162 
‘‘(1) are from disadvantaged backgrounds; 
‘‘(2) have secured admissions to a minority- 
serving institution; and 
‘‘(3) have identified a health professional as a 
mentor at their school or institution and an aca-
demic advisor to assist in the completion of their 
baccalaureate degree. 
‘‘(e) SCHOLARSHIPS.—The Secretary may approve 
payment of scholarships under this section for such indi-
viduals for any period of education in student under-
graduate tenure, except that such a scholarship may not 
be provided to an individual for more than 4 years, and 
such scholarships may not exceed $10,000 per academic 
year (notwithstanding any other provision of law regard-
ing the amount of scholarship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2012 through 2017. 
‘‘SEC. 3420A. PATSY MINK HEALTH AND GENDER RESEARCH 
FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Deputy Assistant Secretary for Minority Health, the Ad-
ministrator of the Substance Abuse and Mental Health 
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Services Administration, and the Director of the Indian 
Health Services, shall award research fellowships to post- 
baccalaureate students to conduct research that will exam-
ine gender and health disparities and to pursue a career 
in the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall— 
‘‘(1) have experience in health research or pub-
lic health practice; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) have expressed an interest in the health 
professions; 
‘‘(4) demonstrate promise for becoming a leader 
in the field of women’s health; 
‘‘(5) secure admission to a health professions 
school or graduate program with an emphasis in 
gender studies; 
‘‘(6) comply with subsection (f); and 
‘‘(7) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become researchers and advance 
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the research base on the intersection between gender and 
health. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
trol and Prevention shall give priority to those applicants 
that— 
‘‘(1) are from disadvantaged backgrounds; and 
‘‘(2) have identified a mentor and academic ad-
visor who will assist in the completion of their grad-
uate or professional degree and have secured a re-
search assistant position with a researcher working 
in the area of gender and health. 
‘‘(e) FELLOWSHIPS.—The Director of the Centers for 
Disease Control and Prevention may approve fellowships 
for individuals under this section for any period of edu-
cation in the student’s graduate or health profession ten-
ure, except that such a fellowship may not be provided 
to an individual for more than 3 years, and such a fellow-
ship may not exceed $18,000 per academic year (notwith-
standing any other provision of law regarding the amount 
of fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2012 through 2017. 
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‘‘SEC. 3420B. PAUL DAVID WELLSTONE INTERNATIONAL 
HEALTH FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
the Deputy Assistant Secretary for Minority Health, shall 
award research fellowships to college students or recent 
graduates to advance their understanding of international 
health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall— 
‘‘(1) have educational experience in the field of 
international health; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) demonstrate promise for becoming a leader 
in the field of international health; 
‘‘(4) be a college senior or recent graduate of 
a four-year higher education institution; 
‘‘(5) comply with subsection (f); and 
‘‘(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become health professionals and 
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to advance their knowledge about international issues re-
lating to health care access and quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those appli-
cants that— 
‘‘(1) are from a disadvantaged background; and 
‘‘(2) have identified a mentor at a health pro-
fessions school or institution, an academic advisor to 
assist in the completion of their graduate or profes-
sional degree, and an advisor from an international 
health non-governmental organization, private volun-
teer organization, or other international institution 
or program that focuses on increasing health care 
access and quality for residents in developing coun-
tries. 
‘‘(e) FELLOWSHIPS.—The Secretary shall approve 
fellowships for college seniors or recent graduates, except 
that such a fellowship may not be provided to an indi-
vidual for more than 6 months, may not be awarded to 
a graduate that has not been enrolled in school for more 
than 1 year, and may not exceed $4,000 per academic year 
(notwithstanding any other provision of law regarding the 
amount of fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
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such sums as may be necessary for each of fiscal years 
2012 through 2017. 
‘‘SEC. 3420C. EDWARD R. ROYBAL HEALTH CARE SCHOLAR 
PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, the Director of the Cen-
ters for Medicaid & Medicare, and the Administrator for 
Health Resources and Services Administration, in collabo-
ration with the Deputy Assistant Secretary for Minority 
Health, shall award grants to eligible entities to expose 
entering graduate students to the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall— 
‘‘(1) be a clinical, public health or health serv-
ices organization, community-based or nonprofit en-
tity, or other entity determined appropriate by the 
Director of the Agency for Healthcare Research and 
Quality; 
‘‘(2) serve in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) work with students obtaining a degree in 
the health professions; and 
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
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‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
port opportunities that expose students to non-research- 
based health professions, including— 
‘‘(1) public health policy; 
‘‘(2) health care and pharmaceutical policy; 
‘‘(3) health care administration and manage-
ment; 
‘‘(4) health economics; and 
‘‘(5) other professions determined appropriate 
by the Director of the Agency for Healthcare Re-
search and Quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Agency for Healthcare Re-
search and Quality shall give priority to those entities 
that— 
‘‘(1) have experience with health disparity elimi-
nation programs; 
‘‘(2) facilitate training in the fields described in 
subsection (c); and 
‘‘(3) provide counseling or other services de-
signed to assist such individuals in successfully com-
pleting their education at the postsecondary level. 
‘‘(e) STIPENDS.—The Secretary may approve the 
payment of stipends for individuals under this section for 
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any period of education in student-enhancement programs 
(other than regular courses) at health professions schools 
or entities, except that such a stipend may not be provided 
to an individual for more than 2 months, and such a sti-
pend may not exceed $100 per day (notwithstanding any 
other provision of law regarding the amount of stipends). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2012 through 2017.’’. 
SEC. 307. ADVISORY COMMITTEE ON HEALTH PROFES-
SIONS TRAINING FOR DIVERSITY. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall establish an advisory committee to be known 
as the Advisory Committee on Health Professions Train-
ing for Diversity (in this section referred to as the ‘‘Advi-
sory Committee’’). 
(b) COMPOSITION.— 
(1) IN GENERAL.—The Secretary shall deter-
mine the appropriate number of individuals to serve 
on the Advisory Committee. Such individuals shall 
not be officers or employees of the Federal Govern-
ment. 
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(2) APPOINTMENT.—Not later than 60 days 
after the date of enactment of this section, the Sec-
retary shall appoint the members of the Advisory 
Committee from among individuals who are health 
professionals. In making such appointments, the 
Secretary shall ensure a fair balance between the 
health professions, that at least 75 percent of the 
members of the Advisory Committee are health pro-
fessionals, a broad geographic representation of 
members and a balance between urban and rural 
members. Members shall be appointed based on their 
competence, interest, and knowledge of the mission 
of the profession involved. 
(3) MINORITY REPRESENTATION.—In appoint-
ing the members of the Advisory Committee under 
paragraph (2), the Secretary shall ensure the ade-
quate representation of women and minorities. 
(c) TERMS.— 
(1) IN GENERAL.—A member of the Advisory 
Committee shall be appointed for a term of 3 years, 
except that of the members first appointed— 
(A) 1⁄3 of such members shall serve for a 
term of 1 year; 
(B) 1⁄3 of such members shall serve for a 
term of 2 years; and 
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(C) 1⁄3 of such members shall serve for a 
term of 3 years. 
(2) VACANCIES.— 
(A) IN GENERAL.—A vacancy on the Advi-
sory Committee shall be filled in the manner in 
which the original appointment was made and 
shall be subject to any conditions which applied 
with respect to the original appointment. 
(B) FILLING UNEXPIRED TERM.—An indi-
vidual chosen to fill a vacancy shall be ap-
pointed for the unexpired term of the member 
replaced. 
(d) DUTIES.— 
(1) IN
GENERAL.—The Advisory Committee 
shall— 
(A) provide advice and recommendations to 
the Secretary concerning policy and program 
development and other matters of significance 
concerning activities under this part; and 
(B) not later than 2 years after the date 
of enactment of this section, and annually 
thereafter, prepare and submit to the Secretary, 
and the Committee on Health, Education, 
Labor, and Pensions of the Senate, and the 
Committee on Energy and Commerce of the 
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House of Representatives, a report describing 
the activities of the Committee. 
(2) CONSULTATION WITH STUDENTS.—In car-
rying out duties under paragraph (1), the Advisory 
Committee shall consult with individuals who are at-
tending health professions schools with which this 
part is concerned. 
(e) MEETINGS AND DOCUMENTS.— 
(1) MEETINGS.—The Advisory Committee shall 
meet not less than 2 times each year. Such meetings 
shall be held jointly with other related entities estab-
lished under this title where appropriate. 
(2) DOCUMENTS.—Not later than 14 days prior 
to the convening of a meeting under paragraph (1), 
the Advisory Committee shall prepare and make 
available an agenda of the matters to be considered 
by the Advisory Committee at such meeting. At any 
such meeting, the Advisory Committee shall dis-
tribute materials with respect to the issues to be ad-
dressed at the meeting. Not later than 30 days after 
the adjourning of such a meeting, the Advisory Com-
mittee shall prepare and make available a summary 
of the meeting and any actions taken by the Com-
mittee based upon the meeting. 
(f) COMPENSATION AND EXPENSES.— 
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(1) COMPENSATION.—Each member of the Ad-
visory Committee shall be compensated at a rate 
equal to the daily equivalent of the annual rate of 
basic pay prescribed for level IV of the Executive 
Schedule under section 5315 of title 5, United 
States Code, for each day (including travel time) 
during which such member is engaged in the per-
formance of the duties of the Committee. 
(2) EXPENSES.—The members of the Advisory 
Committee shall be allowed travel expenses, includ-
ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business 
in the performance of services for the Committee. 
(g) FACA.—The Federal Advisory Committee Act 
shall apply to the Advisory Committee under this section 
only to the extent that the provisions of such Act do not 
conflict with the requirements of this section. 
SEC. 308. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 
PROGRAM. 
Section 402E of the Higher Education Act of 1965 
(20 U.S.C. 1070a–15) is amended by striking subsection 
(g) and inserting the following: 
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‘‘(g) COLLABORATION IN HEALTH PROFESSION DI-
VERSITY TRAINING PROGRAMS.—The Secretary shall co-
ordinate with the Secretary of Health and Human Serv-
ices to ensure that there is collaboration between the goals 
of the program under this section and programs of the 
Health Resources and Services Administration that pro-
mote health workforce diversity. The Secretary of Edu-
cation shall take such measures as may be necessary to 
encourage participants in programs under this section to 
consider health profession careers. 
‘‘(h) FUNDING.—From amounts appropriated pursu-
ant to the authority of section 402A(g), the Secretary 
shall, to the extent practicable, allocate funds for projects 
authorized by this section in an amount which is not less 
than $31,000,000 for each of the fiscal years 2012 
through 2018.’’. 
SEC. 309. RULES FOR DETERMINATION OF FULL-TIME 
EQUIVALENT RESIDENTS FOR COST REPORT-
ING PERIODS. 
(a) DGME DETERMINATIONS.—Section 1886(h)(4) 
of the Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) 
is amended— 
(1) in subparagraph (E), by striking ‘‘Subject 
to subparagraphs (J) and (K), such rules’’ and in-
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serting ‘‘Subject to subparagraphs (J), (K), and (L), 
such rules’’; 
(2) in subparagraph (J), by striking ‘‘Such 
rules’’ and inserting ‘‘Subject to subparagraph (L), 
such rules’’; 
(3) in subparagraph (K), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subparagraph 
(L), in determining’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(L) For purposes of cost-reporting peri-
ods beginning on or after October 1, 2011, in 
determining the hospital’s number of full-time 
equivalent residents for purposes of this sub-
paragraph, all the time spent by an intern or 
resident in an approved medical residency train-
ing program shall be counted toward the deter-
mination of full-time equivalency if the hos-
pital— 
‘‘(i) is recognized as a subsection (d) 
hospital; 
‘‘(ii) is recognized as a subsection (d) 
Puerto Rico hospital; 
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‘‘(iii) is reimbursed under a reim-
bursement system authorized under section 
1814(b)(3); or 
‘‘(iv) is a provider-based hospital out-
patient department.’’. 
(b) IME DETERMINATIONS.—Section 1886(d)(5)(B) 
of such Act (42 U.S.C. 1395ww(d)(5)(B)) is amended— 
(1) in clause (x)(II), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subclause (x)(IV), 
in determining’’; 
(2) in clause (x)(III), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subclause (x)(IV), 
in determining’’; and 
(3) by adding at the end the following new sub-
clause: 
‘‘(IV) The provisions of subpara-
graph (L) of subsection (h)(4) shall 
apply under this subparagraph in the 
same manner as they apply under 
such subsection.’’. 
SEC. 310. DEVELOPING AND IMPLEMENTING STRATEGIES 
FOR LOCAL HEALTH EQUITY. 
(a) GRANTS.—The Secretaries of Health and Human 
Services, Education, and Labor, acting jointly, shall make 
grants to academic institutions for the purposes of— 
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(1) in accordance with subsection (b), devel-
oping capacity— 
(A) to build an evidence base for successful 
strategies for increasing local health equity; and 
(B) to serve as national models of driving 
local health equity; 
(2) in accordance with subsection (c), devel-
oping a strategic partnership with the community in 
which the academic institution is located; and 
(3) collecting data on, and periodically evalu-
ating, the effectiveness of the institution’s programs 
funded through this section to enable the institution 
to adapt accordingly for maximum efficiency and 
success. 
(b) DEVELOPING CAPACITY FOR INCREASING LOCAL 
HEALTH EQUITY.—As a condition on receipt of a grant 
under subsection (a), an academic institution shall agree 
to use the grant to build an evidence base for successful 
strategies for increasing local health equity, and to serve 
as a national model of driving local health equity, by sup-
porting— 
(1) resources to strengthen institutional metrics 
and capacity to execute institutionwide health work-
force goals that can serve as models for increasing 
health equity in communities across the country ; 
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(2) collaborations among a cohort of institu-
tions in implementing systemic change, partnership 
development, and programmatic efforts supportive of 
health equity goals across disciplines and popu-
lations; and 
(3) enhanced or newly developed data systems 
and research infrastructure capable of informing 
current and future workforce efforts and building a 
foundation for a broader research agenda targeting 
urban health disparities. 
(c) STRATEGIC PARTNERSHIPS.—As a condition on 
receipt of a grant under subsection (a), an academic insti-
tution shall agree to use the grant to develop a strategic 
partnership with the community in which the institution 
is located for the purposes of— 
(1) strengthening connections between the insti-
tution and the community— 
(A) to improve evaluation of and address 
the community’s health and health workforce 
needs; and 
(B) to engage the community in health 
workforce development; 
(2) developing, enhancing, or accelerating inno-
vative undergraduate and graduate programs in the 
biomedical sciences and health professions; and 
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(3) strengthening the ‘‘birth to career’’ pipeline 
in the biomedical sciences and health professions, in-
cluding by developing partnerships between institu-
tions of higher education and elementary and sec-
ondary schools to recruit the next generation of 
health professionals earlier in the pipeline to a 
health care career. 
SEC. 311. LOAN FORGIVENESS FOR MENTAL AND BEHAV-
IORAL HEALTH SOCIAL WORKERS. 
Section 455 of the Higher Education Act of 1965 (20 
U.S.C. 1087e) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(q) REPAYMENT PLAN FOR MENTAL AND BEHAV-
IORAL HEALTH SOCIAL WORKERS.— 
‘‘(1) IN GENERAL.—The Secretary shall cancel 
the balance of interest and principal due on any eli-
gible Federal Direct Loan not in default for a bor-
rower who— 
‘‘(A) has made 120 monthly payments on 
the eligible Federal Direct Loan after October 
1, 2012, pursuant to any one or a combination 
of the following— 
‘‘(i) payments under an income-based 
repayment plan under section 493C; 
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‘‘(ii) payments under a standard re-
payment plan under subsection (d)(1)(A), 
based on a 10-year repayment period; 
‘‘(iii) monthly payments under a re-
payment plan under subsection (d)(1) or 
(g) of not less than the monthly amount 
calculated 
under 
subsection 
(d)(1)(A), 
based on a 10-year repayment period; or 
‘‘(iv) payments under an income con-
tingent repayment plan under subsection 
(d)(1)(D); and 
‘‘(B)(i) is employed as a mental health or 
behavioral health social worker, as defined by 
the Secretary by regulation, at the time of such 
forgiveness; and 
‘‘(ii) has been employed as such a mental 
health or behavioral health social worker during 
the period in which the borrower makes each of 
the 120 payments as described in subparagraph 
(A). 
‘‘(2) LOAN CANCELLATION AMOUNT.—After the 
conclusion of the employment period described in 
paragraph (1), the Secretary shall cancel the obliga-
tion to repay the balance of principal and interest 
due as of the time of such cancellation, on the eligi-
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ble Federal Direct Loans made to the borrower 
under this part. 
‘‘(3) DEFINITION
OF
ELIGIBLE
FEDERAL
DI-
RECT LOAN.—In this subsection, the term ‘eligible 
Federal Direct Loan’ means a Federal Direct Staf-
ford Loan, Federal Direct PLUS Loan, Federal Di-
rect Unsubsidized Stafford Loan, or a Federal Di-
rect Consolidation Loan.’’. 
TITLE IV—IMPROVEMENT OF 
HEALTH CARE SERVICES 
Subtitle A—Health Empowerment 
Zones 
SEC. 401. SHORT TITLE. 
This subtitle may be cited as the ‘‘Health Empower-
ment Zone Act of 2011’’. 
SEC. 402. FINDINGS. 
The Congress finds the following: 
(1) Numerous studies and reports, including 
the National Healthcare Disparities Report and Un-
equal Treatment, the 2002 Institute of Medicine Re-
port, document the extensiveness to which health 
disparities exist across the country. 
(2) These studies have found that, on average, 
racial and ethnic minorities are disproportionately 
afflicted with chronic and acute conditions—such as 
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cancer, diabetes, and hypertension—and suffer 
worse health outcomes, worse health status, and 
higher mortality rates than their White counter-
parts. 
(3) Several recent studies also show that health 
disparities are a function of not only access to health 
care, but also the social determinants of health—in-
cluding the environment, the physical structure of 
communities, nutrition and food options, educational 
attainment, employment, race, ethnicity, geography, 
and language preference—that directly and indi-
rectly affect the health, health care, and wellness of 
individuals and communities. 
(4) Integrally involving and fully supporting the 
communities most affected by health inequities in 
the assessment, planning, launch, and evaluation of 
health disparity elimination efforts is among the 
leading recommendations made to adequately ad-
dress and ultimately reduce health disparities. 
(5) Recommendations also include supporting 
the efforts of community stakeholders from a broad 
crosssection—including, but not limited to local 
businesses, local departments of commerce, edu-
cation, labor, urban planning, and transportation, 
and community-based and other nonprofit organiza-
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tions—to find areas of common ground around 
health disparity elimination and collaborate to im-
prove the overall health and wellness of a community 
and its residents. 
SEC. 
403. 
DESIGNATION 
OF 
HEALTH 
EMPOWERMENT 
ZONES. 
(a) IN GENERAL.—At the request of an eligible com-
munity partnership, the Secretary may designate an eligi-
ble area as a health empowerment zone. 
(b) ELIGIBILITY CRITERIA.— 
(1) ELIGIBLE
COMMUNITY
PARTNERSHIP.—A 
community partnership is eligible to submit a re-
quest under this section if the partnership— 
(A) demonstrates widespread public sup-
port from key individuals and entities in the eli-
gible area, including State and local govern-
ments, nonprofit organizations, and community 
and industry leaders, for designation of the eli-
gible area as a health empowerment zone; and 
(B) includes representatives of— 
(i) a broad cross section of stake-
holders and residents from communities in 
the eligible area experiencing dispropor-
tionate disparities in health status and 
health care; and 
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(ii) organizations, facilities, and insti-
tutions that have a history of working 
within and serving such communities. 
(2) ELIGIBLE AREA.—An area is eligible to be 
designated as a health empowerment zone under this 
section if one or more communities in the area expe-
rience disproportionate disparities in health status 
and health care. In determining whether a commu-
nity experiences such disparities, the Secretary shall 
consider the data collected by the Department of 
Health and Human Services focusing on the fol-
lowing areas: 
(A) Access to affordable high-quality 
health services. 
(B) Arthritis, osteoporosis, and chronic 
back conditions. 
(C) Cancer. 
(D) Chronic kidney disease. 
(E) Diabetes. 
(F) Injury and violence prevention. 
(G) Maternal, infant, and child health. 
(H) Medical product safety. 
(I) Mental health and mental disorders. 
(J) Nutrition and overweight. 
(K) Disability and secondary conditions. 
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(1) REQUEST.—A request under subsection (a) 
shall— 
(A) describe the bounds of the area to be 
designated as a health empowerment zone and 
the process used to select those bounds; 
(B) demonstrate that the partnership sub-
mitting the request is an eligible community 
partnership described in subsection (b)(1); 
(C) demonstrate that the area is an eligible 
area described in subsection (b)(2); 
(D) include a comprehensive assessment of 
disparities in health status and health care ex-
perience by one or more communities in the 
area; 
(E) set forth— 
(i) a vision and a set of values for the 
area; and 
(ii) a comprehensive and holistic set of 
goals to be achieved in the area through 
designation as a health empowerment zone; 
and 
(F) include a strategic plan for achieving 
the goals described in subparagraph (E)(ii). 
(2) APPROVAL.—Not later than 60 days after 
the receipt of a request for designation of an area 
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as a health empowerment zone under this section, 
the Secretary shall approve or disapprove the re-
quest. 
(d) MINIMUM NUMBER.—The Secretary— 
(1) shall designate not more than 110 health 
empowerment zones under this section; and 
(2) shall designate at least one health empower-
ment zone in each of the several States, the District 
of Columbia, and each territory or possession of the 
United States. 
SEC. 404. ASSISTANCE TO THOSE SEEKING DESIGNATION. 
At the request of any organization or entity seeking 
to submit a request under section 403(a), the Secretary 
shall provide technical assistance, and may award a grant, 
to assist such organization or entity— 
(1) to form an eligible community partnership 
described in section 403(b)(1); 
(2) to complete a health assessment, including 
an assessment of health disparities under section 
403(c)(1)(D); or 
(3) to prepare and submit a request, including 
a strategic plan, in accordance with section 403. 
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SEC. 405. BENEFITS OF DESIGNATION. 
(a) PRIORITY.—In awarding any competitive grant, 
a Federal official shall give priority to any applicant 
that— 
(1) meets the eligibility criteria for the grant; 
(2) proposes to use the grant for activities in a 
health empowerment zone; and 
(3) demonstrates that such activities will di-
rectly and significantly further the goals of the stra-
tegic plan approved for such zone under section 403. 
(b) GRANTS
FOR INITIAL IMPLEMENTATION
OF 
STRATEGIC PLAN.— 
(1) IN GENERAL.—Upon designating an eligible 
area as a health empowerment zone at the request 
of an eligible community partnership, the Secretary 
shall, subject to the availability of appropriations, 
make a grant to the community partnership for im-
plementation of the strategic plan for such zone. 
(2) GRANT PERIOD.—A grant under paragraph 
(1) for a health empowerment zone shall be for a pe-
riod of 2 years and may be renewed, except that the 
total period of grants under paragraph (1) for such 
zone may not exceed 10 years. 
(3) LIMITATION.—In awarding grants under 
this subsection, the Secretary shall not give less pri-
ority to an applicant or reduce the amount of a 
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grant because the Secretary rendered technical as-
sistance or made a grant to the same applicant 
under section 404. 
(4) REPORTING.—The Secretary shall require 
each recipient of a grant under this subsection to re-
port to the Secretary not less than every 6 months 
on the progress in implementing the strategic plan 
for the health empowerment zone. 
SEC. 406. DEFINITION. 
In this subtitle, the term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services, acting through the 
Administrator of the Health Resources and Services Ad-
ministration and the Deputy Assistant Secretary for Mi-
nority Health, and in cooperation with the Director of the 
Office of Community Services and the Director of the Na-
tional Institute for Minority Health and Health Dispari-
ties. 
SEC. 407. AUTHORIZATION OF APPROPRIATIONS. 
To carry out this subtitle, there is authorized to be 
appropriated $100,000,000 for fiscal year 2012. 
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Subtitle B—Other Improvements of 
Health Care Services 
CHAPTER 1—EXPANSION OF COVERAGE 
SEC. 411. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXIV of the Public Health Service Act, as 
amended by titles I, II, III, and IX of this Act, is further 
amended by inserting after subtitle C the following: 
‘‘Subtitle 
D—Reconstruction 
and 
Improvement Grants for Public 
Health Care Facilities Serving 
Pacific Islanders and the Insu-
lar Areas 
‘‘SEC. 3451. GRANT SUPPORT FOR QUALITY IMPROVEMENT 
INITIATIVES. 
‘‘(a) IN GENERAL.—The Secretary, in collaboration 
with the Administrator of the Health Resources and Serv-
ices Administration, the Director of the Agency for 
Healthcare Research and Quality, and the Administrator 
of the Centers for Medicare & Medicaid Services, shall 
award grants to eligible entities for the conduct of dem-
onstration projects to improve the quality of and access 
to health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
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‘‘(1) be a health center, hospital, health plan, 
health system, community clinic. or other health en-
tity determined appropriate by the Secretary— 
‘‘(A) that, by legal mandate or explicitly 
adopted mission, provides patients with access 
to services regardless of their ability to pay; 
‘‘(B) that provides care or treatment for a 
substantial number of patients who are unin-
sured, are receiving assistance under a State 
program under title XIX of the Social Security 
Act, or are members of vulnerable populations, 
as determined by the Secretary; and 
‘‘(C)(i) with respect to which, not less than 
50 percent of the entity’s patient population is 
made up of racial and ethnic minorities; or 
‘‘(ii) that— 
‘‘(I) serves a disproportionate percent-
age of local, minority racial and ethnic pa-
tients, or that has a patient population, at 
least 50 percent of which is limited-English 
proficient; and 
‘‘(II) provides an assurance that 
amounts received under the grant will be 
used only to support quality improvement 
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activities in the racial and ethnic popu-
lation served; and 
‘‘(2) prepare and submit to the Secretary an 
application at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
‘‘(c) PRIORITY.—In awarding grants under sub-
section (a), the Secretary shall give priority to applicants 
under subsection (b)(2) that— 
‘‘(1) demonstrate an intent to operate as part 
of a health care partnership, network, collaborative, 
coalition, or alliance where each member entity con-
tributes to the design, implementation, and evalua-
tion of the proposed intervention; or 
‘‘(2) intend to use funds to carry out system-
wide changes with respect to health care quality im-
provement, including— 
‘‘(A) improved systems for data collection 
and reporting; 
‘‘(B) innovative collaborative or similar 
processes; 
‘‘(C) group programs with behavioral or 
self-management interventions; 
‘‘(D) case management services; 
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‘‘(E) physician or patient reminder sys-
tems; 
‘‘(F) educational interventions; or 
‘‘(G) other activities determined appro-
priate by the Secretary. 
‘‘(d) USE OF FUNDS.—An entity shall use amounts 
received under a grant under subsection (a) to support 
the implementation and evaluation of health care quality 
improvement activities or minority health and health care 
disparity reduction activities that include— 
‘‘(1) with respect to health care systems, activi-
ties relating to improving— 
‘‘(A) patient safety; 
‘‘(B) timeliness of care; 
‘‘(C) effectiveness of care; 
‘‘(D) efficiency of care; 
‘‘(E) patient centeredness; and 
‘‘(F) health information technology; and 
‘‘(2) with respect to patients, activities relating 
to— 
‘‘(A) staying healthy; 
‘‘(B) getting well; 
‘‘(C) living with illness or disability; and 
‘‘(D) coping with end-of-life issues. 
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‘‘(e) COMMON DATA SYSTEMS.—The Secretary shall 
provide financial and other technical assistance to grant-
ees under this section for the development of common data 
systems. 
‘‘(f) 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 
2010 through 2015. 
‘‘SEC. 3452. CENTERS OF EXCELLENCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall designate centers of excellence at 
public hospitals, and other health systems serving large 
numbers of minority patients, that— 
‘‘(1) 
meet 
the 
requirements 
of 
section 
3451(b)(1); 
‘‘(2) demonstrate excellence in providing care to 
minority populations; and 
‘‘(3) demonstrate excellence in reducing dispari-
ties in health and health care. 
‘‘(b) REQUIREMENTS.—A hospital or health system 
that serves as a Center of Excellence under subsection (a) 
shall— 
‘‘(1) design, implement, and evaluate programs 
and policies relating to the delivery of care in ra-
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cially, ethnically, and linguistically diverse popu-
lations; 
‘‘(2) provide training and technical assistance 
to other hospitals and health systems relating to the 
provision of quality health care to minority popu-
lations; and 
‘‘(3) develop activities for graduate or con-
tinuing medical education that institutionalize a 
focus on cultural competence training for health care 
providers. 
‘‘(c) 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 
2010 through 2015. 
‘‘SEC. 3453. RECONSTRUCTION AND IMPROVEMENT GRANTS 
FOR PUBLIC HEALTH CARE FACILITIES SERV-
ING PACIFIC ISLANDERS AND THE INSULAR 
AREAS. 
‘‘(a) IN GENERAL.—The Secretary shall provide di-
rect financial assistance to designated health care pro-
viders and community health centers in American Samoa, 
Guam, the Commonwealth of the Northern Mariana Is-
lands, the United States Virgin Islands, Puerto Rico, and 
Hawaii for the purposes of reconstructing and improving 
health care facilities and services. 
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‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi-
nancial assistance under subsection (a), an entity shall be 
a public health facility or community health center located 
in American Samoa, Guam, the Commonwealth of the 
Northern Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, or Hawaii that— 
‘‘(1) is owned or operated by— 
‘‘(A) the Government of American Samoa, 
Guam, the Commonwealth of the Northern 
Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, or Hawaii or a unit of local 
government; or 
‘‘(B) a nonprofit organization; and 
‘‘(2)(A) provides care or treatment for a sub-
stantial number of patients who are uninsured, re-
ceiving assistance under a State program under a 
title XVIII of the Social Security Act, or a State 
program under title XIX of such Act, or who are 
members of a vulnerable population, as determined 
by the Secretary; or 
‘‘(B) serves a disproportionate percentage of 
local, minority racial and ethnic patients. 
‘‘(c) REPORT.—Not later than 180 days after the 
date of enactment of this title and annually thereafter, the 
Secretary shall submit to the Congress and the President 
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a report that includes an assessment of health resources 
and facilities serving populations in American Samoa, 
Guam, the Commonwealth of the Northern Mariana Is-
lands, the United States Virgin Islands, Puerto Rico, and 
Hawaii. In preparing such report, the Secretary shall— 
‘‘(1) consult with and obtain information on all 
health care facilities needs from the entities de-
scribed in subsection (b); 
‘‘(2) include all amounts of Federal assistance 
received by each entity in the preceding fiscal year; 
‘‘(3) review the total unmet needs of each juris-
diction for health care facilities, including needs for 
renovation and expansion of existing facilities; and 
‘‘(4) include a strategic plan for addressing the 
needs of each jurisdiction identified in the report. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as necessary 
to carry out this section.’’. 
SEC. 412. REMOVING BARRIERS TO UNSUBSIDIZED PUR-
CHASE OF PRIVATE INSURANCE IN AMER-
ICAN HEALTH BENEFIT EXCHANGES. 
(a) IN GENERAL.—Section 1312(f) of the Patient 
Protection and Affordable Care Act (42 U.S.C.18032(f)) 
is amended— 
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(1) in the subsection heading, by striking the 
semicolon and all that follows through ‘‘RESI-
DENTS’’; and 
(2) by striking paragraph (3). 
(b) CONFORMING AMENDMENT.—Section 1411(a)(1) 
of such Act (42 U.S.C. 18081(a)(1)) is amended by strik-
ing ‘‘1312(f)(3),’’. 
SEC. 413. STUDY ON THE UNINSURED. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
(1) conduct a study on the demographic charac-
teristics of the population of individuals who do not 
have health insurance coverage; and 
(2) predict, based on such study, the demo-
graphic characteristics of the population of individ-
uals who will not have health insurance coverage 
after January 1, 2014. 
(b) REPORTING REQUIREMENTS.— 
(1) IN GENERAL.—Not later than 12 months 
after the date of the enactment of this Act, the Sec-
retary shall submit to the Congress the results of 
the study under subsection (a)(1) and the prediction 
made under subsection (a)(2). 
(2) REPORTING OF DEMOGRAPHIC CHARACTER-
ISTICS.—The Secretary shall report the demographic 
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characteristics under paragraphs (1) and (2) of sub-
section (a) on the basis of racial and ethnic group, 
and shall stratify the reporting on each racial and 
ethnic group by other demographic characteristics 
that can impact access to health insurance coverage, 
such as sexual orientation, gender identity, primary 
language, disability status, sex, socioeconomic sta-
tus, and citizenship and immigration status, in a 
manner consistent with title I of this Act. 
SEC. 414. MEDICAID PAYMENT PARITY FOR THE TERRI-
TORIES. 
(a) ELIMINATION OF FUNDING LIMITATIONS FOR 
PUERTO RICO, THE UNITED STATES VIRGIN ISLANDS, 
GUAM, THE COMMONWEALTH OF THE NORTHERN MAR-
IANA ISLANDS, AND AMERICAN SAMOA.— 
(1) IN GENERAL.—Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended— 
(A) in subsection (f), in the matter before 
paragraph (1), by striking ‘‘subsection (g)’’ and 
inserting ‘‘subsections (g) and (h)’’; 
(B) in subsection (g)(2), in the matter be-
fore subparagraph (A), by inserting ‘‘and sub-
section (h)’’ after ‘‘paragraphs (3) and (5)’’; 
and 
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(C) by adding at the end the following new 
subsection: 
‘‘(h) SUNSET OF FUNDING LIMITATIONS FOR PUER-
TO RICO, THE UNITED STATES VIRGIN ISLANDS, GUAM, 
THE COMMONWEALTH OF THE NORTHERN MARIANA IS-
LANDS, AND AMERICAN SAMOA.—Subsections (f) and (g) 
shall not apply to Puerto Rico, the United States Virgin 
Islands, Guam, the Commonwealth of the Northern Mar-
iana Islands, and American Samoa for any fiscal year 
after fiscal year 2011.’’. 
(2) 
CONFORMING
AMENDMENT.—Section 
1903(u) of such Act (42 U.S.C. 1396c(u)) is amend-
ed by striking paragraph (4). 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply beginning with fiscal 
year 2012. 
(b) PARITY IN FMAP.— 
(1) IN GENERAL.—Section 1905(b)(2) of such 
Act (42 U.S.C. 1396d(b)(2)) is amended by insert-
ing after ‘‘50 per centum’’ the following: ‘‘(except 
that, beginning with fiscal year 2014, the Federal 
medical assistance percentage for Puerto Rico, the 
United States Virgin Islands, Guam, the Common-
wealth of the Northern Mariana Islands, and Amer-
ican Samoa shall be the Federal medical assistance 
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percentage determined by the Secretary in consulta-
tion (for the United States Virgin Islands, Guam, 
the Commonwealth of the Northern Mariana Is-
lands, and American Samoa) with the Secretary of 
the Interior)’’. 
(2) 
2-FISCAL-YEAR
TRANSITION.—Notwith-
standing any other provision of law, during fiscal 
years 2012 and 2013, the Federal medical assist-
ance percentage established under section 1905(b) of 
the Social Security Act (42 U.S.C. 1396d(b)) for 
Puerto Rico, the United States Virgin Islands, 
Guam, the Commonwealth of the Northern Mariana 
Islands, and American Samoa shall be the highest 
such Federal medical assistance percentage applica-
ble to any of the 50 States or the District of Colum-
bia for the fiscal year involved, taking into account 
the application of subsections (a) and (b)(1) of 5001 
of division B of the American Recovery and Rein-
vestment Act of 2009 (Public Law 111–5) to such 
States and District of Columbia for calendar quar-
ters during such fiscal years for which such sub-
sections apply respectively. 
(3) PER CAPITA INCOME DATA.— 
(A) REPORT
TO
CONGRESS.—Not later 
than October 1, 2012, the Secretary of Health 
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Mariana Islands, or American Samoa, sat-
isfactory data available from the Depart-
ment of the Interior for the same period, 
or if such satisfactory data are not avail-
able in the case of Puerto Rico, satisfac-
tory data available from the government of 
the Commonwealth of Puerto Rico for the 
same period)’’ after ‘‘Department of Com-
merce’’. 
(4) RELATION
TO
AMERICAN
RECOVERY
AND 
REINVESTMENT ACT OF 2009.—For any period and 
territory in which the provisions of this subsection 
apply to a territory, the provisions of section 
5001(b)(2) of division B of the American Recovery 
and Reinvestment Act of 2009 (Public Law 111–5) 
shall not apply (except as otherwise specifically pro-
vided in paragraph (2)). 
SEC. 415. CLARIFICATION OF MEDICAID COVERAGE FOR 
CITIZENS OF FREELY ASSOCIATED STATES. 
(a) IN GENERAL.—Section 402(b)(2) of the Personal 
Responsibility and Work Opportunity Reconciliation Act 
of 1996 (8 U.S.C. 1612(b)(2)) is amended by adding at 
the end the following: 
‘‘(G) MEDICAID EXCEPTION FOR CITIZENS 
OF FREELY ASSOCIATED STATES.—With respect 
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