waiting lists 
for ESL instruction, how many programs main-
tain waiting lists, and, for programs that do not 
have waiting lists, the reasons why such a list 
is unnecessary or otherwise not maintained; 
(C) the availability of programs to geo-
graphically isolated communities; 
(D) the impact of course enrollment poli-
cies, including open enrollment, on the avail-
ability of ESL instruction; 
(E) the number of individuals with limited 
English proficiency and the number of individ-
uals enrolled in ESL instruction programs in 
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191 
Administration and in consultation with the Secretary of 
Education, shall award grants to Hispanic-serving institu-
tions, historically Black colleges and universities, histori-
cally Black professional or graduate institutions eligible 
for grants under section 326 of the Higher Education Act 
of 1965, Asian American and Native American Pacific Is-
lander-serving institutions, Tribal Colleges or Universities, 
regional community-based organizations, and national mi-
nority medical associations, for counseling, mentoring, and 
providing information on financial assistance to prepare 
underrepresented minority individuals to enroll in and 
graduate from health professional schools and to increase 
services for underrepresented minority students includ-
ing— 
‘‘(1) mentoring with underrepresented health 
professionals; 
‘‘(2) providing financial assistance information 
for continued education and applications to health 
professional schools; and 
‘‘(3) retaining existing enrolled underrep-
resented minority students in a health professions 
school. 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) ASIAN AMERICAN AND NATIVE AMERICAN 
PACIFIC
ISLANDER-SERVING
INSTITUTION.—The 
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1002 
SEC. 5724. CHILD CARE AND DEVELOPMENT BLOCK GRANT. 
Section 658O(b) of the Child Care and Development 
Block Grant Act of 1990 (42 U.S.C. 9858m(b)) is amend-
ed— 
(1) in paragraph (1)(B), by striking ‘‘school 
lunch factor’’ and inserting ‘‘identified students fac-
tor’’; and 
(2) by striking paragraph (3) and inserting the 
following: 
‘‘(3) IDENTIFIED
STUDENTS
FACTOR.—The 
term ‘identified students factor’ means the ratio of 
the number of children in the State who are identi-
fied students (as defined in paragraph (8) of section 
1113(a) of the Elementary and Secondary Edu-
cation Act of 1965 (20 U.S.C. 6313(a))) to the 
number of such children in all the States as deter-
mined annually by the Secretary of Education.’’. 
SEC. 5725. CHILDREN’S HEALTH ACT OF 2000. 
Section 1404(b) of the Children’s Health Act of 2000 
(42 U.S.C. 9859c(b)) is amended— 
(1) in paragraph (1)(B), by striking ‘‘school 
lunch factor’’ and inserting ‘‘identified students fac-
tor’’; and 
(2) by amending paragraph (3) to read as fol-
lows: 
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