719 
such sums as may be necessary for fiscal years 2021 
through 2024. 
SEC. 747. SERVICES TO REDUCE HIV/AIDS IN RACIAL AND 
ETHNIC MINORITY COMMUNITIES. 
(a) IN GENERAL.—For the purpose of reducing new 
HIV diagnoses in racial and ethnic minority communities, 
the Secretary of Health and Human Services, acting 
through the Deputy Assistant Secretary for Minority 
Health, may make grants to public health agencies and 
faith-based organizations to conduct— 
(1) outreach activities related to HIV preven-
tion and testing activities; 
(2) HIV prevention activities; and 
(3) HIV testing activities. 
(b) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2021 
through 2024. 
SEC. 748. MINORITY AIDS INITIATIVE. 
(a) EXPANDED FUNDING.—The Secretary of Health 
and Human Services, in collaboration with the Deputy As-
sistant Secretary for Minority Health, the Director of the 
Centers for Disease Control and Prevention, the Adminis-
trator of the Health Resources and Services Administra-
tion, and the Assistant Secretary for Mental Health and 
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Substance Use, shall provide funds and carry out activities 
to expand the Minority HIV/AIDS Initiative. 
(b) USE OF FUNDS.—The additional funds made 
available under this section may be used, through the Mi-
nority AIDS Initiative, to support the following activities: 
(1) Providing technical assistance and infra-
structure support to reduce HIV/AIDS in minority 
populations. 
(2) Increasing minority populations’ access to 
HIV prevention and care services. 
(3) Building strong community programs and 
partnerships to address HIV prevention and the 
health care needs of specific racial and ethnic minor-
ity populations. 
(c) PRIORITY INTERVENTIONS.—Within the racial 
and ethnic minority populations referred to in subsection 
(b), priority in conducting intervention services shall be 
given to— 
(1) men who have sex with men; 
(2) youth; 
(3) persons who engage in intravenous drug 
abuse; 
(4) women; 
(5) homeless individuals; and 
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(6) individuals incarcerated or in the penal sys-
tem. 
(d) AUTHORIZATION OF APPROPRIATIONS.—For car-
rying out this section, there are authorized to be appro-
priated $610,000,000 for fiscal year 2021 and such sums 
as may be necessary for each of fiscal years 2022 through 
2025. 
SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI-
VIDUALS WITH HIV. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration, shall ex-
pand, intensify, and coordinate workforce initiatives of the 
Health Resources and Services Administration to increase 
the capacity of the health workforce focusing primarily on 
HIV to meet the demand for culturally competent care, 
and may award grants for any of the following: 
(1) Development of curricula for training pri-
mary care providers in HIV/AIDS prevention and 
care, including routine HIV testing. 
(2) Support to expand access to culturally and 
linguistically accessible benefits counselors, trained 
peer navigators, and mental and behavioral health 
professionals with expertise in HIV. 
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(3) Training health care professionals to pro-
vide care to individuals living with HIV. 
(4) Development by grant recipients under title 
XXVI of the Public Health Service Act (42 U.S.C. 
300ff–11 et seq.; commonly referred to as the ‘‘Ryan 
White HIV/AIDS Program’’) and other persons, of 
policies for providing culturally relevant and sen-
sitive treatment to individuals living with HIV, with 
particular emphasis on treatment to racial and eth-
nic minorities, men who have sex with men, and 
women, young people, and children living with HIV. 
(5) Development and implementation of pro-
grams to increase the use of telehealth to respond to 
HIV-specific health care needs in rural and minority 
communities, with particular emphasis given to 
medically underserved communities and insular 
areas. 
(6) Evaluating interdisciplinary medical pro-
vider care team models that promote high-quality 
care, with particular emphasis on care to racial and 
ethnic minorities. 
(7) Training health care professionals to make 
them aware of the high rates of chronic hepatitis B 
and chronic hepatitis C in adult racial and ethnic 
populations, and the importance of prevention, de-
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tection, and medical management of hepatitis B and 
hepatitis C and of liver cancer screening. 
(8) Development of curricula for training pri-
mary care providers that HIV and tuberculosis are 
significant mutual comorbidities, and that a patient 
who tests positive for one disease should be offered 
and encouraged to receive testing for the other. 
(b) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2021 
through 2024. 
SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO-
GRAM. 
(a) IN GENERAL.—The Secretary may enter into an 
agreement with any physician, nurse practitioner, or phy-
sician assistant under which— 
(1) the physician, nurse practitioner, or physi-
cian assistant agrees to serve as a medical provider 
for a period of not less than 2 years— 
(A) at a Ryan White-funded or title X- 
funded facility with a critical shortage of doc-
tors (as determined by the Secretary); or 
(B) in an area with a high incidence of 
HIV; and 
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(2) the Secretary agrees to make payments in 
accordance with subsection (b) on the professional 
education loans of the physician, nurse practitioner, 
or physician assistant. 
(b) MANNER
OF PAYMENTS.—The payments de-
scribed in subsection (a) shall be made by the Secretary 
as follows: 
(1) Upon completion by the physician, nurse 
practitioner, or physician assistant for whom the 
payments are to be made of the first year of the 
service specified in the agreement entered into with 
the Secretary under subsection (a), the Secretary 
shall pay 30 percent of the principal of and the in-
terest on the individual’s professional education 
loans. 
(2) Upon completion by the physician, nurse 
practitioner, or physician assistant of the second 
year of such service, the Secretary shall pay another 
30 percent of the principal of and the interest on 
such loans. 
(3) Upon completion by that individual of a 
third year of such service, the Secretary shall pay 
another 25 percent of the principal of and the inter-
est on such loans. 
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(c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub-
part III of part D of title III of the Public Health Service 
Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 
with this section, apply to the program carried out under 
this section in the same manner and to the same extent 
as such provisions apply to the National Health Service 
Corps loan repayment program. 
(d) REPORTS.—Not later than 18 months after the 
date of the enactment of this Act, and annually thereafter, 
the Secretary shall prepare and submit to Congress a re-
port describing the program carried out under this section, 
including statements regarding the following: 
(1) The number of physicians, nurse practi-
tioners, and physician assistants enrolled in the pro-
gram. 
(2) The number and amount of loan repay-
ments. 
(3) The placement location of loan repayment 
recipients at facilities described in subsection (a)(1). 
(4) The default rate and actions required. 
(5) The amount of outstanding default funds. 
(6) To the extent that it can be determined, the 
reason for the default. 
(7) The demographics of individuals partici-
pating in the program. 
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(8) An evaluation of the overall costs and bene-
fits of the program. 
(e) DEFINITIONS.—In this section: 
(1) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 
human immunodeficiency virus and acquired im-
mune deficiency syndrome. 
(2) NURSE PRACTITIONER.—The term ‘‘nurse 
practitioner’’ means a registered nurse who has com-
pleted an accredited graduate degree program in ad-
vanced nurse practice and has successfully passed a 
national certification exam. 
(3) PHYSICIAN.—The term ‘‘physician’’ means 
a graduate of a school of medicine who has com-
pleted postgraduate training in general or pediatric 
medicine. 
(4) PHYSICIAN ASSISTANT.—The term ‘‘physi-
cian assistant’’ means a medical provider who com-
pleted an accredited physician assistant training pro-
gram and successfully passed the Physician Assist-
ant National Certifying Examination. 
(5) PROFESSIONAL
EDUCATION
LOAN.—The 
term ‘‘professional education loan’’— 
(A) means a loan that is incurred for the 
cost of attendance (including tuition, other rea-
sonable educational expenses, and reasonable 
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living costs) at a school of medicine, nursing, or 
physician assistant training program; and 
(B) includes only the portion of the loan 
that is outstanding on the date the physician, 
nurse practitioner, or physician assistant in-
volved begins the service specified in the agree-
ment under subsection (a). 
(6) RYAN WHITE-FUNDED.—The term ‘‘Ryan 
White-funded’’ means, with respect to a facility, re-
ceiving funds under title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff–11 et seq.). 
(7) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(8) SCHOOL OF MEDICINE.—The term ‘‘school 
of medicine’’ has the meaning given to that term in 
section 799B of the Public Health Service Act (42 
U.S.C. 295p). 
(9) TITLE X-FUNDED.—The term ‘‘title X-fund-
ed’’ means, with respect to a facility, receiving funds 
under title X of the Public Health Service Act (42 
U.S.C. 300 et seq.). 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2021 
through 2024. 
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SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO-
GRAM. 
(a) IN GENERAL.—The Secretary may enter into an 
agreement with any dentist under which— 
(1) the dentist agrees to serve as a dentist for 
a period of not less than 2 years at a facility with 
a critical shortage of dentists (as determined by the 
Secretary) in an area with a high incidence of HIV; 
and 
(2) the Secretary agrees to make payments in 
accordance with subsection (b) on the dental edu-
cation loans of the dentist. 
(b) MANNER
OF PAYMENTS.—The payments de-
scribed in subsection (a) shall be made by the Secretary 
as follows: 
(1) Upon completion by the dentist for whom 
the payments are to be made of the first year of the 
service specified in the agreement entered into with 
the Secretary under subsection (a), the Secretary 
shall pay 30 percent of the principal of and the in-
terest on the dental education loans of the dentist. 
(2) Upon completion by the dentist of the sec-
ond year of such service, the Secretary shall pay an-
other 30 percent of the principal of and the interest 
on such loans. 
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(3) Upon completion by that individual of a 
third year of such service, the Secretary shall pay 
another 25 percent of the principal of and the inter-
est on such loans. 
(c) APPLICABILITY OF CERTAIN PROVISIONS.—Sub-
part III of part D of title III of the Public Health Service 
Act (42 U.S.C. 254l et seq.) shall, except as inconsistent 
with this section, apply to the program carried out under 
this section in the same manner and to the same extent 
as such provisions apply to the National Health Service 
Corps Loan Repayment Program. 
(d) REPORTS.—Not later than 18 months after the 
date of the enactment of this Act, and annually thereafter, 
the Secretary shall prepare and submit to the Congress 
a report describing the program carried out under this sec-
tion, including statements regarding the following: 
(1) The number of dentists enrolled in the pro-
gram. 
(2) The number and amount of loan repay-
ments. 
(3) The placement location of loan repayment 
recipients at facilities described in subsection (a)(1). 
(4) The default rate and actions required. 
(5) The amount of outstanding default funds. 
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(6) To the extent that it can be determined, the 
reason for the default. 
(7) The demographics of individuals partici-
pating in the program. 
(8) An evaluation of the overall costs and bene-
fits of the program. 
(e) DEFINITIONS.—In this section: 
(1) DENTAL
EDUCATION
LOAN.—The term 
‘‘dental education loan’’— 
(A) means a loan that is incurred for the 
cost of attendance (including tuition, other rea-
sonable educational expenses, and reasonable 
living costs) at a school of dentistry; and 
(B) includes only the portion of the loan 
that is outstanding on the date the dentist in-
volved begins the service specified in the agree-
ment under subsection (a). 
(2) DENTIST.—The term ‘‘dentist’’ means a 
graduate of a school of dentistry who has completed 
postgraduate training in general or pediatric den-
tistry. 
(3) HIV/AIDS.—The term ‘‘HIV/AIDS’’ means 
human immunodeficiency virus and acquired im-
mune deficiency syndrome. 
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(4) SCHOOL OF DENTISTRY.—The term ‘‘school 
of dentistry’’ has the meaning given to that term in 
section 799B of the Public Health Service Act (42 
U.S.C. 295p). 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2021 through 2024. 
SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT-
ING DRUG USERS. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that providing sterile syringes and sterilized equip-
ment to injecting drug users substantially reduces risk of 
HIV infection, increases the probability that they will ini-
tiate drug treatment, and does not increase drug use. 
(b) IN GENERAL.—The Secretary of Health and 
Human Services may provide grants and technical assist-
ance for the purpose of reducing the rate of HIV infections 
among injecting drug users through a comprehensive 
package of services for such users, including the provision 
of sterile syringes, education and outreach, access to infec-
tious disease testing, overdose prevention, and treatment 
for drug dependence. 
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(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2021 
through 2024. 
SEC. 753. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 
POPULATIONS. 
(a) IN GENERAL.—The Secretary shall submit to 
Congress and the President an annual report on the im-
pact of HIV for racial and ethnic minority communities, 
women, and youth aged 24 and younger. 
(b) CONTENTS.—The report under subsection (a) 
shall include information on the— 
(1) progress that has been made in reducing 
the impact of HIV/AIDS in such communities; 
(2) opportunities that exist to make additional 
progress in reducing the impact of HIV/AIDS in 
such communities; 
(3) challenges that may impede such additional 
progress; and 
(4) Federal funding necessary to achieve sub-
stantial reductions in HIV in racial and ethnic mi-
nority communities. 
SEC. 754. NATIONAL HIV/AIDS OBSERVANCE DAYS. 
(a) NATIONAL OBSERVANCE DAYS.—It is the sense 
of Congress that national observance days highlighting the 
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impact of HIV on communities of color include the fol-
lowing: 
(1) National Black HIV/AIDS Awareness Day. 
(2) National Latino AIDS Awareness Day. 
(3) National Asian and Pacific Islander HIV/ 
AIDS Awareness Day. 
(4) National Native American HIV/AIDS 
Awareness Day. 
(5) National Youth HIV/AIDS Awareness Day. 
(b) CALL TO ACTION.—It is the sense of Congress 
that the President should call on members of communities 
of color— 
(1) to become involved at the local community 
level in HIV testing, policy, and advocacy; 
(2) to become aware, engaged, and empowered 
on the HIV epidemic within their communities; and 
(3) to urge members of their communities to re-
duce risk factors, practice safe sex and other preven-
tive measures, be tested for HIV, and seek care 
when appropriate. 
SEC. 755. REVIEW OF ALL FEDERAL AND STATE LAWS, 
POLICIES, AND REGULATIONS REGARDING 
THE CRIMINAL PROSECUTION OF INDIVID-
UALS FOR HIV-RELATED OFFENSES. 
(a) DEFINITIONS.—In this section: 
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(1) HIV.—The term ‘‘HIV’’ has the meaning 
given to the term in section 2689 of the Public 
Health Service Act (42 U.S.C. 300ff–88). 
(2) STATE.—The term ‘‘State’’ includes the 
District of Columbia, American Samoa, the Com-
monwealth of the Northern Mariana Islands, Guam, 
Puerto Rico, and the United States Virgin Islands. 
(b) SENSE OF CONGRESS REGARDING LAWS OR REG-
ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV.— 
It is the sense of Congress that Federal and State laws, 
policies, and regulations regarding people living with 
HIV— 
(1) should not place unique or additional bur-
dens on such individuals solely as a result of their 
HIV status; and 
(2) should instead demonstrate a public health- 
oriented, evidence-based, medically accurate, and 
contemporary understanding of— 
(A) the multiple factors that lead to HIV 
transmission; 
(B) the relative risk of HIV transmission 
routes; 
(C) the current health implications of liv-
ing with HIV; 
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(D) the associated benefits of treatment 
and support services for people living with HIV; 
(E) the impact of punitive HIV-specific 
laws and policies on public health, on people liv-
ing with or affected by HIV, and on their fami-
lies and communities; and 
(F) the current science on HIV prevention 
and treatment, including pre-exposure prophy-
laxis (PrEP), post-exposure prophylaxis (PEP), 
and viral suppression. 
(c) REVIEW OF ALL FEDERAL AND STATE LAWS, 
POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 
PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF-
FENSES.— 
(1) REVIEW OF FEDERAL AND STATE LAWS.— 
(A) IN GENERAL.—Not later than 90 days 
after the date of the enactment of this Act, the 
Attorney General, the Secretary of Health and 
Human Services, and the Secretary of Defense 
acting jointly (in this paragraph and paragraph 
(2) referred to as the ‘‘designated officials’’) 
shall initiate a national review of Federal and 
State laws, policies, regulations, and judicial 
precedents and decisions regarding criminal and 
related civil commitment cases involving people 
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living with HIV, including in regards to the 
Uniform Code of Military Justice. 
(B) CONSULTATION.—In carrying out the 
review under subparagraph (A), the designated 
officials shall ensure diverse participation and 
consultation from each State, including with— 
(i) State attorneys general (or their 
representatives); 
(ii) State public health officials (or 
their representatives); 
(iii) State judicial and court system 
officers, including judges, district attor-
neys, prosecutors, defense attorneys, law 
enforcement, and correctional officers; 
(iv) members of the United States 
Armed Forces, including members of other 
Federal services subject to the Uniform 
Code of Military Justice; 
(v) people living with HIV, particu-
larly those who have been subject to HIV- 
related prosecution or who are from com-
munities whose members have been dis-
proportionately subject to HIV-specific ar-
rests and prosecutions; 
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(vi) legal advocacy and HIV service 
organizations that work with people living 
with HIV; 
(vii) nongovernmental health organi-
zations that work on behalf of people living 
with HIV; and 
(viii) trade organizations or associa-
tions representing persons or entities de-
scribed in clauses (i) through (vii). 
(C) RELATION
TO
OTHER
REVIEWS.—In 
carrying out the review under subparagraph 
(A), the designated officials may utilize other 
existing reviews of criminal and related civil 
commitment cases involving people living with 
HIV, including any such review conducted by 
any Federal or State agency or any public 
health, legal advocacy, or trade organization or 
association if the designated officials determine 
that such reviews were conducted in accordance 
with the principles set forth in subsection (b). 
(2) REPORT.—No later than 180 days after ini-
tiating the review required by paragraph (1), the At-
torney General shall transmit to Congress and make 
publicly available a report containing the results of 
the review, which includes the following: 
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(A) For each State and for the Uniform 
Code of Military Justice, a summary of the rel-
evant laws, policies, regulations, and judicial 
precedents and decisions regarding criminal 
cases involving people living with HIV, includ-
ing, if applicable, the following: 
(i) A determination of whether such 
laws, policies, regulations, and judicial 
precedents and decisions place any unique 
or additional burdens upon people living 
with HIV. 
(ii) A determination of whether such 
laws, policies, regulations, and judicial 
precedents and decisions demonstrate a 
public 
health-oriented, 
evidence-based, 
medically accurate, and contemporary un-
derstanding of— 
(I) the multiple factors that lead 
to HIV transmission; 
(II) the relative risk of HIV 
transmission routes; 
(III) the current health implica-
tions of living with HIV; 
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(IV) the associated benefits of 
treatment and support services for 
people living with HIV; 
(V) the impact of punitive HIV- 
specific laws and policies on public 
health, on people living with or af-
fected by HIV, and on their families 
and communities; and 
(VI) the current science on HIV 
prevention and treatment, including 
pre-exposure 
prophylaxis 
(PrEP), 
post-exposure prophylaxis (PEP), and 
viral suppression. 
(iii) An analysis of the public health 
and legal implications of such laws, poli-
cies, regulations, and judicial precedents, 
including an analysis of the consequences 
of having a similar penal scheme applied to 
comparable situations involving other com-
municable diseases. 
(iv) An analysis of the proportionality 
of punishments imposed under HIV-spe-
cific laws, policies, regulations, and judicial 
precedents, taking into consideration pen-
alties attached to violation of State laws 
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against similar degrees of endangerment or 
harm, such as driving while intoxicated or 
transmission of other communicable dis-
eases, or more serious harms, such as ve-
hicular manslaughter offenses. 
(B) An analysis of common elements 
shared among State laws, policies, regulations, 
and judicial precedents. 
(C) A set of best practice recommendations 
directed to State governments, including State 
attorneys general, public health officials, and 
judicial officers, in order to ensure that laws, 
policies, regulations, and judicial precedents re-
garding people living with HIV are in accord-
ance with the principles set forth in subsection 
(b). 
(D) Recommendations for adjustments to 
the Uniform Code of Military Justice, as may 
be necessary, in order to ensure that laws, poli-
cies, regulations, and judicial precedents re-
garding people living with HIV are in accord-
ance with the principles set forth in subsection 
(b). 
(3) GUIDANCE.—Within 90 days of the release 
of the report required by paragraph (2), the Attor-
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ney General and the Secretary of Health and 
Human Services, acting jointly, shall develop and 
publicly release updated guidance for States based 
on the set of best practice recommendations required 
by paragraph (2)(C) in order to assist States dealing 
with criminal and related civil commitment cases re-
garding people living with HIV. 
(4) MONITORING AND EVALUATION SYSTEM.— 
Within 60 days of the release of the guidance re-
quired by paragraph (3), the Attorney General and 
the Secretary of Health and Human Services, acting 
jointly, shall establish an integrated monitoring and 
evaluation system which includes, where appropriate, 
objective and quantifiable performance goals and in-
dicators to measure progress toward statewide im-
plementation in each State of the best practice rec-
ommendations required in paragraph (2)(C), includ-
ing to monitor, track, and evaluate the effectiveness 
of assistance provided pursuant to subsection (d). 
(5) ADJUSTMENTS TO FEDERAL LAWS, POLI-
CIES, OR REGULATIONS.—Within 90 days of the re-
lease of the report required by paragraph (2), the 
Attorney General, the Secretary of Health and 
Human Services, and the Secretary of Defense, act-
ing jointly, shall develop and transmit to the Presi-
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dent and the Congress, and make publicly available, 
such proposals as may be necessary to implement 
adjustments to Federal laws, policies, or regulations, 
including to the Uniform Code of Military Justice, 
based on the recommendations required by para-
graph (2)(D), either through Executive order or 
through changes to statutory law. 
(6) AUTHORIZATION OF APPROPRIATIONS.— 
(A) IN GENERAL.—There are authorized to 
be appropriated such sums as may be necessary 
for the purpose of carrying out this subsection. 
Amounts authorized to be appropriated by the 
preceding sentence are in addition to amounts 
otherwise authorized to be appropriated for 
such purpose. 
(B) AVAILABILITY
OF
FUNDS.—Amounts 
appropriated pursuant to the authorization of 
appropriations in subparagraph (A) are author-
ized to remain available until expended. 
(d) AUTHORIZATION TO PROVIDE GRANTS.— 
(1) GRANTS BY ATTORNEY GENERAL.— 
(A) IN GENERAL.—The Attorney General 
may provide assistance to eligible State and 
local entities and eligible nongovernmental orga-
nizations for the purpose of incorporating the 
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best practice recommendations developed under 
subsection (c)(2)(C) within relevant State laws, 
policies, regulations, and judicial decisions re-
garding people living with HIV. 
(B) AUTHORIZED ACTIVITIES.—The assist-
ance authorized by subparagraph (A) may in-
clude— 
(i) direct technical assistance to eligi-
ble State and local entities in order to de-
velop, disseminate, or implement State 
laws, policies, regulations, or judicial deci-
sions that conform with the best practice 
recommendations developed under sub-
section (c)(2)(C); 
(ii) direct technical assistance to eligi-
ble nongovernmental organizations in order 
to provide education and training, includ-
ing through classes, conferences, meetings, 
and other educational activities, to eligible 
State and local entities; and 
(iii) subcontracting authority to allow 
eligible State and local entities and eligible 
nongovernmental organizations to seek 
technical assistance from legal and public 
health experts with a demonstrated under-
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standing of the principles underlying the 
best practice recommendations developed 
under subsection (c)(2)(C). 
(2) GRANTS BY SECRETARY OF HEALTH AND 
HUMAN SERVICES.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services, acting through the 
Director of the Centers for Disease Control and 
Prevention, may provide assistance to State and 
local public health departments and eligible 
nongovernmental organizations for the purpose 
of supporting eligible State and local entities to 
incorporate the best practice recommendations 
developed under subsection (c)(2)(C) within rel-
evant State laws, policies, regulations, and judi-
cial decisions regarding people living with HIV. 
(B) AUTHORIZED ACTIVITIES.—The assist-
ance authorized by subparagraph (A) may in-
clude— 
(i) direct technical assistance to State 
and local public health departments in 
order to support the development, dissemi-
nation, or implementation of State laws, 
policies, regulations, or judicial decisions 
that conform with the set of best practice 
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recommendations developed under sub-
section (c)(2)(C); 
(ii) direct technical assistance to eligi-
ble nongovernmental organizations in order 
to provide education and training, includ-
ing through classes, conferences, meetings, 
and other educational activities, to State 
and local public health departments; and 
(iii) subcontracting authority to allow 
State and local public health departments 
and eligible nongovernmental organizations 
to seek technical assistance from legal and 
public health experts with a demonstrated 
understanding of the principles underlying 
the best practice recommendations devel-
oped under subsection (c)(2)(C). 
(3) LIMITATION.—As a condition of receiving 
assistance through this subsection, eligible State and 
local entities, State and local public health depart-
ments, and eligible nongovernmental organizations 
shall agree— 
(A) not to place any unique or additional 
burdens on people living with HIV solely as a 
result of their HIV status; and 
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(B) that if the entity, department, or orga-
nization promulgates any laws, policies, regula-
tions, or judicial decisions regarding people liv-
ing with HIV, such actions shall demonstrate a 
public health-oriented, evidence-based, medically 
accurate, and contemporary understanding of— 
(i) the multiple factors that lead to 
HIV transmission; 
(ii) the relative risk of HIV trans-
mission routes; 
(iii) the current health implications of 
living with HIV; 
(iv) the associated benefits of treat-
ment and support services for people living 
with HIV; 
(v) the impact of punitive HIV-spe-
cific laws and policies on public health, on 
people living with or affected by HIV, and 
on their families and communities; and 
(vi) the current science on HIV pre-
vention and treatment, including pre-expo-
sure prophylaxis (PrEP), post-exposure 
prophylaxis (PEP), and viral suppression. 
(4) REPORT.—No later than 1 year after the 
date of the enactment of this Act, and annually 
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thereafter, the Attorney General and the Secretary 
of Health and Human Services, acting jointly, shall 
transmit to Congress and make publicly available a 
report describing, for each State, the impact and ef-
fectiveness of the assistance provided through this 
section. Each such report shall include— 
(A) a detailed description of the progress 
each State has made, if any, in implementing 
the best practice recommendations developed 
under subsection (c)(2)(C) as a result of the as-
sistance provided under this subsection, and 
based on the performance goals and indicators 
established as part of the monitoring and eval-
uation system in subsection (c)(4); 
(B) a brief summary of any outreach ef-
forts undertaken during the prior year by the 
Attorney General and the Secretary of Health 
and Human Services to encourage States to 
seek assistance under this subsection in order 
to implement the best practice recommenda-
tions developed under subsection (c)(2)(C); 
(C) a summary of how assistance provided 
through this subsection is being utilized by eli-
gible State and local entities, State and local 
public health departments, and eligible non-
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(V) the impact of punitive HIV- 
specific laws and policies on public 
health, on people living with or af-
fected by HIV, and on their families 
and communities; and 
(VI) the current science on HIV 
prevention and treatment, including 
pre-exposure 
prophylaxis 
(PrEP), 
post-exposure prophylaxis (PEP), and 
viral suppression. 
(6) AUTHORIZATION OF APPROPRIATIONS.— 
(A) IN GENERAL.—In addition to amounts 
otherwise made available, there are authorized 
to be appropriated to the Attorney General and 
the Secretary of Health and Human Services 
such sums as may be necessary to carry out 
this subsection for each of the fiscal years 2021 
through 2024. 
(B) AVAILABILITY
OF
FUNDS.—Amounts 
appropriated pursuant to the authorizations of 
appropriations in subparagraph (A) are author-
ized to remain available until expended. 
SEC. 756. EXPANDING SUPPORT FOR CONDOMS IN PRIS-
ONS. 
(a) DEFINITIONS.—For the purposes of this section: 
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(1) COMMUNITY
ORGANIZATION.—The term 
‘‘community organization’’ means a public health 
care facility or a nonprofit organization which pro-
vides health- or STI-related services according to es-
tablished public health standards. 
(2) COMPREHENSIVE SEXUALITY EDUCATION.— 
The term ‘‘comprehensive sexuality education’’ 
means sexuality education— 
(A) that includes information about absti-
nence and about the proper use and disposal of 
sexual barrier protection devices; and 
(B) which is— 
(i) evidence-based; 
(ii) medically accurate; 
(iii) age and developmentally appro-
priate; 
(iv) gender and identity sensitive; 
(v) culturally and linguistically appro-
priate; and 
(vi) structured to promote critical 
thinking, self-esteem, respect for others, 
and the development of healthy attitudes 
and relationships. 
(3) CORRECTIONAL FACILITY.—The term ‘‘cor-
rectional facility’’ means any prison, penitentiary, 
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adult detention facility, juvenile detention facility, 
jail, or other facility to which persons may be sent 
after conviction of a crime or act of juvenile delin-
quency within the United States. 
(4) INCARCERATED PERSON.—The term ‘‘incar-
cerated person’’ means any person who is serving a 
sentence in a correctional facility after conviction of 
a crime. 
(5) SEXUALLY TRANSMITTED INFECTION.—The 
term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 
means any disease or infection that is commonly 
transmitted through sexual activity, including HIV, 
gonorrhea, chlamydia, syphilis, genital herpes, viral 
hepatitis, and human papillomavirus. 
(6) SEXUAL BARRIER PROTECTION DEVICE.— 
The term ‘‘sexual barrier protection device’’ means 
any FDA-approved physical device which has not 
been tampered with and which reduces the prob-
ability of STI transmission or infection between sex-
ual partners, including female condoms, male 
condoms, and dental dams. 
(7) STATE.—The term ‘‘State’’ includes the 
District of Columbia, American Samoa, the Com-
monwealth of the Northern Mariana Islands, Guam, 
Puerto Rico, and the United States Virgin Islands. 
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(b) AUTHORITY TO ALLOW COMMUNITY ORGANIZA-
TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 
EDUCATION, AND SEXUAL BARRIER PROTECTION DE-
VICES IN FEDERAL CORRECTIONAL FACILITIES.— 
(1) DIRECTIVE TO ATTORNEY GENERAL.—Not 
later than 30 days after the date of enactment of 
this Act, the Attorney General shall direct the Direc-
tor of the Bureau of Prisons to allow community or-
ganizations to, in accordance with all relevant Fed-
eral laws and regulations which govern visitation in 
correctional facilities— 
(A) distribute sexual barrier protection de-
vices in Federal correctional facilities; and 
(B) engage in STI counseling and STI pre-
vention education in Federal correctional facili-
ties. 
(2) INFORMATION
REQUIREMENT.—Any com-
munity organization permitted to distribute sexual 
barrier protection devices under paragraph (1) shall 
ensure that the persons to whom the devices are dis-
tributed are informed about the proper use and dis-
posal of sexual barrier protection devices in accord-
ance with established public health practices. Any 
community organization conducting STI counseling 
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or STI prevention education under paragraph (1) 
shall offer comprehensive sexuality education. 
(3) POSSESSION
OF
DEVICE
PROTECTED.—A 
Federal correctional facility may not, because of the 
possession or use of a sexual barrier protection de-
vice— 
(A) take adverse action against an incar-
cerated person; or 
(B) consider possession or use as evidence 
of prohibited activity for the purpose of any 
Federal correctional facility administrative pro-
ceeding. 
(4) IMPLEMENTATION.—The Attorney General 
and Bureau of Prisons shall implement this section 
according to established public health practices in a 
manner that protects the health, safety, and privacy 
of incarcerated persons and of correctional facility 
staff. 
(c) SENSE OF CONGRESS REGARDING DISTRIBUTION 
OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 
PRISON SYSTEMS.—It is the sense of the Congress that 
States should allow for the legal distribution of sexual bar-
rier protection devices in State correctional facilities to re-
duce the prevalence and spread of STIs in those facilities. 
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(d) SURVEY OF AND REPORT ON CORRECTIONAL FA-
CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 
STIS.— 
(1) SURVEY.—Not later than 180 days after 
the date of enactment of this Act, and annually 
thereafter for 5 years, the Attorney General, after 
consulting with the Secretary of Health and Human 
Services, State officials, and community organiza-
tions, shall, to the maximum extent practicable, con-
duct a survey of all Federal and State correctional 
facilities, to determine the following: 
(A) COUNSELING, TREATMENT, AND SUP-
PORTIVE SERVICES.—Whether the correctional 
facility— 
(i) requires incarcerated persons to 
participate in counseling, treatment, and 
supportive services related to STIs; or 
(ii) offers such programs to incarcer-
ated persons. 
(B) ACCESS TO SEXUAL BARRIER PROTEC-
TION DEVICES.—Whether incarcerated persons 
can— 
(i) possess sexual barrier protection 
devices; 
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(i) at intake; 
(ii) on a regular basis; and 
(iii) prior to release. 
(F) STI TEST RESULTS.—The number of 
incarcerated persons who are tested for STIs 
and the outcome of such tests at each correc-
tional facility, disaggregated to include results 
for— 
(i) the type of sexually transmitted in-
fection tested for; 
(ii) the race and ethnicity of individ-
uals tested; 
(iii) the age of individuals tested; and 
(iv) the gender of individuals tested. 
(G) PRERELEASE
REFERRAL
POLICY.— 
Whether incarcerated persons are informed 
prior to release about STI-related services or 
other health services in their communities, in-
cluding free and low-cost counseling and treat-
ment options. 
(H) PRERELEASE
REFERRALS
MADE.— 
The number of referrals to community-based 
organizations or public health facilities offering 
STI-related or other health services provided to 
incarcerated persons prior to release, and the 
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type of counseling or treatment for which the 
referral was made. 
(I) REINSTATEMENT OF MEDICAID BENE-
FITS.—Whether the correctional facility assists 
incarcerated persons that were enrolled in the 
State Medicaid program prior to their incarcer-
ation, in reinstating their enrollment upon re-
lease and whether such individuals receive refer-
rals as provided by subparagraph (G) to entities 
that accept the State Medicaid program, includ-
ing if applicable— 
(i) the number of such individuals, in-
cluding those diagnosed with HIV, that 
have been reinstated; 
(ii) a list of obstacles to reinstating 
enrollment or to making determinations of 
eligibility for reinstatement, if any; and 
(iii) the number of individuals denied 
enrollment. 
(J) OTHER ACTIONS TAKEN.—Whether the 
correctional facility has taken any other action, 
in conjunction with community organizations or 
otherwise, to reduce the prevalence and spread 
of STIs in that facility. 
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(2) PRIVACY.—In conducting the survey under 
paragraph (1), the Attorney General shall not re-
quest or retain the identity of any person who has 
sought or been offered counseling, treatment, test-
ing, or prevention education information regarding 
an STI (including information about sexual barrier 
protection devices), or who has tested positive for an 
STI. 
(3) REPORT.— 
(A) IN GENERAL.—The Attorney General 
shall transmit to Congress and make publicly 
available the results of the survey required 
under paragraph (1), both for the United 
States as a whole and disaggregated as to each 
State and each correctional facility. 
(B) DEADLINES.—To the maximum extent 
possible, the Attorney General shall— 
(i) issue the first report under sub-
paragraph (A) not later than 1 year after 
the date of enactment of this Act; and 
(ii) issue reports under subparagraph 
(A) annually thereafter for 5 years. 
(e) STRATEGY.— 
(1) DIRECTIVE TO ATTORNEY GENERAL.—The 
Attorney General, in consultation with the Secretary 
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of Health and Human Services, State officials, and 
community organizations, shall develop and imple-
ment a 5-year strategy to reduce the prevalence and 
spread of STIs in Federal and State correctional fa-
cilities. To the maximum extent possible, the strat-
egy shall be developed, transmitted to Congress, and 
made publicly available no later than 180 days after 
the transmission of the first report required under 
subsection (d)(3). 
(2) CONTENTS
OF
STRATEGY.—The strategy 
developed under paragraph (1) shall include the fol-
lowing: 
(A) PREVENTION EDUCATION.—A plan for 
improving prevention education, information, 
and training offered to incarcerated persons 
and correctional facility staff, including infor-
mation and training on sexual violence and the 
spread of STIs, and comprehensive sexuality 
education. 
(B) SEXUAL BARRIER PROTECTION DEVICE 
ACCESS.—A plan for expanding access to sexual 
barrier protection devices in correctional facili-
ties. 
(C) SEXUAL
VIOLENCE
REDUCTION.—A 
plan for reducing the incidence of sexual vio-
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763 
lence among incarcerated persons and correc-
tional facility staff, developed in consultation 
with the National Prison Rape Elimination 
Commission. 
(D) COUNSELING AND SUPPORTIVE SERV-
ICES.—A plan for expanding access to coun-
seling and supportive services related to STIs in 
correctional facilities. 
(E) TESTING.—A plan for testing incarcer-
ated persons for STIs during intake, during 
regular health exams, and prior to release, and 
that— 
(i) is conducted in accordance with 
guidelines established by the Centers for 
Disease Control and Prevention; 
(ii) includes pretest counseling; 
(iii) requires that incarcerated persons 
are notified of their option to decline test-
ing at any time; 
(iv) requires that incarcerated persons 
are confidentially notified of their test re-
sults in a timely manner; and 
(v) ensures that incarcerated persons 
testing positive for STIs receive post-test 
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counseling, care, treatment, and supportive 
services. 
(F) TREATMENT.—A plan for ensuring 
that correctional facilities have the necessary 
medicine and equipment to treat and monitor 
STIs and for ensuring that incarcerated per-
sons living with or testing positive for STIs re-
ceive and have access to care and treatment 
services. 
(G) 
STRATEGIES
FOR
DEMOGRAPHIC 
GROUPS.—A plan for developing and imple-
menting culturally appropriate, sensitive, and 
specific strategies to reduce the spread of STIs 
among demographic groups heavily impacted by 
STIs. 
(H) LINKAGES
WITH
COMMUNITIES
AND 
FACILITIES.—A plan for establishing and 
strengthening linkages to local communities and 
health facilities that— 
(i) provide counseling, testing, care, 
and treatment services; 
(ii) may receive persons recently re-
leased from incarceration who are living 
with STIs; and 
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(iii) accept payment through the State 
Medicaid program. 
(I) ENROLLMENT
IN
STATE
MEDICAID 
PROGRAMS.—Plans to ensure that— 
(i) incarcerated persons who were en-
rolled in their State Medicaid program 
prior to incarceration in a correctional fa-
cility are automatically reenrolled in such 
program upon their release; and 
(ii) incarcerated persons who were not 
enrolled in their State Medicaid program 
prior to incarceration, and who are diag-
nosed with HIV while incarcerated in a 
correctional facility, are automatically en-
rolled in such program upon their release. 
(J) OTHER PLANS.—Any other plans de-
veloped by the Attorney General for reducing 
the spread of STIs or improving the quality of 
health care in correctional facilities. 
(K) MONITORING SYSTEM.—A monitoring 
system that establishes performance goals re-
lated to reducing the prevalence and spread of 
STIs in correctional facilities and which, where 
feasible, expresses such goals in quantifiable 
form. 
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(L) MONITORING
SYSTEM
PERFORMANCE 
INDICATORS.—Performance 
indicators 
that 
measure or assess the achievement of the per-
formance goals described in subparagraph (K). 
(M) COST ESTIMATE.—A detailed estimate 
of the funding necessary to implement the 
strategy at the Federal and State levels for all 
5 years, including the amount of funds required 
by community organizations to implement the 
parts of the strategy in which they take part. 
(3) REPORT.—Not later than 1 year after the 
date of the enactment of this Act, and annually 
thereafter, the Attorney General shall transmit to 
Congress and make publicly available an annual 
progress report regarding the implementation and 
effectiveness of the strategy described in paragraph 
(1). The progress report shall include an evaluation 
of the implementation of the strategy using the mon-
itoring system and performance indicators provided 
for in subparagraphs (K) and (L) of paragraph (2). 
(f) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—There are authorized to be 
appropriated such sums as may be necessary to 
carry out this section for each of fiscal years 2021 
through 2025. 
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(2) AVAILABILITY OF FUNDS.—Amounts made 
available under paragraph (1) are authorized to re-
main available until expended. 
SEC. 757. AUTOMATIC REINSTATEMENT OR ENROLLMENT 
IN MEDICAID FOR PEOPLE WHO TEST POSI-
TIVE FOR HIV BEFORE REENTERING COMMU-
NITIES. 
(a) IN GENERAL.—Section 1902(e) of the Social Se-
curity Act (42 U.S.C. 1396a(e)) is amended by adding at 
the end the following: 
‘‘(16) ENROLLMENT OF EX-OFFENDERS.— 
‘‘(A) AUTOMATIC ENROLLMENT OR REIN-
STATEMENT.— 
‘‘(i) IN
GENERAL.—The State plan 
shall provide for the automatic enrollment 
or reinstatement of enrollment of an eligi-
ble individual— 
‘‘(I) if such individual is sched-
uled to be released from a public insti-
tution due to the completion of sen-
tence, not less than 30 days prior to 
the scheduled date of the release; and 
‘‘(II) if such individual is to be 
released from a public institution on 
parole or on probation, as soon as 
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768 
possible after the date on which the 
determination to release such indi-
vidual was made, and before the date 
such individual is released. 
‘‘(ii) EXCEPTION.—If a State makes a 
determination that an individual is not eli-
gible to be enrolled under the State plan— 
‘‘(I) on or before the date by 
which the individual would be enrolled 
under clause (i), such clause shall not 
apply to such individual; or 
‘‘(II) after such date, the State 
may terminate the enrollment of such 
individual. 
‘‘(B) RELATIONSHIP OF ENROLLMENT TO 
PAYMENT FOR SERVICES.— 
‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (A)(ii), an eligible individual 
who is enrolled, or whose enrollment is re-
instated, under subparagraph (A) shall be 
eligible for all services for which medical 
assistance is provided under the State plan 
after the date that the eligible individual is 
released from the public institution. 
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‘‘(ii) RELATIONSHIP
TO
PAYMENT 
PROHIBITION FOR INMATES.—No provision 
of this paragraph may be construed to per-
mit payment for care or services for which 
payment is excluded under subdivision (A) 
following 
paragraph 
(29) 
of 
section 
1905(a). 
‘‘(C) TREATMENT OF CONTINUOUS ELIGI-
BILITY.— 
‘‘(i) SUSPENSION FOR INMATES.—Any 
period of continuous eligibility under this 
title shall be suspended on the date an in-
dividual enrolled under this title becomes 
an inmate of a public institution (except as 
a patient of a medical institution). 
‘‘(ii) DETERMINATION OF REMAINING 
PERIOD.—Notwithstanding any changes to 
State law related to continuous eligibility 
during the time that an individual is an in-
mate of a public institution (except as a 
patient of a medical institution), subject to 
clause (iii), with respect to an eligible indi-
vidual who was subject to a suspension 
under clause (i), on the date that such in-
dividual is released from a public institu-
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tion the suspension of continuous eligibility 
under such clause shall be lifted for a pe-
riod that is equal to the time remaining in 
the period of continuous eligibility for such 
individual on the date that such period was 
suspended under such clause. 
‘‘(iii) EXCEPTION.—If a State makes 
a determination that an individual is not 
eligible to be enrolled under the State 
plan— 
‘‘(I) on or before the date that 
the suspension of continuous eligibility 
is lifted under clause (ii), such clause 
shall not apply to such individual; or 
‘‘(II) after such date, the State 
may terminate the enrollment of such 
individual. 
‘‘(D) AUTOMATIC ENROLLMENT OR REIN-
STATEMENT OF ENROLLMENT DEFINED.—For 
purposes of this paragraph, the term ‘automatic 
enrollment or reinstatement of enrollment’ 
means that the State determines eligibility for 
medical assistance under the State plan without 
a program application from, or on behalf of, the 
eligible individual, but an individual can only be 
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automatically enrolled in the State Medicaid 
plan if the individual affirmatively consents to 
being enrolled through affirmation in writing, 
by telephone, orally, through electronic signa-
ture, or through any other means specified by 
the Secretary. 
‘‘(E) ELIGIBLE
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘eligi-
ble individual’ means an individual who is an 
inmate of a public institution (except as a pa-
tient in a medical institution)— 
‘‘(i) who was enrolled under the State 
plan for medical assistance immediately be-
fore becoming an inmate of such an insti-
tution; or 
‘‘(ii) who is diagnosed with human im-
munodeficiency virus.’’. 
(b) SUPPLEMENTAL FUNDING FOR STATE IMPLE-
MENTATION OF AUTOMATIC REINSTATEMENT OF MED-
ICAID BENEFITS.— 
(1) IN GENERAL.—Subject to paragraphs (3), 
with respect to a State, for each of the first 4 cal-
endar quarters in which the State plan meets the re-
quirements of paragraph (16) of section 1902(e) of 
the Social Security Act (42 U.S.C. 1396a(e)) (as 
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added by subsection (a)), the Federal matching pay-
ments (including payments based on the Federal 
medical assistance percentage) made to such State 
under section 1903 of the Social Security Act (42 
U.S.C. 1396b) for the State expenditures described 
in paragraph (2) shall be increased by 5 percentage 
points. 
(2) EXPENDITURES.—The expenditures de-
scribed in this paragraph are the following: 
(A) Expenditures for which payment is 
available under section 1903 of the Social Secu-
rity Act (42 U.S.C. 1396b) and which are at-
tributable to strengthening the State’s enroll-
ment and administrative resources for the pur-
pose of improving processes for enrolling (or re-
instating the enrollment of) eligible individuals 
(as such term is defined in subparagraph (E) of 
paragraph (16) of section 1902(e) of the Social 
Security Act (42 U.S.C. 1396a(e)) (as amended 
by subsection (a)). 
(B) Expenditures for medical assistance 
(as such term is defined in section 1905(a) of 
the Social Security Act (42 U.S.C. 1396d(a))) 
provided to such eligible individuals. 
(3) REQUIREMENTS; LIMITATION.— 
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(A) REPORT.—A State is not eligible for 
an increase in its Federal matching payments 
under paragraph (1) unless the State agrees to 
submit to the Secretary of Health and Human 
Services, and make publicly available, a report 
that contains the information required under 
paragraph (4) by the end of the 1-year period 
during which the State receives increased Fed-
eral matching payments in accordance with that 
paragraph. 
(B) MAINTENANCE OF ELIGIBILITY.— 
(i) IN
GENERAL.—Subject to clause 
(ii), a State is not eligible for an increase 
in its Federal matching payments under 
paragraph (1) if eligibility standards, 
methodologies, or procedures under its 
State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.), or 
waiver of such a plan, are more restrictive 
than the eligibility standards, methodolo-
gies, or procedures, respectively, under 
such plan or waiver as in effect on the date 
of enactment of this Act. 
(ii) STATE REINSTATEMENT OF ELIGI-
BILITY PERMITTED.—A State that has re-
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stricted eligibility standards, methodolo-
gies, or procedures under its State plan 
under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), or a waiver of 
such plan, after the date of enactment of 
this Act, is no longer ineligible under 
clause (i) beginning with the first calendar 
quarter in which the State has reinstated 
eligibility standards, methodologies, or pro-
cedures that are no more restrictive than 
the eligibility standards, methodologies, or 
procedures, respectively, under such plan 
(or waiver) as in effect on such date. 
(C) LIMITATION OF MATCHING PAYMENTS 
TO 100 PERCENT.—In no case shall an increase 
in Federal matching payments under paragraph 
(1) result in Federal matching payments that 
exceed 100 percent of State expenditures. 
(4) REQUIRED REPORT INFORMATION.—The in-
formation that is required in the report under para-
graph (3)(A) shall include— 
(A) the results of an evaluation of the im-
pact of the implementation of the requirements 
of paragraph (16) of section 1902(e) of the So-
cial Security Act (42 U.S.C. 1396a(e)) on im-
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775 
proving the State’s processes for enrolling indi-
viduals who are released from public institu-
tions under the State Medicaid plan; 
(B) the number of individuals who were 
automatically enrolled (or whose enrollment was 
reinstated) under such paragraph during the 1- 
year period during which the State received in-
creased payments under this subsection; and 
(C) any other information that is required 
by the Secretary of Health and Human Serv-
ices. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by subsection (a) 
shall take effect 180 days after the date of the en-
actment of this Act. 
(2) RULE
FOR
CHANGES
REQUIRING
STATE 
LEGISLATION.—In the case of a State plan for med-
ical assistance under title XIX of the Social Security 
Act (42 U.S.C. 1396 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 subsection (a), the State plan shall not be 
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776 
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. 
SEC. 758. STOP HIV IN PRISON. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Stop HIV in Prison Act’’. 
(b) IN GENERAL.—The Director of the Bureau of 
Prisons (referred to in this section as the ‘‘Director’’) shall 
develop a comprehensive policy to provide HIV testing, 
treatment, and prevention for inmates within the correc-
tional setting and upon reentry. 
(c) PURPOSE.—The purposes of the policy required 
to be developed under subsection (b) shall be as follows: 
(1) To stop the spread of HIV among inmates. 
(2) To protect prison guards and other per-
sonnel from HIV infection. 
(3) To provide comprehensive medical treat-
ment to inmates who are living with HIV. 
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(4) To promote HIV awareness and prevention 
among inmates. 
(5) To encourage inmates to take personal re-
sponsibility for their health. 
(6) To reduce the risk that inmates will trans-
mit HIV to other persons in the community fol-
lowing their release from prison. 
(d) CONSULTATION.—The Director shall consult with 
appropriate officials of the Department of Health and 
Human Services, the Office of National Drug Control Pol-
icy, and the Centers for Disease Control and Prevention 
regarding the development of the policy required under 
subsection (b). 
(e) TIME LIMIT.—Not later than 1 year after the 
date of enactment of this Act, the Director shall draft ap-
propriate regulations to implement the policy required to 
be developed under subsection (b). 
(f) REQUIREMENTS
FOR POLICY.—The policy re-
quired to be developed under subsection (b) shall provide 
for the following: 
(1) TESTING
AND
COUNSELING
UPON
IN-
TAKE.— 
(A) Health care personnel shall provide 
routine HIV testing to all inmates as a part of 
a comprehensive medical examination imme-
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diately following admission to a facility. Health 
care personnel need not provide routine HIV 
testing to an inmate who is transferred to a fa-
cility from another facility if the inmate’s med-
ical records are transferred with the inmate and 
indicate that the inmate has been tested pre-
viously. 
(B) To all inmates admitted to a facility 
prior to the effective date of this policy, health 
care personnel shall provide routine HIV testing 
within no more than 6 months. HIV testing for 
these inmates may be performed in conjunction 
with other health services provided to these in-
mates by health care personnel. 
(C) All HIV tests under this paragraph 
shall comply with the opt-out provision. 
(2) PRE-TEST AND POST-TEST COUNSELING.— 
Health care personnel shall provide confidential pre- 
test and post-test counseling to all inmates who are 
tested for HIV. Counseling may be included with 
other general health counseling provided to inmates 
by health care personnel. 
(3) HIV PREVENTION EDUCATION.— 
(A) Health care personnel shall improve 
HIV awareness through frequent educational 
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programs for all inmates. HIV educational pro-
grams may be provided by community-based or-
ganizations, local health departments, and in-
mate peer educators. 
(B) HIV educational materials shall be 
made available to all inmates at orientation, at 
health care clinics, at regular educational pro-
grams, and prior to release. Both written and 
audiovisual materials shall be made available to 
all inmates. 
(C)(i) The HIV educational programs and 
materials under this paragraph shall include in-
formation on— 
(I) modes of transmission, including 
transmission through tattooing, sexual con-
tact, and intravenous drug use; 
(II) prevention methods; 
(III) treatment; and 
(IV) disease progression. 
(ii) The programs and materials shall be 
culturally sensitive, written or designed for low- 
literacy levels, available in a variety of lan-
guages, and present scientifically accurate in-
formation in a clear and understandable man-
ner. 
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(4) HIV TESTING UPON REQUEST.— 
(A) Health care personnel shall allow in-
mates to obtain HIV tests upon request once 
per year or whenever an inmate has a reason to 
believe the inmate may have been exposed to 
HIV. Health care personnel shall, both orally 
and in writing, inform inmates, during orienta-
tion and periodically throughout incarceration, 
of their right to obtain HIV tests. 
(B) Health care personnel shall encourage 
inmates to request HIV tests if the inmate is 
sexually active, has been raped, uses intra-
venous drugs, receives a tattoo, or if the inmate 
is concerned that the inmate may have been ex-
posed to HIV. 
(C) An inmate’s request for an HIV test 
shall not be considered an indication that the 
inmate has put him/herself at risk of infection 
and/or committed a violation of prison rules. 
(5) HIV TESTING OF PREGNANT WOMAN.— 
(A) Health care personnel shall provide 
routine HIV testing to all inmates who become 
pregnant. 
(B) All HIV tests under this paragraph 
shall comply with the opt-out provision. 
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781 
(6) COMPREHENSIVE TREATMENT.— 
(A) Health care personnel shall provide all 
inmates who test positive for HIV— 
(i) 
timely, 
comprehensive 
medical 
treatment; 
(ii) confidential counseling on man-
aging their medical condition and pre-
venting its transmission to other persons; 
and 
(iii) voluntary partner notification 
services. 
(B) Health care provided under this para-
graph shall be consistent with current Depart-
ment of Health and Human Services guidelines 
and standard medical practice. Health care per-
sonnel shall discuss treatment options, the im-
portance of adherence to antiretroviral therapy, 
and the side effects of medications with inmates 
receiving treatment. 
(C) Health care personnel and pharmacy 
personnel shall ensure that the facility for-
mulary contains all Food and Drug Administra-
tion-approved medications necessary to provide 
comprehensive treatment for inmates living with 
HIV, and that the facility maintains adequate 
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783 
quest and obtain these services as routine med-
ical services. 
(8) TESTING, COUNSELING, AND
REFERRAL 
PRIOR TO REENTRY.— 
(A) Health care personnel shall provide 
routine HIV testing to all inmates not earlier 
than 3 months prior to their release and re-
entry into the community. Inmates who are al-
ready known to be infected need not be tested 
again. This requirement may be waived if an in-
mate’s release occurs without sufficient notice 
to the Bureau to allow health care personnel to 
perform a routine HIV test and notify the in-
mate of the results. 
(B) All HIV tests under this paragraph 
shall comply with the opt-out provision. 
(C) To all inmates who test positive for 
HIV and all inmates who already are known to 
have HIV, health care personnel shall provide— 
(i) confidential prerelease counseling 
on managing their medical condition in the 
community, accessing appropriate treat-
ment and services in the community, and 
preventing the transmission of their condi-
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784 
tion to family members and other persons 
in the community; 
(ii) referrals to appropriate health 
care providers and social service agencies 
in the community that meet the inmate’s 
individual needs, including voluntary part-
ner notification services and prevention 
counseling services for people living with 
HIV; and 
(iii) a 30-day supply of any medically 
necessary medications the inmate is cur-
rently receiving. 
(9) OPT-OUT PROVISION.—Inmates shall have 
the right to refuse routine HIV testing. Inmates 
shall be informed both orally and in writing of this 
right. Oral and written disclosure of this right may 
be included with other general health information 
and counseling provided to inmates by health care 
personnel. If an inmate refuses a routine test for 
HIV, health care personnel shall make a note of the 
inmate’s refusal in the inmate’s confidential medical 
records. However, the inmate’s refusal shall not be 
considered a violation of prison rules or result in dis-
ciplinary action. Any reference in this section to the 
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‘‘opt-out provision’’ shall be deemed a reference to 
the requirement of this paragraph. 
(10) EXCLUSION OF TESTS PERFORMED UNDER 
SECTION 4014(b) FROM THE DEFINITION OF ROU-
TINE
HIV
TESTING.—HIV testing of an inmate 
under section 4014(b) of title 18, United States 
Code, is not routine HIV testing for the purposes of 
the opt-out provision. Health care personnel shall 
document the reason for testing under section 
4014(b) of title 18, United States Code, in the in-
mate’s confidential medical records. 
(11) TIMELY
NOTIFICATION
OF
TEST
RE-
SULTS.—Health care personnel shall provide timely 
notification to inmates of the results of HIV tests. 
(g) CHANGES IN EXISTING LAW.— 
(1) SCREENING IN GENERAL.—Section 4014(a) 
of title 18, United States Code, is amended— 
(A) by striking ‘‘for a period of 6 months 
or more’’; 
(B) by striking ‘‘, as appropriate,’’; and 
(C) by striking ‘‘if such individual is deter-
mined to be at risk for infection with such virus 
in accordance with the guidelines issued by the 
Bureau of Prisons relating to infectious disease 
management’’ and inserting ‘‘unless the indi-
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786 
vidual declines. The Attorney General shall also 
cause such individual to be so tested before re-
lease unless the individual declines.’’. 
(2) INADMISSIBILITY OF HIV TEST RESULTS IN 
CIVIL
AND
CRIMINAL
PROCEEDINGS.—Section 
4014(d) of title 18, United States Code, is amended 
by inserting ‘‘or under the Stop HIV in Prison Act’’ 
after ‘‘under this section’’. 
(3) SCREENING AS PART OF ROUTINE SCREEN-
ING.—Section 4014(e) of title 18, United States 
Code, is amended by adding at the end the fol-
lowing: ‘‘Such rules shall also provide that the initial 
test under this section be performed as part of the 
routine health screening conducted at intake.’’. 
(h) REPORTING REQUIREMENTS.— 
(1) REPORT ON HEPATITIS, LIVER, AND OTHER 
DISEASES.—Not later than 1 year after the date of 
enactment of this Act, the Director shall provide a 
report to the Congress on the policies and proce-
dures of the Bureau of Prisons to provide testing, 
treatment, and prevention education programs for 
hepatitis, liver failure, and other liver-related dis-
eases transmitted through sexual activity, intra-
venous drug use, or other means. The Director shall 
consult with appropriate officials of the Department 
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787 
of Health and Human Services, the Office of Na-
tional Drug Control Policy, the Office of National 
AIDS Policy, and the Centers for Disease Control 
and Prevention regarding the development of this re-
port. 
(2) ANNUAL REPORTS.— 
(A) GENERALLY.—Not later than 2 years 
after the date of enactment of this Act, and 
then annually thereafter, the Director shall re-
port to Congress on the incidence among in-
mates of diseases transmitted through sexual 
activity and intravenous drug use. 
(B) MATTERS
PERTAINING
TO
VARIOUS 
DISEASES.—Each report under paragraph (1) 
shall discuss— 
(i) the incidence among inmates of 
HIV, hepatitis, and other diseases trans-
mitted through sexual activity and intra-
venous drug use; and 
(ii) updates on the testing, treatment, 
and prevention education programs for 
these diseases conducted by the Bureau of 
Prisons. 
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(C) 
MATTERS
PERTAINING
TO
HIV 
ONLY.—Each report under paragraph (1) shall 
also include— 
(i) the number of inmates who tested 
positive for HIV upon intake; 
(ii) the number of inmates who tested 
positive prior to reentry; 
(iii) the number of inmates who were 
not tested prior to reentry because they 
were released without sufficient notice; 
(iv) the number of inmates who opted- 
out of taking the test; 
(v) the number of inmates who were 
tested under section 4014(b) of title 18, 
United States Code; and 
(vi) the number of inmates under 
treatment for HIV. 
(D) CONSULTATION.—The Director shall 
consult with appropriate officials of the Depart-
ment of Health and Human Services, the Office 
of National Drug Control Policy, and the Cen-
ters for Disease Control and Prevention regard-
ing the development of each report under para-
graph (1). 
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789 
SEC. 759. SUPPORT DATA SYSTEM REVIEW AND INDICA-
TORS FOR MONITORING HIV CARE. 
The Secretary of Health and Human Services, in col-
laboration with the Assistant Secretary for Health, the Di-
rector of the Office of Infectious Disease and HIV/AIDS 
Policy, the Director of the Centers for Disease Control and 
Prevention, the Assistant Secretary for Mental Health and 
Substance Use, the Director of the Department of Hous-
ing and Urban Development, the Director of the Office 
of AIDS Research, the Administrator of the Health Re-
sources and Services Administration, and the Adminis-
trator of the Centers for Medicare & Medicaid Services, 
shall expand and coordinate efforts to align metrics across 
agencies and modify Federal data systems, to— 
(1) adopt the National Academy of Medicine’s 
clinical HIV care indicators as the core metrics for 
monitoring the quality of HIV care, mental health, 
substance abuse, and supportive services; 
(2) better enable assessment of the impact of 
the National HIV/AIDS Strategy and the Patient 
Protection and Affordable Care Act (Public Law 
111–148) on improving HIV care and access to sup-
portive services for individuals with HIV; 
(3) expand the demographic data elements to be 
captured by Federal data systems relevant to HIV 
care to permit calculation of the indicators for sub-
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790 
groups of the population of people with diagnosed 
HIV infection, including— 
(A) age; 
(B) race; 
(C) ethnicity; 
(D) sex (assigned at birth); 
(E) gender identity; 
(F) sexual orientation; 
(G) current geographic marker of resi-
dence; 
(H) income or poverty level; and 
(I) primary means of reimbursement for 
medical services (including a State Medicaid 
program, the Medicare program, the Ryan 
White HIV Program, private insurance, health 
maintenance organizations, and no coverage); 
and 
(4) streamline data collection and systematically 
review all existing reporting requirements for feder-
ally funded HIV programs to ensure that only essen-
tial data are collected. 
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791 
SEC. 760. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 
ENDING THE HIV EPIDEMIC: A PLAN FOR 
AMERICA. 
Title II of the Public Health Service Act (42 U.S.C. 
202 et seq.) is amended by inserting after section 241 the 
following: 
‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 
OF NATIONAL HIV/AIDS STRATEGY. 
‘‘(a) TRANSFER AUTHORIZATION.—Of the discre-
tionary appropriations made available to the Department 
of Health and Human Services for any fiscal year for pro-
grams and activities that, as determined by the Secretary, 
pertain to HIV, the Secretary may transfer up to 1 per-
cent of such appropriations to the Office of the Assistant 
Secretary for Health for implementation of the Ending the 
HIV Epidemic: A Plan for America. 
‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 
30 days before making any transfer under this section, 
the Secretary shall give notice of the transfer to the Con-
gress. 
‘‘(c) DEFINITIONS.—In this section, the term ‘End-
ing the HIV Epidemic: A Plan for America’ means the 
initiative that seeks to reduce the number of new HIV in-
fections in the United States by 75 percent by 2025, and 
then by at least 90 percent by 2030, for an estimated 
250,000 total HIV infections averted.’’. 
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Subtitle F—Diabetes 
SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 
Subpart 3 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285c et seq.) is amended by adding 
at the end the following new section: 
‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 
‘‘(a) IN GENERAL.—The Director of NIH shall ex-
pand, intensify, and support ongoing research and other 
activities with respect to prediabetes and diabetes, particu-
larly type 2, in minority populations. 
‘‘(b) RESEARCH.— 
‘‘(1) DESCRIPTION.—Research under subsection 
(a) shall include investigation into— 
‘‘(A) the causes of diabetes, including so-
cioeconomic, geographic, clinical, environmental, 
genetic, and other factors that may contribute 
to increased rates of diabetes in minority popu-
lations; and 
‘‘(B) the causes of increased incidence of 
diabetes complications in minority populations, 
and possible interventions to decrease such inci-
dence. 
‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 
In conducting and supporting research described in 
subsection (a), the Director of NIH shall seek to in-
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clude minority participants as study subjects in clin-
ical trials. 
‘‘(c) REPORT; COMPREHENSIVE PLAN.— 
‘‘(1) IN
GENERAL.—The Diabetes Mellitus 
Interagency Coordinating Committee shall— 
‘‘(A) prepare and submit to the Congress, 
not later than 6 months after the date of enact-
ment of this section, a report on Federal re-
search and public health activities with respect 
to prediabetes and diabetes in minority popu-
lations; and 
‘‘(B) develop and submit to Congress, not 
later than 1 year after the date of enactment of 
this section, an effective and comprehensive 
Federal plan (including all appropriate Federal 
health programs) to address prediabetes and di-
abetes in minority populations. 
‘‘(2) CONTENTS.—The report under paragraph 
(1)(A) shall at minimum address each of the fol-
lowing: 
‘‘(A) Research on diabetes and prediabetes 
in minority populations, including such research 
on— 
‘‘(i) genetic, behavioral, and environ-
mental factors; and 
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‘‘(ii) prevention and complications 
among individuals within these populations 
who have already developed diabetes. 
‘‘(B) Surveillance and data collection on 
diabetes and prediabetes in minority popu-
lations, including with respect to— 
‘‘(i) efforts to better determine the 
prevalence of diabetes among Asian-Amer-
ican and Pacific Islander subgroups; and 
‘‘(ii) efforts to coordinate data collec-
tion on the American Indian population. 
‘‘(C) Community-based interventions to ad-
dress diabetes and prediabetes targeting minor-
ity populations, including— 
‘‘(i) the evidence base for such inter-
ventions; 
‘‘(ii) the cultural appropriateness of 
such interventions; and 
‘‘(iii) efforts to educate the public on 
the causes and consequences of diabetes. 
‘‘(D) Education and training programs for 
health 
professionals 
(including 
community 
health workers) on the prevention and manage-
ment of diabetes and its related complications 
that is supported by the Health Resources and 
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Services Administration, including such pro-
grams supported by— 
‘‘(i) the National Health Service 
Corps; or 
‘‘(ii) the community health centers 
program under section 330. 
‘‘(d) EDUCATION.—The Director of NIH shall— 
‘‘(1) through the National Institute on Minority 
Health and Health Disparities and the National Di-
abetes Education Program— 
‘‘(A) make grants to programs funded 
under section 464z–4 for the purpose of estab-
lishing a mentoring program for health care 
professionals to be more involved in weight 
counseling, obesity research, and nutrition; and 
‘‘(B) provide for the participation of mi-
nority health professionals in diabetes-focused 
research programs; and 
‘‘(2) make grants for programs to establish a 
pipeline from high school to professional school that 
will increase minority representation in diabetes-fo-
cused health fields by expanding Minority Access to 
Research Careers program internships and men-
toring opportunities for recruitment. 
‘‘(e) DEFINITIONS.—For purposes of this section: 
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‘‘(1) DIABETES
MELLITUS
INTERAGENCY
CO-
ORDINATING
COMMITTEE.—The ‘Diabetes Mellitus 
Interagency Coordinating Committee’ means the Di-
abetes Mellitus Interagency Coordinating Committee 
established under section 429. 
‘‘(2) MINORITY POPULATION.—The term ‘mi-
nority population’ means a racial and ethnic minor-
ity group, as defined in section 1707.’’. 
SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.), as amended by section 721, is 
further amended by inserting after section 317W the fol-
lowing section: 
‘‘SEC. 317X. DIABETES IN MINORITY POPULATIONS. 
‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall conduct and support 
research and public health activities with respect to 
diabetes in minority populations. 
‘‘(2) CERTAIN
ACTIVITIES.—Activities under 
paragraph (1) regarding diabetes in minority popu-
lations shall include the following: 
‘‘(A) Further enhancing the National 
Health and Nutrition Examination Survey by 
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oversampling Asian Americans, Native Hawai-
ians, and Pacific Islanders in appropriate geo-
graphic areas to better determine the preva-
lence of diabetes in such populations as well as 
to improve the data collection of diabetes pene-
tration disaggregated into major ethnic groups 
within such populations. The Secretary shall en-
sure that any such oversampling does not re-
duce the oversampling of other minority popu-
lations including African-American and Latino 
populations. 
‘‘(B) Through the Division of Diabetes 
Translation— 
‘‘(i) providing for prevention research 
to better understand how to influence 
health care systems changes to improve 
quality of care being delivered to such pop-
ulations; 
‘‘(ii) carrying out model demonstra-
tion projects to design, implement, and 
evaluate effective diabetes prevention and 
control interventions for minority popu-
lations, including culturally appropriate 
community-based interventions; 
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‘‘(iii) developing and implementing a 
strategic plan to reduce diabetes in minor-
ity populations through applied research to 
reduce disparities and culturally and lin-
guistically appropriate community-based 
interventions; 
‘‘(iv) supporting, through the national 
diabetes prevention program under section 
399V–3, diabetes prevention program sites 
in underserved regions highly impacted by 
diabetes; and 
‘‘(v) implementing, through the na-
tional diabetes prevention program under 
section 399V–3, a demonstration program 
developing new metrics measuring health 
outcomes related to diabetes that can be 
stratified by specific minority populations. 
‘‘(b) EDUCATION.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall direct the Division of Diabetes Translation 
to conduct and support both programs to educate the pub-
lic on diabetes in minority populations and programs to 
educate minority populations about the causes and effects 
of diabetes. 
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‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 
ACTIVITIES, AND ACCESS.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention and the National Diabetes Education Program, 
shall conduct and support programs to educate specific 
minority populations through culturally appropriate and 
linguistically appropriate information campaigns about 
prevention of, and managing, diabetes. 
‘‘(d) DEFINITION.—For purposes of this section, the 
term ‘minority population’ means a racial and ethnic mi-
nority group, as defined in section 1707.’’. 
SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended by section 733, is 
further amended by adding at the end the following new 
section: 
‘‘SEC. 399V–9. PROGRAMS TO EDUCATE HEALTH PRO-
VIDERS ON THE CAUSES AND EFFECTS OF DI-
ABETES IN MINORITY POPULATIONS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Health Resources and Services Admin-
istration, shall conduct and support programs described 
in subsection (b) to educate health professionals on the 
causes and effects of diabetes in minority populations. 
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‘‘(b) PROGRAMS.—Programs described in this sub-
section, with respect to education on diabetes in minority 
populations, shall include the following: 
‘‘(1) Giving priority, under the primary care 
training and enhancement program under section 
747— 
‘‘(A) to awarding grants to focus on or ad-
dress diabetes; and 
‘‘(B) to adding minority populations to the 
list of vulnerable populations that should be 
served by such grants. 
‘‘(2) Providing additional funds for the Health 
Careers Opportunity Program, the Centers for Ex-
cellence, and the Minority Faculty Fellowship Pro-
gram to partner with the Office of Minority Health 
under section 1707 and the National Institutes of 
Health to strengthen programs for career opportuni-
ties focused on diabetes treatment and care within 
underserved regions highly impacted by diabetes. 
‘‘(3) Developing a diabetes focus within, and 
providing additional funds for, the National Health 
Service Corps scholarship program— 
‘‘(A) to place individuals in areas that are 
disproportionately affected by diabetes and to 
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provide diabetes treatment and care in such 
areas; and 
‘‘(B) to provide such individuals continuing 
medical education specific to diabetes care.’’. 
SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended by section 773, is 
further amended by adding at the end the following sec-
tion: 
‘‘SEC. 399V–10. RESEARCH, EDUCATION, AND OTHER ACTIVI-
TIES REGARDING DIABETES IN AMERICAN IN-
DIAN POPULATIONS. 
‘‘In addition to activities under sections 399V–6 and 
434B, the Secretary, acting through the Indian Health 
Service and in collaboration with other appropriate Fed-
eral agencies, shall— 
‘‘(1) conduct and support research and other 
activities with respect to diabetes; and 
‘‘(2) coordinate the collection of data on clini-
cally and culturally appropriate diabetes treatment, 
care, prevention, and services by health care profes-
sionals to the American Indian population.’’. 
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SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 
The Secretary of Health and Human Services shall 
seek to enter into an arrangement with the National Acad-
emy of Medicine under which the National Academy will— 
(1) not later than 1 year after the date of en-
actment of this Act, submit to Congress an updated 
version of the 2002 report entitled ‘‘Unequal Treat-
ment: Confronting Racial and Ethnic Disparities in 
Health Care’’; and 
(2) in such updated version, address how racial 
and ethnic health disparities have changed since the 
publication of the original report. 
Subtitle G—Lung Disease 
SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU-
CATION AND PREVENTION PROGRAM. 
(a) FINDINGS.—Congress finds as follows: 
(1) The prevalence of asthma has increased 
since 1980 and affects more than 26,000,000 people 
in the United States. 
(2) Significant disparities in asthma morbidity 
and mortality exist for both adults and children par-
ticularly for low-income and minority populations, 
particularly African Americans and Puerto Ricans. 
(3) African-American children are twice as like-
ly to have asthma as White children. 
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(4) In 2016, almost 4,500,000 non-Hispanic 
African Americans reported having asthma. African 
Americans with asthma are 3 times as likely to visit 
the emergency department and twice as likely to get 
hospitalized as White patients with asthma. 
(5) Puerto Ricans are 3.4 times as likely to die 
from asthma compared with all other Hispanic or 
Latino groups. Overall Hispanic Americans are 30 
percent more likely to be hospitalized for asthma 
than non-Hispanic Whites. 
(6) The majority of adults with asthma are 
women. 
(b) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall convene a working group com-
prised of patient groups, nonprofit organizations, medical 
societies, and other relevant governmental and nongovern-
mental entities, including those that participate in the Na-
tional Asthma Education and Prevention Program, to de-
velop a report to Congress that— 
(1) catalogs, with respect to asthma prevention, 
management, and surveillance— 
(A) the activities of the Federal Govern-
ment, including identifying all Federal pro-
grams that carry out asthma-related activities, 
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as well as assessment of the progress of the 
Federal Government and States, with respect to 
achieving the goals of Healthy People 2020; 
and 
(B) the activities of other entities that par-
ticipate in the program, including nonprofit or-
ganizations, patient advocacy groups, and med-
ical societies; and 
(2) makes recommendations for the future di-
rection of asthma activities, in consultation with re-
searchers from the National Institutes of Health and 
other member bodies of the National Asthma Edu-
cation and Prevention Program who are qualified to 
review and analyze data and evaluate interventions, 
including— 
(A) a description of how the Federal Gov-
ernment may better coordinate and improve its 
response to asthma including identifying any 
barriers that may exist; 
(B) a description of how the Federal Gov-
ernment may continue, expand, and improve its 
private-public partnerships with respect to asth-
ma including identifying any barriers that may 
exist; 
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(C) identification of steps that may be 
taken to reduce the— 
(i) morbidity, mortality, and overall 
prevalence of asthma; 
(ii) financial burden of asthma on so-
ciety; 
(iii) burden of asthma on dispropor-
tionately affected areas, particularly those 
in medically underserved populations (as 
defined in section 330(b)(3) of the Public 
Health 
Service 
Act 
(42 
U.S.C. 
254b(b)(3))); and 
(iv) burden of asthma as a chronic 
disease; 
(D) identification of programs and policies 
that have achieved the steps described in sub-
paragraph (C), and steps that may be taken to 
expand such programs and policies to benefit 
larger populations; and 
(E) recommendations for future research 
and interventions. 
(c) REPORT TO CONGRESS.—At the end of the 5-year 
period following the submission of the report under this 
section, the National Asthma Education and Prevention 
Program shall evaluate the analyses and recommendations 
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under such report and determine whether a new report 
to the Congress is necessary, and make appropriate rec-
ommendations to the Congress. 
SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 
FOR DISEASE CONTROL AND PREVENTION. 
Section 317I of the Public Health Service Act (42 
U.S.C. 247b–10) is amended to read as follows: 
‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 
FOR DISEASE CONTROL AND PREVENTION. 
‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 
EDUCATION
TO
THE PUBLIC.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall collaborate with State and local 
health departments to conduct activities, including the 
provision of information and education to the public re-
garding asthma including— 
‘‘(1) deterring the harmful consequences of un-
controlled asthma; and 
‘‘(2) disseminating health education and infor-
mation regarding prevention of asthma episodes and 
strategies for managing asthma. 
‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 
The Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, shall collaborate with 
State and local health departments to develop State plans 
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incorporating public health responses to reduce the burden 
of asthma, particularly regarding disproportionately af-
fected populations. 
‘‘(c) COMPILATION OF DATA.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall, in cooperation with State and local 
public health officials— 
‘‘(1) conduct asthma surveillance activities to 
collect data on the prevalence and severity of asth-
ma, the effectiveness of public health asthma inter-
ventions, and the quality of asthma management, in-
cluding— 
‘‘(A) collection of household data on the 
local burden of asthma; 
‘‘(B) surveillance of health care facilities; 
and 
‘‘(C) collection of data not containing indi-
vidually identifiable information from electronic 
health records or other electronic communica-
tions; 
‘‘(2) compile and annually publish data regard-
ing the prevalence and incidence of childhood asth-
ma, the child mortality rate, and the number of hos-
pital admissions and emergency department visits by 
children associated with asthma nationally and in 
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each State and at the county level by age, sex, race, 
and ethnicity, as well as lifetime and current preva-
lence; and 
‘‘(3) compile and annually publish data regard-
ing the prevalence and incidence of adult asthma, 
the adult mortality rate, and the number of hospital 
admissions and emergency department visits by 
adults associated with asthma nationally and in each 
State and at the county level by age, sex, race, eth-
nicity, industry, and occupation, as well as lifetime 
and current prevalence. 
‘‘(d) COORDINATION OF DATA COLLECTION.—The 
Director of the Centers for Disease Control and Preven-
tion, in conjunction with State and local health depart-
ments, shall coordinate data collection activities under 
subsection (c)(2) so as to maximize comparability of re-
sults. 
‘‘(e) COLLABORATION.—The Centers for Disease 
Control and Prevention are encouraged to collaborate with 
national, State, and local nonprofit organizations to pro-
vide information and education about asthma, and to 
strengthen such collaborations when possible. 
‘‘(f) ADDITIONAL FUNDING.—In addition to any 
other authorization of appropriations that is available to 
the Centers for Disease Control and Prevention for the 
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purpose of carrying out this section, there are authorized 
to be appropriated to such Centers such sums as may be 
necessary for each of fiscal years 2021 through 2025 for 
the purpose of carrying out this section.’’. 
SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM-
PAIGN. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
(1) enhance the annual campaign by the De-
partment of Health and Human Services to increase 
the number of people vaccinated each year for influ-
enza and pneumonia; and 
(2) include in such campaign the use of written 
educational materials, public service announcements, 
physician education, and any other means which the 
Secretary deems effective. 
(b) MATERIALS AND ANNOUNCEMENTS.—In carrying 
out the annual campaign described in subsection (a), the 
Secretary of Health and Human Services shall ensure 
that— 
(1) educational materials and public service an-
nouncements are readily and widely available in 
communities experiencing disparities in the incidence 
and mortality rates of influenza and pneumonia; and 
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(2) the campaign uses targeted, culturally ap-
propriate messages and messengers to reach under-
served communities. 
(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 
2021 through 2025. 
SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 
ACTION PLAN. 
(a) FINDINGS.—Congress finds as follows: 
(1) Chronic obstructive pulmonary disease (re-
ferred to in this subsection as ‘‘COPD’’) refers to 
chronic bronchitis and emphysema, incurable dis-
eases that make it difficult to exhale all the air from 
one’s lungs, and that can cause persistent coughing, 
shortness of breath, and sputum. 
(2) COPD exacerbations—episodes of acute dif-
ficulty breathing and moderate to severe fatigue— 
are dangerous, and their treatment often requires 
hospitalization. 
(3) While smoking is the primary risk factor for 
COPD, other risk factors include air pollution, occu-
pational exposures, heredity, a history of childhood 
respiratory infections, and socioeconomic status. 
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(4) It is estimated that over 13,500,000 adults 
in the United States have COPD. 
(5) COPD is the third-leading cause of death in 
the United States, claiming over 134,000 lives in 
2010. 
(6) Since 2000, deaths for women with COPD 
have exceeded deaths in men. 
(7) Although African Americans have a lower 
prevalence of COPD in the United States, research-
ers have shown that African Americans may be 
underdiagnosed. Furthermore, research has shown 
that African Americans develop COPD with less cu-
mulative smoke exposure and at a younger age. 
(b) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention shall conduct, support, 
and expand public health strategies, prevention, diagnosis, 
surveillance, and public and professional awareness activi-
ties regarding chronic obstructive pulmonary disease. 
(c) NATIONAL ACTION PLAN.— 
(1) DEVELOPMENT.—Not later than 2 years 
after the date of the enactment of this Act, the Di-
rector of the National Heart, Lung, and Blood Insti-
tute, in consultation with the Director of the Centers 
for Disease Control and Prevention, shall develop a 
national action plan to address chronic obstructive 
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pulmonary disease in the United States with partici-
pation from patients, caregivers, health profes-
sionals, patient advocacy organizations, researchers, 
providers, public health professionals, and other 
stakeholders. 
(2) CONTENTS.—At a minimum, such plan 
shall include recommendations for— 
(A) public health interventions for the pur-
pose of implementation of the national plan; 
(B) biomedical, health services, and public 
health research on chronic obstructive pul-
monary disease; and 
(C) inclusion of chronic obstructive pul-
monary disease in the health data collections of 
all Federal agencies. 
(3) CONSIDERATION.—In developing such plan, 
the Director of the National Heart, Lung, and Blood 
Institute shall consider the recommendations and 
findings of the National Academy of Medicine in the 
report entitled ‘‘A Nationwide Framework for Sur-
veillance of Cardiovascular and Chronic Lung Dis-
eases’’ (July 22, 2011). 
(d) CHRONIC DISEASE PREVENTION PROGRAMS.— 
The Director of the National Heart, Lung, and Blood In-
stitute shall carry out the following: 
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(1) Conduct public education and awareness ac-
tivities with patient and professional organizations 
to stimulate earlier diagnosis and improve patient 
outcomes from treatment of chronic obstructive pul-
monary disease. To the extent known and relevant, 
such public education and awareness activities shall 
reflect differences in chronic obstructive pulmonary 
disease by cause (tobacco, environmental, occupa-
tional, biological, and genetic) and include a focus 
on outreach to undiagnosed and, as appropriate, mi-
nority populations. 
(2) Supplement and expand upon the activities 
of the National Heart, Lung, and Blood Institute by 
making grants to nonprofit organizations, State and 
local jurisdictions, and Indian tribes for the purpose 
of reducing the burden of chronic obstructive pul-
monary disease, especially in disproportionately im-
pacted communities, through public health interven-
tions and related activities. 
(3) Coordinate with the Centers for Disease 
Control and Prevention, the Indian Health Service, 
the Health Resources and Services Administration, 
and the Department of Veterans Affairs to develop 
pilot programs to demonstrate best practices for the 
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diagnosis and management of chronic obstructive 
pulmonary disease. 
(4) Develop improved techniques and identify 
best practices, in coordination with the Secretary of 
Veterans Affairs, for assisting chronic obstructive 
pulmonary disease patients to successfully stop 
smoking, including identification of subpopulations 
with different needs. Initiatives under this para-
graph may include research to determine whether 
successful smoking cessation strategies are different 
for chronic obstructive pulmonary disease patients 
compared to such strategies for patients with other 
chronic diseases. 
(e) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 
PROGRAMS.—The Director of the Centers for Disease 
Control and Prevention shall— 
(1) support research into the environmental and 
occupational causes and biological mechanisms that 
contribute to chronic obstructive pulmonary disease; 
and 
(2) develop and disseminate public health inter-
ventions that will lessen the impact of environmental 
and occupational causes of chronic obstructive pul-
monary disease. 
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(f) DATA COLLECTION.—Not later than 180 days 
after the enactment of this Act, the Director of the Na-
tional Heart, Lung, and Blood Institute and the Director 
of the Centers for Disease Control and Prevention, acting 
jointly, shall assess the depth and quality of information 
on chronic obstructive pulmonary disease that is collected 
in surveys and population studies conducted by the Cen-
ters for Disease Control and Prevention, including wheth-
er there are additional opportunities for information to be 
collected in the National Health and Nutrition Examina-
tion Survey, the National Health Interview Survey, and 
the Behavioral Risk Factors Surveillance System surveys. 
The Director of the National Heart, Lung, and Blood In-
stitute shall include the results of such assessment in the 
national action plan under subsection (c). 
(g) 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 
2021 through 2025. 
Subtitle H—Tuberculosis 
SEC. 781. ELIMINATION OF ALL FORMS OF TUBERCULOSIS. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘End Tuberculosis Act’’. 
(b) FINDINGS.—Congress makes the following find-
ings: 
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(1) In the United States, 9,025 people were di-
agnosed with tuberculosis (referred to in this section 
as ‘‘TB’’) in 2018. 
(2) Disparities in TB exist and significantly im-
pact minority communities in the United States. The 
Centers for Disease Control and Prevention (re-
ferred to in this section as ‘‘CDC’’) finds that 70 
percent of people diagnosed with TB in 2018 self- 
identified as racial and ethnic minorities. 
(3) African Americans comprised 20 percent of 
people diagnosed with TB during 2018. The popu-
lation-adjusted rate of TB among African Americans 
is 1.7 times higher than the national total, and 8.0 
times higher than among Whites. 
(4) Asian Americans, Native Hawaiians, and 
other Pacific Islanders comprised 37 percent of peo-
ple diagnosed with TB during 2018. The population- 
adjusted rate of TB among Asian Americans is 6.2 
times higher than the national total, and 31 times 
higher than among Whites. The population-adjusted 
rate of TB among Native Hawaiians and other Pa-
cific Islanders is 4.8 times higher than the national 
total, and 23.2 times higher than among Whites. 
(5) Hispanics and Latinos comprised 26 per-
cent of people diagnosed with TB during 2018. The 
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population-adjusted rate of TB among Hispanics 
and Latinos is 1.6 times higher than the national 
total, and 8.0 times higher than among Whites. 
(6) TB is both preventable and curable, but the 
current rate of decline of TB in the United States 
remains too slow to achieve TB elimination in this 
century. 
(7) TB is transmitted through the air when a 
person who has TB disease in their lungs coughs or 
sneezes. People who are in close proximity to the 
person with TB can breathe in the TB bacteria, and 
the bacteria will initially settle in their lungs. With-
out proper and timely diagnosis and access to treat-
ment, the TB bacteria may grow and spread to 
other parts of their body. 
(8) As many as 13,000,000 people in the 
United States may have latent TB Infection (re-
ferred to in this section as ‘‘LTBI’’). People with 
LTBI have TB bacteria in their bodies, but their 
immune system is containing the bacteria, and they 
are not sick, nor do they have any current risk of 
spreading TB to others. LTBI can activate into in-
fectious, life-threatening TB if not treated. Modeling 
has shown that eliminating TB is not possible with-
out addressing LTBI. 
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(9) Comorbidities associated with TB include 
cancer, diabetes mellitus, and HIV. People with 
these medical conditions and compromised immune 
systems are more likely to develop active TB disease 
and to have worse outcomes from TB. 
(10) Forms of active TB that do not show drug 
resistance are classified as drug-susceptible TB (re-
ferred to in this section as ‘‘DS–TB’’). Drug-resist-
ant TB (referred to in this section as ‘‘DR–TB’’) is 
a rising threat to the public health of the United 
States. DR–TB that exhibits resistance to two or 
more first-line drugs is referred to as multi-drug re-
sistant TB (referred to in this section as ‘‘MDR– 
TB’’). MDR–TB that also is resistant to at least 
one injectable second-line medication and at least 
one fluoroquinolone is classified as extensively drug- 
resistant TB (referred to in this section as ‘‘XDR– 
TB’’). 
(11) Approximately 97 people in the United 
States were diagnosed with MDR–TB in 2018. One 
person was diagnosed with XDR–TB in the same 
year. 
(12) In the United States, $480 million was 
spent in 2018 to treat TB; direct treatment costs 
average $19,000 to treat a patient with DS–TB, 
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$175,000 to treat a patient with MDR–TB, and 
$544,000 to treat a patient with XDR–TB. When 
factoring in productivity losses during treatment, 
DS–TB averages $46,000, MDR–TB averages 
$294,000 and XDR–TB averages $694,000. Treat-
ment is often difficult, with daily complex multi-pill 
regimens and injections, with side-effects ranging 
from hearing and vision loss to mental health issues. 
(13) Recognizing the public health, economic 
and societal costs to the threat of MDR–TB, the 
National Action Plan to Combat MDR–TB was de-
veloped by the White House to provide the United 
States with a comprehensive three-pronged strategy 
to address MDR–TB by strengthening domestic ca-
pacity to combat MDR–TB; improve international 
capacity and cooperation to combat MDR–TB; accel-
erate basic and applied research and development 
for new therapies, diagnostics and prevention strate-
gies to combat MDR–TB. 
(14) Additional Federal support is necessary to 
expand TB control efforts in case finding and treat-
ment to address LTBI in a national prevention ini-
tiative. Key policy and research breakthroughs in-
crease the success of a TB prevention initiative: the 
U.S. Preventative Services Task Force recommenda-
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tion’s ‘‘B’’ rating, screening for LTBI among high- 
risk adults as a covered service increases the likeli-
hood that impacted racial and ethnic minority 
groups can get tested for TB; a new, shorter course 
treatment regimen reduces the length of treatment 
for LTBI from every day for 6 to 9 months to one 
dose per week for 12 weeks, increasing likelihood of 
treatment completion; and the use of blood-based di-
agnostic tests, Interferon-gamma release assays or 
IGRAs, increases ability to detect LTBI among pa-
tients in affected communities. 
(15) The right to health, and the right to 
science as a necessary human right to help achieve 
the right to health, is enshrined in Articles 25 and 
27 of the Universal Declaration of Human Rights. 
These fundamental human rights cannot be achieved 
when anyone lacks access to TB prevention or treat-
ment, and when the benefits of scientific innovation 
are not extended to people with all forms of TB. 
SEC. 782. ADDITIONAL FUNDING FOR STATES IN COM-
BATING AND ELIMINATING TUBERCULOSIS. 
Section 317E(h) of the Public Health Act (42 U.S.C. 
247b–6(h)) is amended by adding at the end the following: 
‘‘(3) ADDITIONAL
FUNDING
FOR
STATES
IN 
COMBATING AND ELIMINATING TUBERCULOSIS.—In 
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addition to amounts otherwise authorized to be ap-
propriated to carry out this section, there are au-
thorized to be appropriated such sums as may be 
necessary to carry out section 317 for each of fiscal 
years 2020 through 2021.’’. 
SEC. 783. STRENGTHENING CLINICAL RESEARCH FUNDING 
FOR TUBERCULOSIS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall expand and intensify support for 
current and prospective research activities of the National 
Institutes of Health, the Biomedical Advanced Research 
and Development Authority, and the Centers for Disease 
Control and Prevention Division of Tuberculosis Elimi-
nation to develop new therapeutics, diagnostics, vaccines, 
and other prevention modalities in addressing all forms 
of tuberculosis (referred to in this section as ‘‘TB’’). 
(b) INCLUDED RESEARCH ACTIVITIES.—Research 
activities under subsection (a) shall include— 
(1) research and development, and pathways to 
approval, for novel, safe drugs and drug regimens 
for the treatment of TB, including in adolescent and 
pediatric populations and in pregnant and lactating 
women; 
(2) research to develop rapid diagnostic tests 
for all forms of TB, including diagnostics that can 
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be used for pediatric populations and people living 
with HIV, diagnostics that can detect extra pul-
monary TB and drug resistance, and diagnostics 
that can be used at the point of care; 
(3) research to advance basic knowledge of the 
pathogenesis of TB and its major comorbidities, in-
cluding HIV and diabetes mellitus; 
(4) research to improve knowledge and under-
standings of the role of latency in TB and the fac-
tors that increase the risk of latent TB infection 
progressing to active, symptomatic TB disease; 
(5) awarding grants and contracts to specifi-
cally develop new and needed vaccines to address 
TB; 
(6) awarding grants and contracts to support 
the training and development of clinical researchers 
whose research improves the landscape of tools to 
combat TB; and 
(7) awarding grants and contracts to support 
capacity-building and develop clinical trial site infra-
structure in the United States and in TB endemic 
countries to support the aforementioned research ac-
tivities. 
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Subtitle I—Osteoarthritis and 
Musculoskeletal Diseases 
SEC. 785. FINDINGS. 
Congress finds as follows: 
(1) Eighty percent of African-American women 
and nearly 74 percent of Hispanic men are either 
overweight or obese, speeding the onset and progres-
sion of arthritis. 
(2) Arthritis affects 46,000,000 people in the 
United States, and that number will rise to 
67,000,000 by the year 2030. 
(3) Twenty-seven million people in the United 
States suffer from osteoarthritis, the most common 
form of arthritis, making it the leading cause of dis-
ability in the United States. Osteoarthritis is some-
times referred to as degenerative joint disease. 
(4) Obesity accelerates the onset of arthritis: 70 
percent of obese adults with mild osteoarthritis of 
the knee at age 60 will develop advanced end-stage 
disease by age 80. In contrast, just 43 percent of 
non-obese adults will have end-stage disease over the 
same time period. 
(5) Arthritis affects 1 in 5 people in the United 
States and is the single greatest cause of chronic 
pain and disability in the United States. 
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(6) Women, African Americans, and Hispanics 
have more severe arthritis and functional limitations. 
These same individuals are more likely to be obese, 
diabetic, and have higher incidence of heart dis-
ease—medical conditions that can be improved with 
physical activity. Instead of moving, however, these 
groups have an inactivity rate of 40 to 50 percent, 
which continues to increase. 
(7) Arthritis costs $128,000,000,000 a year, in-
cluding $81,000,000,000 in direct costs (medical) 
and $47,000,000,000 in indirect costs (lost earn-
ings). Each year, $309,000,000,000 in direct and in-
direct costs is lost due to disparities in osteoarthritis 
and musculoskeletal diseases. 
(8) Obesity and other chronic health conditions 
exacerbate the debilitating impact of arthritis, lead-
ing to inactivity, loss of independence, and a per-
petual cycle of comorbid chronic conditions. 
(9) Sixty-one percent of arthritis sufferers are 
women, and women represent 64 percent of an esti-
mated 43,000,000 annual visits to physicians’ offices 
and outpatient clinics where arthritis was the pri-
mary diagnosis. Women also represented 60 percent 
of approximately 1,000,000 hospitalizations that oc-
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curred in 2003 for which arthritis was the primary 
diagnosis. 
(10) Women ages 65 and older have up to 21⁄2 
times more disabilities than men of the same age. 
Higher rates of obesity and arthritis among this 
group explained up to 48 percent of the gender gap 
in disability, above all other common chronic health 
conditions. 
(11) The primary indication for total knee 
arthroplasty (referred to in this section as ‘‘TKA’’), 
also known as knee replacement, is relief of signifi-
cant, disabling pain caused by severe arthritis. 
(12) Knee replacement is surgery for people 
with severe knee damage. Knee replacement can re-
lieve pain and allow you to be more active. When 
you have a total knee replacement, the surgeon re-
moves damaged cartilage and bone from the surface 
of your knee joint and replaces them with a man- 
made surface of metal and plastic. In a partial knee 
replacement, the surgeon only replaces one part of 
your knee joint. 
(13) Total hip replacement, also called total hip 
arthroplasty (referred to in this section as ‘‘THA’’), 
is used if your hip pain interferes with daily activi-
ties and more conservative treatments have not 
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helped. Arthritis damage is the most common reason 
to need hip replacement. 
(14) The odds of a family practice physician 
recommending TKA to a male patient with moderate 
arthritis are twice that of a female patient, while the 
odds of an orthopaedic surgeon recommending TKA 
to a male patient with moderate arthritis are 22 
times that of a female patient. 
(15) African Americans with doctor-diagnosed 
arthritis have a higher prevalence of severe pain at-
tributable to arthritis, compared with Whites (34.0 
percent versus 22.6 percent). African Americans, 
compared to Whites, report a higher proportion of 
work limitations (39.5 percent versus 28.0 percent) 
and a higher prevalence of arthritis-attributable 
work limitation (6.6 percent versus 4.6 percent). 
(16) Hispanics are 50 percent more likely than 
non-Hispanic Whites to report needing assistance 
with at least one instrumental activity of daily living 
and to have difficulty walking. 
(17) African Americans and Hispanics were 1.3 
times more likely to have activity limitation, 1.6 
times more likely to have work limitations, and 1.9 
times more likely to have severe joint pain than 
Whites. 
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(18) In 2003, the National Academy of Medi-
cine reported that the rates of TKA and THA 
among African-American and Hispanic patients are 
significantly lower than for Whites—even for those 
with equitable health care coverage such as through 
Medicare or the Department of Veterans Affairs. 
(19) According to the Centers for Disease Con-
trol and Prevention, in 2000, African-American 
Medicare enrollees were 37 percent less likely than 
White Medicare enrollees to undergo total knee re-
placements. In 2006, the disparity increased to 39 
percent. 
(20) Even after adjusting for insurance and 
health access, Hispanics and African Americans are 
almost 50 percent less likely to undergo total knee 
replacement than Whites. 
SEC. 
786. 
OSTEOARTHRITIS 
AND 
OTHER 
MUSCULO-
SKELETAL HEALTH-RELATED ACTIVITIES OF 
THE CENTERS FOR DISEASE CONTROL AND 
PREVENTION. 
(a) EDUCATION AND AWARENESS ACTIVITIES.—The 
Secretary of Health and Human Services, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall direct the National Center for Chronic Dis-
ease Prevention and Health Promotion to conduct and ex-
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pand the Health Community Program and Arthritis Pro-
gram to educate the public on— 
(1) the causes of, preventive health actions for, 
and effects of arthritis and other musculoskeletal 
conditions in minority patient populations; and 
(2) the effects of such conditions on other 
comorbidities including obesity, hypertension, and 
cardiovascular disease. 
(b) PROGRAMS
ON
ARTHRITIS
AND
MUSCULO-
SKELETAL CONDITIONS.—Education and awareness pro-
grams of the Centers for Disease Control and Prevention 
on arthritis and other musculoskeletal conditions in minor-
ity communities shall— 
(1) be culturally and linguistically appropriate 
to minority patients, targeting musculoskeletal 
health promotion and prevention programs of each 
major ethnic group, including— 
(A) Native Americans and Alaska Natives; 
(B) Asian Americans; 
(C) African Americans and Blacks; 
(D) Hispanic and Latino Americans; and 
(E) Native Hawaiians and Pacific Island-
ers; and 
(2) include public awareness campaigns directed 
toward these patient populations that emphasize the 
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importance of musculoskeletal health, physical activ-
ity, diet and healthy lifestyle, and weight reduction 
for overweight and obese patients. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as are necessary for fiscal year 2021 and each 
subsequent fiscal year. 
SEC. 787. GRANTS FOR COMPREHENSIVE OSTEOARTHRITIS 
AND MUSCULOSKELETAL DISEASE HEALTH 
EDUCATION WITHIN HEALTH PROFESSIONS 
SCHOOLS. 
(a) PROGRAM
AUTHORIZED.—The Secretary of 
Health and Human Services (in this section referred to 
as the ‘‘Secretary’’), in coordination with the Secretary of 
Education, shall award grants, on a competitive basis, to 
academic health science centers, health professions 
schools, and other institutions of higher education to en-
able such institutions to provide people with comprehen-
sive education on arthritis and musculoskeletal health, 
particularly— 
(1) obesity-related musculoskeletal diseases; 
(2) arthritis and osteoarthritis; 
(3) arthritis and musculoskeletal health dispari-
ties; and 
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(4) the relationship between arthritis and mus-
culoskeletal diseases and metabolic activity, psycho-
logical health, and comorbidities such as diabetes, 
cardiovascular disease, and hypertension. 
(b) DURATION.—Grants awarded under this section 
shall be for a period of 5 years. 
(c) APPLICATIONS.—An academic health science cen-
ter, health professions school, or other institution of high-
er education seeking a grant under this section shall sub-
mit an application to the Secretary at such time, in such 
manner, and containing such information as the Secretary 
may require. 
(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to an institution of 
higher education that— 
(1) has an enrollment of needy students, as de-
fined in section 318(b) of the Higher Education Act 
of 1965 (20 U.S.C. 1059e(b)); 
(2) is a Hispanic-serving institution, as defined 
in section 502(a) of such Act (20 U.S.C. 1101a(a)); 
(3) is a Tribal College or University, as defined 
in section 316(b) of such Act (20 U.S.C. 1059c(b)); 
(4) is an Alaska Native-serving institution, as 
defined in section 317(b) of such Act (20 U.S.C. 
1059d(b)); 
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(5) is a Native Hawaiian-serving institution, as 
defined in section 317(b) of such Act (20 U.S.C. 
1059d(b)); 
(6) is a Predominately Black Institution, as de-
fined in section 318(b) of such Act (20 U.S.C. 
1059e(b)); 
(7) is a Native American-serving, non-Tribal in-
stitution, as defined in section 319(b) of such Act 
(20 U.S.C. 1059f(b)); 
(8) is an Asian American and Native American 
Pacific Islander-serving institution, as defined in 
section 320(b) of such Act (20 U.S.C. 1059g(b)); or 
(9) is a minority institution, as defined in sec-
tion 365 of such Act (20 U.S.C. 1067k), with an en-
rollment of needy students, as defined in section 312 
of such Act (20 U.S.C. 1058). 
(e) USES OF FUNDS.—An institution of higher edu-
cation receiving a grant under this section may use grant 
funds to integrate issues relating to comprehensive arthri-
tis and musculoskeletal health into the academic or sup-
port sectors of the institution in order to reach a large 
number of students, by carrying out 1 or more of the fol-
lowing activities: 
(1) Developing educational content for issues 
relating to comprehensive arthritis and musculo-
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skeletal health education that will be incorporated 
into first-year orientation or core courses. 
(2) Creating innovative technology-based ap-
proaches to deliver arthritis and musculoskeletal 
health education to students, faculty, and staff. 
(3) Developing and employing peer-outreach 
and education programs to generate discussion, edu-
cate, and raise awareness among students about 
issues relating to arthritis and musculoskeletal 
health disorders, and their relationship to diabetes, 
hypertension, cardiovascular disease, psychological 
health, and other comorbid conditions. 
(f) REPORT TO CONGRESS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, and annually 
thereafter for a period of 5 years, the Secretary shall 
prepare and submit to the appropriate committees of 
Congress a report on the activities to provide health 
professions students with comprehensive arthritis 
and musculoskeletal health education funded under 
this section. 
(2) REPORT ELEMENTS.—The report described 
in paragraph (1) shall include information about— 
(A) the number of entities that are receiv-
ing grant funds; 
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(B) the specific activities supported by 
grant funds; 
(C) the number of students served by 
grant programs; and 
(D) the status of program evaluations. 
Subtitle J—Sleep and Circadian 
Rhythm Disorders 
SEC. 791. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘Sleep and Circadian Rhythm Disorders Health Dispari-
ties Act’’. 
(b) FINDINGS.—Congress finds the following: 
(1) Decrements in sleep health such as sleep 
apnea, insufficient sleep time, and insomnia, affect 
50,000,000 to 70,000,000 adults in the United 
States. Twelve to eighteen million United States 
adults have sleep apnea, a chronic disorder charac-
terized by one or more pauses in breathing which 
can last from a few seconds to minutes. They may 
occur 30 times or more an hour, disrupting sleep 
and resulting in excessive daytime sleepiness and 
loss in productivity. 
(2) Seventy percent of high school students are 
not getting enough sleep on school nights, while 33 
percent of people in the United States get fewer 
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than 7 hours of sleep per night, and roughly 6,000 
fatal motor vehicle crashes are caused by drowsy 
drivers. 
(3) Insufficient sleep and insomnia are more 
prevalent in women. Women who are pregnant and 
have sleep apnea are at an increased risk of cardio-
vascular complications during pregnancy. The im-
pact of disparities in sleep health is associated with 
a growing number of health problems, including the 
following: 
(A) Hypertension. 
(B) Cancer. 
(C) Stroke. 
(D) Cardiac arrhythmia. 
(E) Chronic heart failure and heart dis-
ease. 
(F) Diabetes. 
(G) Cognitive functioning and behavior. 
(H) Depression and bipolar disorder. 
(I) Substance abuse. 
(4) A sleep disparity exists in that poor sleep 
quality is strongly associated with poverty and race. 
Factors such as employment, education, and health 
status, amongst others, significantly mediated this 
effect only in poor subjects, suggesting a differential 
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vulnerability to these factors in poor relative to 
nonpoor individuals in the context of sleep quality. 
(5) African Americans sleep worse than Cauca-
sian Americans. African Americans take longer to 
fall asleep, report poorer sleep quality, have more 
light and less deep sleep, and nap more often and 
longer. 
(6) African Americans and individuals in lower 
socioeconomic status groups may be at an increased 
risk for sleep disturbances and associated health 
consequences. 
(7) Among young African Americans, the likeli-
hood of having sleep disordered breathing and exhib-
iting risk factors for poor sleep is twice that in 
young Caucasians. Frequent snoring is more com-
mon among African-American and Hispanic women 
and Hispanic men compared to non-Hispanic Cauca-
sians, independent of other factors including obesity. 
(8) African Americans with sleep-disordered 
breathing develop symptoms at a younger age than 
Caucasians but appear less likely to be diagnosed 
and treated in a timely manner. This delay may at 
least in part be due to reduced access to care. 
(9) Sleep loss contributes to increased risk for 
chronic conditions such as obesity, diabetes, and hy-
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pertension, all of which have increased prevalence in 
underserved, underrepresented minorities. Racial 
and ethnic disparities related to obesity may also 
contribute to disparities in health outcomes related 
to sleep-disordered breathing. 
(10) Non-Caucasian adults report an insomnia 
rate of 12.9 percent compared to only 6.6 percent 
for Caucasians. 
(11) African-American women have a higher in-
cidence of insomnia than African-American men, 
perhaps related in part to higher risk for chronic 
persisting symptoms. 
SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE-
SEARCH ACTIVITIES OF THE NATIONAL IN-
STITUTES OF HEALTH. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health, acting through the Director of the Na-
tional Heart, Lung, and Blood Institute, shall— 
(1) continue to expand research activities ad-
dressing sleep health disparities; and 
(2) continue implementation of the NIH Sleep 
Disorders Research Plan across all institutes and 
centers of the National Institutes of Health to im-
prove treatment and prevention of sleep health dis-
parities. 
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(b) REQUIRED
RESEARCH
ACTIVITIES.—In con-
ducting or supporting research relating to sleep and circa-
dian rhythm, the Director of the National Heart, Lung, 
and Blood Institute shall— 
(1) advance epidemiology and clinical research 
to achieve a more complete understanding of dispari-
ties in domains of sleep health and across population 
subgroups for which cardiovascular and metabolic 
health disparities exist, including— 
(A) prevalence and severity of sleep apnea; 
(B) habitual sleep duration; 
(C) sleep timing and regularity; and 
(D) insomnia; 
(2) develop study designs and analytical ap-
proaches to explain and predict multilevel and life- 
course determinants of sleep health and to elucidate 
the sleep-related causes of cardiovascular and meta-
bolic health disparities across the age spectrum, in-
cluding such determinants and causes that are— 
(A) environmental; 
(B) biological or genetic; 
(C) psychosocial; 
(D) societal; 
(E) political; or 
(F) economic; 
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(3) determine the contribution of sleep impair-
ments such as sleep apnea, insufficient sleep dura-
tion, irregular sleep schedules, and insomnia to un-
explained disparities in cardiovascular and metabolic 
risk and disease outcomes; 
(4) develop study designs, data sampling and 
collection tools, and analytical approaches to opti-
mize understanding of mediating and moderating 
factors, and feedback mechanisms coupling sleep to 
cardiovascular and metabolic health disparities; 
(5) advance research to understand cultural 
and linguistic barriers (on the person, provider, or 
system level) to access to care, medical diagnosis, 
and treatment of sleep disorders in diverse popu-
lation groups; 
(6) develop and test multilevel interventions (in-
cluding sleep health education in diverse commu-
nities) to reduce disparities in sleep health that will 
impact ability to improve disparities in cardio-
vascular and metabolic risk or disease; 
(7) create opportunities to integrate sleep and 
health disparity science by strategically utilizing re-
sources (existing or anticipated cohorts), exchanging 
scientific data and ideas (cross-over into scientific 
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meetings), and develop multidisciplinary investi-
gator-initiated grant applications; and 
(8) enhance the diversity and foster career de-
velopment of young investigators involved in sleep 
and health disparities science. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal year 2021 and 
each subsequent fiscal year. 
SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS-
PARITIES-RELATED ACTIVITIES OF THE CEN-
TERS FOR DISEASE CONTROL AND PREVEN-
TION. 
(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention shall conduct, support, 
and expand public health strategies and prevention, diag-
nosis, surveillance, and public and professional awareness 
activities regarding sleep and circadian rhythm disorders. 
(b) FINDINGS.—Congress finds as follows: 
(1) Sleep disorders and sleep deficiency unre-
lated to a primary sleep disorder are underdiagnosed 
and are increasingly detrimental to health status. 
(2) The consequences to society include addi-
tional diseases, motor vehicle accidents, decreased 
longevity, elevated direct medical costs, and indirect 
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costs related to work absenteeism and property dam-
age. 
(c) REQUIRED
SURVEILLANCE
AND
EDUCATION 
AWARENESS ACTIVITIES.—In conducting or supporting 
research relating to sleep and circadian rhythm disorders 
surveillance and education awareness activities, the Direc-
tor of the Centers for Disease Control and Prevention 
shall— 
(1) ensure that such activities are culturally 
and linguistically appropriate to minority patients, 
targeting sleep and circadian rhythm health pro-
motion and prevention programs of each major eth-
nic group, including— 
(A) Native Americans and Alaska Natives; 
(B) Asian Americans; 
(C) African Americans and Blacks; 
(D) Hispanic and Latino Americans; and 
(E) Native Hawaiians and Pacific Island-
ers; 
(2) collect and compile national and State sur-
veillance data on sleep disorders health disparities; 
(3) continue to develop and implement new 
sleep questions in public health surveillance systems 
to increase public awareness of sleep health and 
sleep disorders and their impact on health; 
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(4) publish monthly reports highlighting geo-
graphic, racial, and ethnic disparities in sleep health, 
as well as relationships between insufficient sleep 
and chronic disease, health risk behaviors, and other 
outcomes as determined necessary by the Director; 
and 
(5) include public awareness campaigns that in-
form patient populations from major ethnic groups 
about the prevalence of sleep and circadian rhythm 
disorders and emphasize the importance of sleep 
health. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal year 2021 and 
each subsequent fiscal year. 
SEC. 794. GRANTS FOR COMPREHENSIVE SLEEP AND CIR-
CADIAN 
HEALTH 
EDUCATION 
WITHIN 
HEALTH PROFESSIONS SCHOOLS. 
(a) PROGRAM
AUTHORIZED.—The Secretary of 
Health and Human Services (referred to in this section 
as the ‘‘Secretary’’), in coordination with the Secretary of 
Education, shall award grants, on a competitive basis, to 
academic health science centers, health professions 
schools, and other institutions of higher education to en-
able such institutions to provide people with comprehen-
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sive education on sleep and circadian health, particu-
larly— 
(1) poor sleep health; 
(2) sleep disorders; 
(3) sleep health disparities; and 
(4) the relationship between sleep and circadian 
health on metabolic activity, neurological activity, 
comorbidities, and other diseases. 
(b) DURATION.—Grants awarded under this section 
shall be for a period of 5 years. 
(c) APPLICATIONS.—Any academic health science 
center, health professions school, or other institutions of 
higher education seeking a grant under this section shall 
submit an application to the Secretary at such time, in 
such manner, and containing such information as the Sec-
retary may require. 
(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to an institution 
that— 
(1) has an enrollment of needy students, as de-
fined in section 318(b) of the Higher Education Act 
of 1965 (20 U.S.C. 1059e(b)); 
(2) is a Hispanic-serving institution, as defined 
in section 502(a) of such Act (20 U.S.C. 1101a(a)); 
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(3) is a Tribal College or University, as defined 
in section 316(b) of such Act (20 U.S.C. 1059c(b)); 
(4) is an Alaska Native-serving institution, as 
defined in section 317(b) of such Act (20 U.S.C. 
1059d(b)); 
(5) is a Native Hawaiian-serving institution, as 
defined in section 317(b) of such Act (20 U.S.C. 
1059d(b)); 
(6) is a Predominately Black Institution, as de-
fined in section 318(b) of such Act (20 U.S.C. 
1059e(b)); 
(7) is a Native American-serving, nontribal in-
stitution, as defined in section 319(b) of such Act 
(20 U.S.C. 1059f(b)); 
(8) is an Asian American and Native American 
Pacific Islander-serving institution, as defined in 
section 320(b) of such Act (20 U.S.C. 1059g(b)); or 
(9) is a minority institution, as defined in sec-
tion 365 of such Act (20 U.S.C. 1067k), with an en-
rollment of needy students, as defined in section 312 
of such Act (20 U.S.C. 1058). 
(e) USES OF FUNDS.—An institution of higher edu-
cation receiving a grant under this section may use grant 
funds to integrate issues relating to comprehensive sleep 
and circadian health into the academic or support sectors 
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(3) INTEROPERABILITY.—The term ‘‘interoper-
ability’’ has the meaning given such term in section 
3000 of the Public Health Service Act (42 U.S.C. 
300jj). Evaluation and measurement of interoper-
ability shall consider exchange of electronic health 
information, usability of exchanged electronic health 
information, effective application and use of the ex-
changed electronic health information, and impact 
on outcomes of interoperability. 
(4) ACCESS.—The term ‘‘access’’ has the mean-
ing given such term within the definition of ‘‘inter-
operability’’ in section 3000 of the Public Health 
Service Act (42 U.S.C. 300jj) and within HIPAA’s 
Privacy Rule (45 C.F.R. 164.524). 
(5) CERTIFIED ELECTRONIC HEALTH RECORD 
TECHNOLOGY; EHR.—The term ‘‘certified electronic 
health record technology’’ and the term ‘‘EHR’’ both 
include the health information infrastructure for 
interoperability, access, exchange, and use of elec-
tronic health information required by sections 4003 
and 4006 of the 21st Century Cures Act, and are 
not limited solely to doctors’ electronic health 
records. 
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tified EHR technology in communities with 
a high proportion of individuals from racial 
and ethnic minority groups (as so defined), 
while also maintaining the accessibility re-
quirements of section 508 of the Rehabili-
tation Act of 1973 to encourage patient in-
volvement in patient health care. The Na-
tional Coordinator shall— 
‘‘(I) not later than 6 months 
after the submission of the report re-
quired under section 822 of the 
Health Equity and Accountability Act 
of 2020, establish criteria for evalu-
ating the impact of health information 
technology on communities with a 
high proportion of individuals from 
racial and ethnic minority groups (as 
so defined) taking into account the 
findings in such report; and 
‘‘(II) not later than 1 year after 
the submission of such report, conduct 
and publish the results of an evalua-
tion of such impact.’’. 
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ministrator shall, as promptly as practicable, carry out 
each of the following recommendations of the Comptroller 
General of the United States as described in the report 
entitled ‘‘EPA Should Devote More Attention to Environ-
mental Justice when Developing Clean Air Rules’’ (GAO– 
05–289): 
(1) The recommendation that the Administrator 
ensure that workgroups involved in developing a rule 
devote attention to environmental justice while draft-
ing and finalizing the rule. 
(2) The recommendation that the Administrator 
enhance the ability of the workgroups described in 
paragraph (1) to identify potential environmental 
justice issues through steps such as— 
(A) providing workgroup members with 
guidance and training to help those members 
identify potential environmental justice prob-
lems; and 
(B) involving environmental justice coordi-
nators in the workgroups if appropriate. 
(3) The recommendation that the Administrator 
improve assessments of potential environmental jus-
tice impacts in economic reviews by identifying the 
data and developing the modeling techniques needed 
to assess those impacts. 
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(II) generate the environmental 
health issue list; 
(III) analyze issues with a sys-
tems framework; 
(IV) develop appropriate commu-
nity environmental health indicators; 
(V) 
rank 
the 
environmental 
health issues; 
(VI) set priorities for action; 
(VII) develop an action plan; 
(VIII) implement the plan; and 
(IX) evaluate progress and plan-
ning for the future. 
(D) EVALUATION.—Each eligible entity 
that receives a grant under this paragraph shall 
evaluate, report, and disseminate program find-
ings and outcomes. 
(E) TECHNICAL ASSISTANCE.—The Direc-
tor may provide such technical and other non- 
financial assistance to eligible entities as the 
Director determines to be necessary. 
(2) LEVEL 2 COOPERATIVE AGREEMENTS.— 
(A) ELIGIBILITY.— 
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