improve medical outcomes, to improve cultural 
competence, reduce health care costs caused by 
miscommunication with individuals with lim-
ited-English proficiency, and reduce or elimi-
nate the duplication of effort to translate mate-
rials. The clearinghouse shall make such infor-
mation available on the Internet and in print. 
Such information shall include the information 
described in the succeeding provisions of this 
paragraph. 
‘‘(B) DOCUMENT TEMPLATES.—The Cen-
ter shall collect and evaluate for accuracy, de-
velop, and make available templates for stand-
ard documents that are necessary for patients 
and consumers to access and make educated de-
cisions about their health care, including the 
following: 
‘‘(i) Administrative and legal docu-
ments, including— 
‘‘(I) intake forms; 
‘‘(II) Medicare, Medicaid, and 
SCHIP forms, including eligibility in-
formation; 
‘‘(III) forms informing patient of 
HIPAA compliance and consent; and 
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‘‘(IV) documents concerning in-
formed consent, advanced directives, 
and waivers of rights. 
‘‘(ii) Clinical information, such as how 
to take medications, how to prevent trans-
mission of a contagious disease, and other 
prevention and treatment instructions. 
‘‘(iii) Public health, patient education, 
and outreach materials, such as immuniza-
tion notices, health warnings, or screening 
notices. 
‘‘(iv) Additional health or health-care- 
related materials as determined appro-
priate by the Director of the Center. 
‘‘(C) STRUCTURE
OF
FORMS.—In oper-
ating the clearinghouse, the Center shall— 
‘‘(i) ensure that the documents posted 
in English and non-English languages are 
culturally appropriate; 
‘‘(ii) allow public review of the docu-
ments before dissemination in order to en-
sure that the documents are understand-
able and culturally appropriate for the tar-
get populations; 
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‘‘(iii) allow health care providers to 
customize the documents for their use; 
‘‘(iv) facilitate access to these docu-
ments; 
‘‘(v) provide technical assistance with 
respect to the access and use of such infor-
mation; and 
‘‘(vi) carry out any other activities the 
Secretary determines to be useful to fulfill 
the purposes of the clearinghouse. 
‘‘(D) 
LANGUAGE
ASSISTANCE
PRO-
GRAMS.—The Center shall provide for the col-
lection and dissemination of information on cur-
rent examples of language assistance programs 
and strategies to improve language services for 
LEP individuals, including case studies using 
de-identified patient information, program sum-
maries, and program evaluations. 
‘‘(E) CULTURAL
AND
LINGUISTIC
COM-
PETENCE MATERIALS.—The Center shall pro-
vide information relating to culturally and lin-
guistically competent health care for minority 
populations residing in the United States to all 
health care providers and health-care-related 
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services at no cost. Such information shall in-
clude— 
‘‘(i) tenets of culturally and linguis-
tically competent care; 
‘‘(ii) cultural and linguistic com-
petence self-assessment tools; 
‘‘(iii) cultural and linguistic com-
petence training tools; 
‘‘(iv) strategic plans to increase cul-
tural and linguistic competence in different 
types of providers of health care and 
health-care-related services, including re-
gional collaborations among health care or-
ganizations; and 
‘‘(v) cultural and linguistic com-
petence information for educators, practi-
tioners, and researchers. 
‘‘(F) INFORMATION
ABOUT
PROGRESS.— 
The Center shall regularly collect and make 
publicly 
available 
information 
about 
the 
progress of entities receiving grants under sec-
tion 3404 regarding successful innovations in 
implementing the obligations under this sub-
section and provide public notice in the entities’ 
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communities about the availability of this infor-
mation. 
‘‘(b) DIRECTOR.—The Center shall be headed by a 
Director who shall be appointed by, and who shall report 
to, the Director of the Agency for Healthcare Research 
and Quality. 
‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di-
rector shall collaborate with the Deputy Assistant Sec-
retary for Minority Health, the Administrator of the Cen-
ters for Medicare & Medicaid Services, and the Adminis-
trator of the Health Resources and Services Administra-
tion to notify health care providers and health care organi-
zations about the availability of language access services 
by the Center. 
‘‘(d) 
EDUCATION.—The 
Secretary, 
directly 
or 
through contract, shall undertake a national education 
campaign to inform providers, LEP individuals, health 
professionals, graduate schools, and community health 
centers about— 
‘‘(1) Federal and State laws and guidelines gov-
erning access to language services; 
‘‘(2) the value of using trained interpreters and 
the risks associated with using family members, 
friends, minors, and untrained bilingual staff; 
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‘‘(3) funding sources for developing and imple-
menting language services; and 
‘‘(4) promising practices to effectively provide 
language services. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—In ad-
dition to the amounts authorized under subsection 
(e)(8)(F), there are authorized to be appropriated to carry 
out this section such sums as may be necessary for each 
of fiscal years 2017 through 2021. 
‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 
COMPETENCE GRANTS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Agency for Healthcare Research and 
Quality, shall award grants to eligible entities to enable 
such entities to design, implement, and evaluate innova-
tive, cost-effective programs to improve cultural com-
petence and language access in health care for individuals 
with limited-English proficiency. The Director of the 
Agency for Healthcare Research and Quality shall coordi-
nate with, and ensure the participation of, other agencies 
including the Health Resources and Services Administra-
tion, the Center on Minority Health and Health Dispari-
ties at the National Institutes of Health, and the Office 
of Minority Health, regarding the design and evaluation 
of the grants program. 
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‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall— 
‘‘(1) be— 
‘‘(A) a city, county, Indian tribe, State, 
territory, or subdivision thereof; 
‘‘(B) an organization described in section 
501(c)(3) of the Internal Revenue Code of 1986 
and exempt from tax under section 501(a) of 
such Code; 
‘‘(C) a community health, mental health, 
or substance use center or clinic; 
‘‘(D) a solo or group physician practice; 
‘‘(E) an integrated health care delivery 
system; 
‘‘(F) a public hospital; 
‘‘(G) a health care group, university, or 
college; or 
‘‘(H) other entity designated by the Sec-
retary; and 
‘‘(2) prepare and submit to the Secretary an 
application, at such time, in such manner, and ac-
companied by such additional information as the 
Secretary may require. 
‘‘(c) USE OF FUNDS.—An entity shall use funds re-
ceived under a grant under this section to— 
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‘‘(1) develop, implement, and evaluate models of 
providing competent interpretation services through 
onsite interpretation, telephonic interpretation, or 
video interpretation; 
‘‘(2) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
promote and provide language services to patient 
populations of the service area of the organization; 
‘‘(3) develop and maintain a needs assessment 
that identifies the current demographic, cultural, 
and epidemiological profile of the community to ac-
curately plan for and implement language services 
needed in service area of the organization; 
‘‘(4) develop a strategic plan to implement lan-
guage services; 
‘‘(5) develop participatory, collaborative part-
nerships with communities encompassing the LEP 
patient populations being served to gain input in de-
signing and implementing language services; 
‘‘(6) develop and implement grievance resolu-
tion processes that are culturally and linguistically 
sensitive and capable of identifying, preventing, and 
resolving complaints by LEP individuals; 
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‘‘(7) develop short-term medical mental health 
interpretation training courses and incentives for bi-
lingual health care staff who are asked to interpret 
in the workplace; 
‘‘(8) develop formal training programs, includ-
ing continued professional development and edu-
cation programs as well as supervision, for individ-
uals interested in becoming dedicated health care in-
terpreters and culturally competent providers; 
‘‘(9) provide staff language training instruction, 
which shall include information on the practical limi-
tations of such instruction for non-native speakers; 
‘‘(10) develop policies that address compensa-
tion in salary for staff who receive training to be-
come either a staff interpreter or bilingual provider; 
‘‘(11) develop other language assistance services 
as determined appropriate by the Secretary; 
‘‘(12) develop, implement, and evaluate models 
of improving cultural competence, including cultural 
competence programs for community health workers; 
and 
‘‘(13) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
mulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 (42 
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U.S.C. 1320d–2 note) and any applicable State pri-
vacy laws, data on the individual patient or recipi-
ent’s race, ethnicity, and primary language are col-
lected (and periodically updated) in health records 
and integrated into the organization’s information 
management systems or any similar system used to 
store and retrieve data. 
‘‘(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to entities that pri-
marily engage in providing direct care and that have devel-
oped partnerships with community organizations or with 
agencies with experience in improving language access. 
‘‘(e) EVALUATION.— 
‘‘(1) BY GRANTEES.—An entity that receives a 
grant under this section shall submit to the Sec-
retary an evaluation that describes, in the manner 
and to the extent required by the Secretary, the ac-
tivities carried out with funds received under the 
grant, and how such activities improved access to 
health and health-care-related services and the qual-
ity of health care for individuals with limited-English 
proficiency. Such evaluation shall be collected and 
disseminated through the Robert T. Matsui Center 
for Cultural and Linguistic Competence in Health 
Care established under section 3403. The Director 
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of the Agency for Healthcare Research and Quality 
shall notify grantees of the availability of technical 
assistance for the evaluation and provide such assist-
ance upon request. 
‘‘(2) BY
SECRETARY.—The Director of the 
Agency for Healthcare Research and Quality shall 
evaluate or arrange with other individuals or organi-
zations to evaluate projects funded under this sec-
tion. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$5,000,000 for each of fiscal years 2017 through 2021. 
‘‘SEC. 3405. RESEARCH ON CULTURAL AND LANGUAGE COM-
PETENCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Agency for Healthcare Research and 
Quality, shall expand research concerning language access 
in the provision of health care. 
‘‘(b) ELIGIBILITY.—The Director of the Agency for 
Healthcare Research and Quality may conduct the re-
search described in subsection (a) or enter into contracts 
with other individuals or organizations to do so. 
‘‘(c) USE OF FUNDS.—Research under this section 
shall be designed to do one or more of the following: 
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‘‘(1) To identify the barriers to mental and be-
havioral services that are faced by LEP individuals. 
‘‘(2) To identify health care providers’ and 
health administrators’ attitudes, knowledge, and 
awareness of the barriers to quality health care serv-
ices that are faced by LEP individuals. 
‘‘(3) To identify optimal approaches for deliv-
ering language access. 
‘‘(4) To identify best practices for data collec-
tion, including— 
‘‘(A) the collection by providers of health 
care and health-care-related services of data on 
the race, ethnicity, and primary language of re-
cipients of such services, taking into account ex-
isting research conducted by the Government or 
private sector; 
‘‘(B) the development and implementation 
of data collection and reporting systems; and 
‘‘(C) effective privacy safeguards for col-
lected data. 
‘‘(5) To develop a minimum data collection set 
for primary language. 
‘‘(6) To evaluate the most effective ways in 
which the Department can create or coordinate, and 
then subsidize or otherwise fund telephonic interpre-
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tation providers for health care providers, taking 
into consideration, among other factors, the flexi-
bility necessary for such a system to accommodate 
variations in— 
‘‘(A) provider type; 
‘‘(B) languages needed and their frequency 
of use; 
‘‘(C) type of encounter; 
‘‘(D) time of encounter, including regular 
business hours and after hours; and 
‘‘(E) location of encounter. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2021.’’. 
SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE-
VELOPMENT 
OF 
STATE 
MEDICAL 
INTER-
PRETING SERVICES. 
(a) GRANTS
AUTHORIZED.—The Secretary shall 
award one grant in accordance with this section to each 
of three States to assist each such State in designing, im-
plementing, and evaluating a statewide program to provide 
onsite interpreter services under Medicaid. 
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(b) GRANT PERIOD.—A grant awarded under this 
section is authorized for a period of three fiscal years be-
ginning on October 1, 2016. 
(c) PREFERENCE.—In awarding a grant under this 
section, the Secretary shall give preference to a State— 
(1) that has a high proportion of qualified LEP 
enrollees, as determined by the Secretary; 
(2) that has a large number of qualified LEP 
enrollees, as determined by the Secretary; 
(3) that has a high growth rate of the popu-
lation of LEP individuals, as determined by the Sec-
retary; and 
(4) that has a population of qualified LEP en-
rollees that is linguistically diverse, requiring inter-
preter services in at least 200 non-English lan-
guages. 
(d) USE OF FUNDS.—A State receiving a grant under 
this section shall use the grant funds to— 
(1) ensure that all health care providers in the 
State participating in the State plan under Medicaid 
have access to onsite interpreter services, for the 
purpose of enabling effective communication between 
such providers and qualified LEP enrollees during 
the furnishing of items and services and administra-
tive interactions; 
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(2) establish, expand, procure, or contract for— 
(A) a statewide health care information 
technology system that is designed to achieve 
efficiencies and economies of scale with respect 
to onsite interpreter services provided to health 
care providers in the State participating in the 
State plan under Medicaid; and 
(B) an entity to administer such system, 
the duties of which shall include— 
(i) procuring and scheduling inter-
preter services for qualified LEP enrollees; 
(ii) procuring and scheduling inter-
preter services for LEP individuals seeking 
to enroll in the State plan under Medicaid; 
(iii) ensuring that interpreters receive 
payment for interpreter services rendered 
under the system; and 
(iv) consulting regularly with organi-
zations 
representing 
consumers, 
inter-
preters, and health care providers; and 
(3) develop mechanisms to establish, improve, 
and strengthen the competency of the medical inter-
pretation workforce that serves qualified LEP enroll-
ees in the State, including a national certification 
process that is valid, credible, and vendor-neutral. 
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(e) APPLICATION.—To receive a grant under this sec-
tion, a State shall submit an application at such time and 
containing such information as the Secretary may require, 
which shall include the following: 
(1) A description of the language access needs 
of individuals in the State enrolled in the State plan 
under Medicaid. 
(2) A description of the extent to which the 
program will— 
(A) use the grant funds for the purposes 
described in subsection (d); 
(B) meet the health care needs of rural 
populations of the State; and 
(C) collect information that accurately 
tracks the language services requested by con-
sumers as compared to the language services 
provided by health care providers in the State 
participating in the State plan under Medicaid. 
(3) A description of how the program will be 
evaluated, including a proposal for collaboration with 
organizations representing interpreters, consumers, 
and LEP individuals. 
(f) DEFINITIONS.—In this section: 
(1) QUALIFIED
LEP
ENROLLEE.—The term 
‘‘qualified LEP enrollee’’ means an individual— 
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(A) who is limited-English-proficient; and 
(B) who is enrolled in a State plan under 
Medicaid. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given the term in section 1101(a)(1) of the So-
cial Security Act (42 U.S.C. 1301(a)(1)), for pur-
poses of title XIX of such Act. 
(3) 
UNITED
STATES.—The 
term 
‘‘United 
States’’ has the meaning given the term in section 
1101(a)(2) of the Social Security Act (42 U.S.C. 
1301(a)(2)), for purposes of title XIX of such Act. 
(g) FUNDING.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated $5,000,000 
to carry out this section. 
(2) AVAILABILITY OF FUNDS.—The funds au-
thorized by paragraph (1) shall be available without 
fiscal year limitation. 
(3) INCREASED FEDERAL FINANCIAL PARTICI-
PATION.—Section 1903(a)(2)(E) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 
section 205(d)(1) of this Act, is further amended by 
inserting ‘‘(or, in the case of a State receiving a 
grant under section 203 of the Health Equity and 
Accountability Act of 2016, 100 percent for each 
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quarter occurring during the grant period)’’ after 
‘‘90 percent’’. 
(h) LIMITATION.—No Federal funds under this sec-
tion may be used to provide interpreter services from a 
location outside the United States. 
SEC. 204. TRAINING TOMORROW’S DOCTORS FOR CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE CARE: GRADUATE MEDICAL EDU-
CATION. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h)(4) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(L) TREATMENT OF CULTURALLY COM-
PETENCY
TRAINING.—In determining a hos-
pital’s number of full-time equivalent residents 
for purposes of this subsection, all the time that 
is spent by an intern or resident in an approved 
medical residency training program for edu-
cation and training in cultural competency and 
linguistically appropriate service delivery shall 
be counted toward the determination of full- 
time equivalency.’’. 
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(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended— 
(1) by redesignating the clause (x) added by 
section 5505(b) of the Patient Protection and Af-
fordable Care Act as clause (xi); and 
(2) by adding at the end the following new 
clause: 
‘‘(xii) The provisions of subparagraph (L) of 
subsection (h)(4) shall apply under this subpara-
graph in the same manner as they apply under such 
subsection.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply with respect to pay-
ments made to hospitals on or after the date that is one 
year after the date of the enactment of this Act. 
SEC. 205. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID, AND 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAMS. 
(a) LANGUAGE ACCESS GRANTS
FOR MEDICARE 
PROVIDERS.— 
(1) ESTABLISHMENT.— 
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(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices, acting through the Centers for Medicare & 
Medicaid Services and in consultation with the 
Center for Medicare and Medicaid Innovation, 
shall establish a demonstration program under 
which the Secretary shall award grants to eligi-
ble Medicare service providers to improve com-
munication between such providers and Medi-
care beneficiaries who are English learners, in-
cluding beneficiaries who live in diverse and un-
derserved communities. 
(B) 
APPLICATION
OF
INNOVATION 
RULES.—The demonstration project under sub-
paragraph (A) shall be conducted in a manner 
that is consistent with the applicable provisions 
of subsections (b), (c), and (d) of section 1115A 
of the Social Security Act (42 U.S.C. 1315a). 
(C) NUMBER OF GRANTS.—To the extent 
practicable, the Secretary shall award not less 
than 24 grants under this subsection. 
(D) GRANT PERIOD.—Except as provided 
under paragraph (2)(D), each grant awarded 
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under this subsection shall be for a 3-year pe-
riod. 
(2) ELIGIBILITY REQUIREMENTS.—To be eligi-
ble for a grant under this subsection, an entity must 
meet the following requirements: 
(A) MEDICARE
PROVIDER.—The entity 
must be— 
(i) a provider of services under part A 
of title XVIII of the Social Security Act; 
(ii) a provider of services under part 
B of such title; 
(iii) a Medicare Advantage organiza-
tion offering a Medicare Advantage plan 
under part C of such title; or 
(iv) a PDP sponsor offering a pre-
scription drug plan under part D of such 
title. 
(B) UNDERSERVED
COMMUNITIES.—The 
entity must serve a community that, with re-
spect to necessary language services for improv-
ing access and utilization of health care among 
English learners, is disproportionally under-
served. 
(C) APPLICATION.—The entity must pre-
pare and submit to the Secretary an applica-
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tion, at such time, in such manner, and accom-
panied by such additional information as the 
Secretary may require. 
(D) REPORTING.—In the case of a grantee 
that received a grant under this subsection in 
a previous year, such grantee is only eligible for 
continued payments under a grant under this 
subsection if the grantee met the reporting re-
quirements under paragraph (9) for such year. 
If a grantee fails to meet the requirement of 
such paragraph for the first year of a grant, the 
Secretary may terminate the grant and solicit 
applications from new grantees to participate in 
the demonstration program. 
(3) DISTRIBUTION.—To the extent feasible, the 
Secretary shall award— 
(A) at least 6 grants to providers of serv-
ices described in paragraph (2)(A)(i); 
(B) at least 6 grants to service providers 
described in paragraph (2)(A)(ii); 
(C) at least 6 grants to organizations de-
scribed in paragraph (2)(A)(iii); and 
(D) at least 6 grants to sponsors described 
in paragraph (2)(A)(iv). 
(4) CONSIDERATIONS IN AWARDING GRANTS.— 
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(A) VARIATION IN GRANTEES.—In award-
ing grants under this subsection, the Secretary 
shall select grantees to ensure the following: 
(i) The grantees provide many dif-
ferent types of language services. 
(ii) The grantees serve Medicare bene-
ficiaries who speak different languages, 
and who, as a population, have differing 
needs for language services. 
(iii) The grantees serve Medicare 
beneficiaries in both urban and rural set-
tings. 
(iv) The grantees serve Medicare 
beneficiaries in at least two geographic re-
gions, as defined by the Secretary. 
(v) The grantees serve Medicare bene-
ficiaries in at least two large metropolitan 
statistical areas with racial, ethnic, and 
economically diverse populations. 
(B) PRIORITY
FOR
PARTNERSHIPS
WITH 
COMMUNITY ORGANIZATIONS AND AGENCIES.— 
In awarding grants under this subsection, the 
Secretary shall give priority to eligible entities 
that have a partnership with— 
(i) a community organization; or 
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(ii) a consortia of community organi-
zations, State agencies, and local agencies, 
that has experience in providing language serv-
ices. 
(5) USE OF FUNDS FOR COMPETENT LANGUAGE 
SERVICES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (E), a grantee may only use grant funds 
received under this subsection to pay for the 
provision of competent language services to 
Medicare beneficiaries who are English learn-
ers. 
(B) COMPETENT LANGUAGE SERVICES DE-
FINED.—For purposes of this subsection, the 
term ‘‘competent language services’’ means— 
(i) interpreter and translation services 
that— 
(I) subject to the exceptions 
under subparagraph (C)— 
(aa) if the grantee operates 
in a State that has statewide 
health care interpreter standards, 
meet the State standards cur-
rently in effect; or 
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(bb) if the grantee operates 
in a State that does not have 
statewide health care interpreter 
standards, utilizes competent in-
terpreters who follow the Na-
tional Council on Interpreting in 
Health Care’s Code of Ethics and 
Standards of Practice; and 
(II) that, in the case of inter-
preter 
services, 
are 
provided 
through— 
(aa) onsite interpretation; 
(bb) telephonic interpreta-
tion; or 
(cc) 
video 
interpretation; 
and 
(ii) the direct provision of health care 
or health-care-related services by a com-
petent bilingual health care provider. 
(C) EXCEPTIONS.—The requirements of 
subparagraph (B)(i)(I) do not apply, with re-
spect to interpreter and translation services and 
a grantee— 
(i) in the case of a Medicare bene-
ficiary who is an English learner if— 
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(I) such beneficiary has been in-
formed, in the beneficiary’s primary 
language, of the availability of free in-
terpreter and translation services and 
the beneficiary instead requests that a 
family member, friend, or other per-
son provide such services; and 
(II) the grantee documents such 
request in the beneficiary’s medical 
record; or 
(ii) in the case of a medical emergency 
where the delay directly associated with ob-
taining a competent interpreter or trans-
lation services would jeopardize the health 
of the patient. 
Clause (ii) shall not be construed to exempt 
emergency rooms or similar entities that regu-
larly provide health care services in medical 
emergencies to patients who are English learn-
ers from any applicable legal or regulatory re-
quirements related to providing competent in-
terpreter and translation services without undue 
delay. 
(D) MEDICARE
ADVANTAGE
ORGANIZA-
TIONS AND PDP SPONSORS.—If a grantee is a 
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Medicare Advantage organization offering a 
Medicare Advantage plan under part C of title 
XVIII of the Social Security Act or a PDP 
sponsor offering a prescription drug plan under 
part D of such title, such entity must provide 
at least 50 percent of the grant funds that the 
entity receives under this subsection directly to 
the entity’s network providers (including all 
health providers and pharmacists) for the pur-
pose of providing support for such providers to 
provide competent language services to Medi-
care beneficiaries who are English learners. 
(E) ADMINISTRATIVE
AND
REPORTING 
COSTS.—A grantee may use up to 10 percent of 
the grant funds to pay for administrative costs 
associated with the provision of competent lan-
guage services and for reporting required under 
paragraph (9). 
(6) DETERMINATION
OF
AMOUNT
OF
GRANT 
PAYMENTS.— 
(A) IN GENERAL.—Payments to grantees 
under this subsection shall be calculated based 
on the estimated numbers of Medicare bene-
ficiaries who are English learners in a grantee’s 
service area utilizing— 
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(i) data on the numbers of English 
learners who speak English less than ‘‘very 
well’’ from the most recently available data 
from the Bureau of the Census or other 
State-based study the Secretary determines 
likely to yield accurate data regarding the 
number of such individuals in such service 
area; or 
(ii) data provided by the grantee, if 
the grantee routinely collects data on the 
primary language of the Medicare bene-
ficiaries that the grantee serves and the 
Secretary determines that the data is accu-
rate and shows a greater number of 
English learners than would be estimated 
using the data under clause (i). 
(B) DISCRETION OF SECRETARY.—Subject 
to subparagraph (C), the amount of payment 
made to a grantee under this subsection may be 
modified annually at the discretion of the Sec-
retary, based on changes in the data under sub-
paragraph (A) with respect to the service area 
of a grantee for the year. 
(C) 
LIMITATION
ON
AMOUNT.—The 
amount of a grant made under this subsection 
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to a grantee may not exceed $500,000 for the 
period under paragraph (1)(D). 
(7) ASSURANCES.—Grantees under this sub-
section shall, as a condition of receiving a grant 
under this subsection— 
(A) ensure that clinical and support staff 
receive appropriate ongoing education and 
training in linguistically appropriate service de-
livery; 
(B) ensure the linguistic competence of bi-
lingual providers; 
(C) offer and provide appropriate language 
services at no additional charge to each patient 
who is an English learner for all points of con-
tact between the patient and the grantee, in a 
timely manner during all hours of operation; 
(D) notify Medicare beneficiaries of their 
right to receive language services in their pri-
mary language; 
(E) post signage in the primary languages 
commonly used by the patient population in the 
service area of the organization; and 
(F) ensure that— 
(i) primary language data are col-
lected for recipients of language services 
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100 
and such data are consistent with stand-
ards developed under title XXXIV of the 
Public Health Service Act, as added by 
section 202 of this Act, to the extent such 
standards are available upon the initiation 
of the demonstration program; and 
(ii) consistent with the privacy protec-
tions provided under the regulations pro-
mulgated pursuant to section 264(c) of the 
Health Insurance Portability and Account-
ability Act of 1996 (42 U.S.C. 1320d–2 
note), if the recipient of language services 
is a minor or is incapacitated, primary lan-
guage data are collected on the parent or 
legal guardian of such recipient. 
(8) NO COST-SHARING.—Medicare beneficiaries 
who are English learners shall not have to pay cost- 
sharing or co-payments for competent language serv-
ices provided under this demonstration program. 
(9) REPORTING
REQUIREMENTS
FOR
GRANT-
EES.—Not later than the end of each calendar year, 
a grantee that receives funds under this subsection 
in such year shall submit to the Secretary a report 
that includes the following information: 
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101 
(A) The number of Medicare beneficiaries 
to whom competent language services are pro-
vided. 
(B) The primary languages of those Medi-
care beneficiaries. 
(C) The types of language services pro-
vided to such beneficiaries. 
(D) Whether such language services were 
provided by employees of the grantee or 
through a contract with external contractors or 
agencies. 
(E) The types of interpretation services 
provided to such beneficiaries, and the approxi-
mate length of time such service is provided to 
such beneficiaries. 
(F) The costs of providing competent lan-
guage services. 
(G) An account of the training or accredi-
tation of bilingual staff, interpreters, and trans-
lators providing services funded by the grant 
under this subsection. 
(10) EVALUATION
AND
REPORT
TO
CON-
GRESS.—Not later than 1 year after the completion 
of a 3-year grant under this subsection, the Sec-
retary shall conduct an evaluation of the demonstra-
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102 
tion program under this subsection and shall submit 
to the Congress a report that includes the following: 
(A) An analysis of the patient outcomes 
and the costs of furnishing care to the Medicare 
beneficiaries who are English learners partici-
pating in the project as compared to such out-
comes and costs for such Medicare beneficiaries 
not participating, based on the data provided 
under paragraph (9) and any other information 
available to the Secretary. 
(B) The effect of delivering language serv-
ices on— 
(i) Medicare beneficiary access to care 
and utilization of services; 
(ii) the efficiency and cost effective-
ness of health care delivery; 
(iii) patient satisfaction; 
(iv) health outcomes; and 
(v) the provision of culturally appro-
priate services provided to such bene-
ficiaries. 
(C) The extent to which bilingual staff, in-
terpreters, and translators providing services 
under such demonstration were trained or ac-
credited and the nature of accreditation or 
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103 
training needed by type of provider, service, or 
other category as determined by the Secretary 
to ensure the provision of high-quality interpre-
tation, translation, or other language services to 
Medicare beneficiaries if such services are ex-
panded pursuant to subsection (c) of section 
1907 of this Act. 
(D) Recommendations, if any, regarding 
the extension of such project to the entire Medi-
care program, subject to the provisions of sec-
tion 1115A(c) of the Social Security Act (42 
U.S.C. 1315a(c)). 
(11) APPROPRIATIONS.—There is appropriated 
to carry out this subsection, in equal parts from the 
Federal Hospital Insurance Trust Fund under sec-
tion 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical In-
surance Trust Fund under section 1841 of such Act 
(42 U.S.C. 1395t), $16,000,000 for each fiscal year 
of the demonstration program. 
(12) ENGLISH
LEARNER
DEFINED.—In this 
subsection, the term ‘‘English learner’’ has the 
meaning given such term in section 8101(20) of the 
Elementary and Secondary Education Act of 1965, 
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104 
except that subparagraphs (A), (B), and (D) of such 
section shall not apply. 
(b) LANGUAGE SERVICES UNDER THE MEDICARE 
PROGRAM.— 
(1) INCLUSION
AS
RURAL
HEALTH
CLINIC 
SERVICES.—Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended— 
(A) in subsection (aa)(1)— 
(i) in subparagraph (B), by striking 
the ‘‘and’’ at the end; 
(ii) by adding ‘‘and’’ at the end of 
subparagraph (C); and 
(iii) by inserting after subparagraph 
(C) the following new subparagraph: 
‘‘(D) language services as defined in subsection 
(iii)(1),’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Language Services and Related Terms 
‘‘(iii) 
‘‘(1) The term ‘language services’ has the same 
meaning given the term ‘language or language ac-
cess services’ in section 3400 of the Public Health 
Service Act. 
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105 
‘‘(2) The term ‘interpreter services’ has the meaning 
given the term ‘competent interpreter services’ in section 
3400(3) of the Public Health Service Act. 
‘‘(3) The term ‘interpreter’— 
‘‘(A) means an individual— 
‘‘(i) who faithfully, accurately, and objec-
tively transmits a spoken message from one lan-
guage into another language; and 
‘‘(ii) who knows health and health-related 
terminology in both languages; and 
‘‘(B) includes individuals who provide in-person, 
telephonic, and video interpretation. 
‘‘(4) The term ‘translation’ means the transmission 
of a written message in one language into a written mes-
sage in another language that retains the intended mean-
ing of the original message. 
‘‘(5) The term ‘English learner’ has the meaning 
given such term in section 8101(20) of the Elementary 
and Secondary Education Act of 1965, except that sub-
paragraphs (A), (B), and (D) of such section shall not 
apply.’’. 
(2) COVERAGE.—Section 1832(a)(2) of the So-
cial Security Act (42 U.S.C. 1395k(a)(2)) is amend-
ed— 
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106 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (I); 
(B) by striking the period at the end of 
subparagraph (J) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) language services (as defined in para-
graph (1) of section 1861(iii)) furnished by an 
interpreter (as defined in paragraph (3) of such 
section) or translator.’’. 
(3) PAYMENT.—Section 1833(a) of the Social 
Security Act (42 U.S.C. 1395l(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (8); 
(B) by striking the period at the end of 
paragraph (9) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (9) the 
following new paragraph: 
‘‘(10) in the case of language services described 
in section 1861(iii)(1), 100 percent of the reasonable 
charges for such services, as determined in consulta-
tion with the Medicare Payment Advisory Commis-
sion; and’’. 
(4) WAIVER
OF
BUDGET
NEUTRALITY.—For 
the 3-year period beginning on the date of enact-
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107 
ment of this section, the budget neutrality provision 
of section 1848(c)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 
apply with respect to language services (as such 
term is defined in section 1861(iii)(1) of such Act). 
(c) MEDICARE PARTS C AND D.— 
(1) IN GENERAL.—Medicare Advantage plans 
under part C of the Social Security Act and pre-
scription drug plans under part D of such Act shall 
comply with title VI of the Civil Rights Act of 1964 
and section 1557 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18116) to provide ef-
fective language services to enrollees of such plans. 
(2) MEDICARE
ADVANTAGE
PLANS
AND
PRE-
SCRIPTION
DRUG
PLANS
REPORTING
REQUIRE-
MENT.—Section 1857(e) of the Social Security Act 
(42 U.S.C. 1395w–27(e)) is amended by adding at 
the end the following new paragraph: 
‘‘(5) REPORTING REQUIREMENTS RELATING TO 
EFFECTIVE LANGUAGE SERVICES.—A contract under 
this part shall require a Medicare Advantage organi-
zation (and, through application of section 1860D– 
12(b)(3)(D), a contract under section 1860D–12 
shall require a PDP sponsor) to annually submit 
(for each year of the contract) a report that contains 
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108 
information on the plan’s internal policies and proce-
dures related to recruitment and retention efforts di-
rected to workforce diversity and linguistically and 
culturally appropriate provision of services in each of 
the following contexts: 
‘‘(A) The collection of data in a manner 
that meets the requirements of title I of the 
Health Equity and Accountability Act of 2016, 
regarding the enrollee population. 
‘‘(B) Education of staff and contractors 
who have routine contact with enrollees regard-
ing the various needs of the diverse enrollee 
population. 
‘‘(C) Evaluation of the health plan’s lan-
guage services programs and services with re-
spect to the plan’s enrollee population, such as 
through analysis of complaints or satisfaction 
survey results. 
‘‘(D) Methods by which the plan provides 
to the Secretary information regarding the eth-
nic diversity of the plan’s enrollee population. 
‘‘(E) The periodic provision of educational 
information to plan enrollees on the plan’s lan-
guage services and programs.’’. 
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109 
(d) IMPROVING LANGUAGE SERVICES IN MEDICAID 
AND CHIP.— 
(1) 
PAYMENTS
TO
STATES.—Section 
1903(a)(2)(E) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(E)) is amended by— 
(A) striking ‘‘75’’ and inserting ‘‘90’’; 
(B) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language services’’; 
and 
(C) striking ‘‘children of families’’ and in-
serting ‘‘individuals’’. 
(2) STATE
PLAN
REQUIREMENTS.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended by striking 
‘‘and (28)’’ and inserting ‘‘(28), and (29)’’. 
(3) DEFINITION
OF
MEDICAL
ASSISTANCE.— 
Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended by— 
(A) in paragraph (28), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (29) as 
paragraph (30); and 
(C) by inserting after paragraph (28) the 
following new paragraph: 
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110 
‘‘(29) language services, as such term is defined 
in section 1861(iii)(1), provided in a timely manner 
to 
English 
learners 
(as 
defined 
in 
section 
1861(iii)(5)) who need such services; and’’. 
(4) USE
OF
DEDUCTIONS
AND
COST
SHAR-
ING.—Section 1916(a)(2) of the Social Security Act 
(42 U.S.C. 1396o(2)) is amended by— 
(A) by striking ‘‘or’’ at the end of subpara-
graph (D); 
(B) by striking ‘‘; and’’ at the end of sub-
paragraph (E) and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) language services described in section 
1905(a)(29); and’’. 
(5) CHIP COVERAGE REQUIREMENTS.—Section 
2103 of the Social Security Act (42 U.S.C. 1397cc) 
is amended— 
(A) in subsection (a), in the matter before 
paragraph (1), by striking ‘‘and (7)’’ and in-
serting ‘‘(7), and (9)’’; and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(9) LANGUAGE SERVICES.—The child health 
assistance provided to a targeted low-income child 
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111 
shall include coverage of language services, as such 
term is defined in section 1861(iii)(1), provided in a 
timely manner to English learners (as defined in 
section 1861(iii)(5)) who need such services.’’; and 
(C) in subsection (e)(2)— 
(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
(ii) by inserting ‘‘or subsection (c)(9)’’ 
after ‘‘subsection (c)(1)(D)’’. 
(6) DEFINITION
OF
CHILD
HEALTH
ASSIST-
ANCE.—Section 2110(a)(27) of the Social Security 
Act (42 U.S.C. 1397jj) is amended by striking 
‘‘translation’’ and inserting ‘‘language services as 
described in section 2103(c)(9)’’. 
(7) STATE
DATA
COLLECTION.—Pursuant to 
the reporting requirement described in section 
2107(b)(1) of the Social Security Act (42 U.S.C. 
1397gg(b)(1)), the Secretary of Health and Human 
Services shall require that States collect data on— 
(A) the primary language of individuals re-
ceiving child health assistance under title XXI 
of the Social Security Act; and 
(B) in the case of such individuals who are 
minors or incapacitated, the primary language 
of the individual’s parent or guardian. 
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112 
(8) CHIP PAYMENTS
TO
STATES.—Section 
2105 of the Social Security Act (42 U.S.C. 
1397ee(c)) is amended— 
(A) in subsection (a)(1), by striking ‘‘75’’ 
and inserting ‘‘90’’; and 
(B) in subsection (c)(2)(A), by inserting 
before the period at the end the following: ‘‘, 
except that expenditures pursuant to clause (iv) 
of subparagraph (D) of such paragraph shall 
not count towards this total’’. 
(e) FUNDING LANGUAGE SERVICES FURNISHED BY 
PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE-
LATED SERVICES THAT SERVE HIGH RATES OF UNIN-
SURED LEP INDIVIDUALS.— 
(1) PAYMENT OF COSTS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services shall make payments (on a quarterly 
basis) directly to eligible entities to support the 
provision of language services to English learn-
ers in an amount equal to an eligible entity’s el-
igible costs for such services for the quarter. 
(B) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there are 
appropriated to the Secretary of Health and 
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113 
Human Services such sums as may be nec-
essary for each of fiscal years 2017 through 
2021. 
(C) RELATION TO MEDICAID DSH.—Pay-
ments under this subsection shall not offset or 
reduce payments under section 1923 of the So-
cial Security Act, nor shall payments under 
such section be considered when determining 
uncompensated costs associated with the provi-
sion of language services. 
(2) 
METHODOLOGY
FOR
PAYMENT
OF 
CLAIMS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a methodology to determine the average 
per person cost of language services. 
(B) 
DIFFERENT
ENTITIES.—In 
estab-
lishing such methodology, the Secretary may es-
tablish different methodologies for different 
types of eligible entities. 
(C) NO
INDIVIDUAL
CLAIMS.—The Sec-
retary may not require eligible entities to sub-
mit individual claims for language services for 
individual patients as a requirement for pay-
ment under this subsection. 
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(3) DATA COLLECTION INSTRUMENT.—For pur-
poses of this subsection, the Secretary shall create a 
standard data collection instrument that is con-
sistent with any existing reporting requirements by 
the Secretary or relevant accrediting organizations 
regarding the number of individuals to whom lan-
guage access are provided. 
(4) GUIDELINES.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary of Health and Human Services shall establish 
and distribute guidelines concerning the implementa-
tion of this subsection. 
(5) REPORTING REQUIREMENTS.— 
(A) REPORT TO SECRETARY.—Entities re-
ceiving payment under this subsection shall pro-
vide the Secretary with a quarterly report on 
how the entity used such funds. Such report 
shall contain aggregate (and may not contain 
individualized) data collected using the instru-
ment under paragraph (3) and shall otherwise 
be in a form and manner determined by the 
Secretary. 
(B) REPORT
TO
CONGRESS.—Not later 
than 2 years after the date of enactment of this 
Act, and every 2 years thereafter, the Secretary 
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shall submit a report to Congress concerning 
the implementation of this subsection. 
(6) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE COSTS.—The term ‘‘eligible 
costs’’ means, with respect to an eligible entity 
that provides language services to English 
learners, the product of— 
(i) the average per person cost of lan-
guage services, determined according to 
the methodology devised under paragraph 
(2); and 
(ii) the number of English learners 
who are provided language services by the 
entity and for whom no reimbursement is 
available for such services under the 
amendments made by subsections (a), (b), 
(c), or (d) or by private health insurance. 
(B) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means an entity that— 
(i) is a Medicaid provider that is— 
(I) a physician; 
(II) a hospital with a low-income 
utilization rate (as defined in section 
1923(b)(3) of the Social Security Act 
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(42 U.S.C. 1396r–4(b)(3))) of greater 
than 25 percent; or 
(III) a federally qualified health 
center 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
(ii) provide language services to at 
least 8 percent of the entity’s total number 
of patients, not later than 6 months after 
the date of the enactment of the Act; and 
(iii) prepare and submit an applica-
tion to the Secretary, at such time, in such 
manner, and accompanied by such infor-
mation as the Secretary may require to as-
certain the entity’s eligibility for funding 
under this subsection. 
(C) 
ENGLISH
LEARNER.—The 
term 
‘‘English learner’’ has the meaning given such 
term in section 8101(20) of the Elementary 
and Secondary Education Act of 1965, except 
that subparagraphs (A), (B), and (D) of such 
section shall not apply. 
(D) 
LANGUAGE
SERVICES.—The 
term 
‘‘language services’’ has the meaning given such 
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term in section 1861(iii)(1) of the Social Secu-
rity Act. 
(f) APPLICATION OF CIVIL RIGHTS ACT OF 1964 AND 
OTHER LAWS.—Nothing in this section shall be construed 
to limit otherwise existing obligations of recipients of Fed-
eral financial assistance under title VI of the Civil Rights 
Act of 1964 (42 U.S.C. 2000(d) et seq.) or other laws 
that protect the civil rights of individuals. 
(g) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided and subject to paragraph (2), the amendments 
made by this section shall take effect on January 1, 
2017. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
which the Secretary of Health and Human Services 
determines requires State legislation (other than leg-
islation appropriating funds) in order for the plan to 
meet the additional requirement imposed by the 
amendments made by this section, the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet this additional requirement before 
the first day of the first calendar quarter beginning 
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after the close of the first regular session of the 
State legislature that begins after the date of the en-
actment 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. 206. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity and the Administrator of the Health Resources and 
Services Administration, in consultation with the Director 
of the National Institute on Minority Health and Health 
Disparities and the Office of Minority Health, shall award 
grants to eligible entities to improve health care for pa-
tient populations that have low functional health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
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taining such information as the Secretary may re-
quire. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—Grants awarded under subsection (a) 
through the Agency for Healthcare Research and 
Quality shall be used— 
(A) to define and increase the under-
standing of health literacy; 
(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
(D) for any other activity determined ap-
propriate by the Director of the Agency. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—Grants awarded under subsection (a) 
through the Health Resources and Services Adminis-
tration shall be used to conduct demonstration 
projects for interventions for patients with low 
health literacy that may include— 
(A) the development of new disease man-
agement programs for patients with low health 
literacy; 
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(B) the tailoring of existing disease man-
agement programs addressing mental, physical, 
oral, and behavioral health conditions for pa-
tients with low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; and 
(F) other activities determined appropriate 
by the Administrator of the Health Resources 
and Services Administration. 
(d) DEFINITIONS.—In this section, the term ‘‘low 
health literacy’’ means the inability of an individual to ob-
tain, process, and understand basic health information 
and services needed to make appropriate health decisions. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2017 through 2021. 
SEC. 207. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 
(a) IN GENERAL.—Any health program or activity, 
any part of which is receiving Federal financial assistance, 
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including credits, subsidies, or contracts of insurance, and 
any program or activity that is administered by an execu-
tive agency or any entity established under title I of the 
Patient Protection and Affordable Care Act (or amend-
ments made thereby), as such programs, activities, agen-
cies, and entities are described in section 1557(a) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18116), in order to ensure the right of LEP individuals 
to receive access to quality health care, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in lin-
guistically appropriate service delivery; 
(2) offer and provide appropriate language serv-
ices at no additional charge to each patient with lim-
ited-English-proficiency at all points of contact, in a 
timely manner during all hours of operation; 
(3) notify patients of their right to receive lan-
guage services in their primary language; and 
(4) utilize only competent interpreter or trans-
lation services, as defined in section 3400 of the 
Public Health Service Act. 
(b) EXEMPTIONS.—The requirements of subsection 
(a)(4) shall not apply as follows: 
(1) When a patient (who has been informed in 
his or her primary language of the availability of 
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free interpreter and translation services) requests 
the use of family, friends, or other persons untrained 
in interpretation or translation if the following con-
ditions are met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
(B) The recipient informs the patient that 
he or she has the option of having the recipient 
provide an interpreter for him or her without 
charge, or of using his or her own interpreter. 
(C) The recipient informs the patient that 
the recipient may not require an LEP person to 
use a family member or friend as an inter-
preter. 
(D) The recipient evaluates whether the 
person the patient wishes to use as an inter-
preter is competent. If the recipient has reason 
to believe that the interpreter is not competent, 
the recipient provides the recipient’s own inter-
preter to protect the recipient from liability if 
the patient’s interpreter is later found not com-
petent. 
(E) If the recipient has reason to believe 
that there is a conflict of interest between the 
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interpreter and patient, the recipient may not 
use the patient’s interpreter. 
(F) The recipient has the patient sign a 
waiver, witnessed by at least 1 individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
(E) and is translated into the patient’s lan-
guage. 
(2) When a medical emergency exists and the 
delay directly associated with obtaining competent 
interpreter or translation services would jeopardize 
the health of the patient, but only until a competent 
interpreter or translation service is available. 
(c) RULE
OF CONSTRUCTION.—Subsection (b)(2) 
shall not be construed to mean that emergency rooms or 
similar entities that regularly provide health care services 
in medical emergencies are exempt from legal or regu-
latory requirements related to competent interpreter serv-
ices. 
SEC. 208. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTH CARE SERVICES. 
(a) REPORT.—Not later than 1 year after the date 
of enactment of this Act and annually thereafter, the Sec-
retary of Health and Human Services shall enter into a 
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contract with the Institute of Medicine for the preparation 
and publication of a report that describes Federal efforts 
to ensure that all individuals with limited-English pro-
ficiency have meaningful access culturally competent to 
health care and health-care-related services. Such report 
shall include— 
(1) a description and evaluation of the activities 
carried out under this Act; 
(2) a description and analysis of best practices, 
model programs, guidelines, and other effective 
strategies for providing access to culturally and lin-
guistically appropriate health care services; 
(3) recommendations on the development and 
implementation of policies and practices by providers 
of health care and health-care-related services for 
limited-English-proficient individuals; 
(4) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(5) a description of the costs associated with or 
savings related to the provision of language services. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2021. 
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SEC. 209. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to eligible entities 
for the provision of English as a second language (in this 
section referred to ‘‘ESL’’) instruction and shall deter-
mine, after consultation with appropriate stakeholders, the 
mechanism for administering and distributing such 
grants. 
(b) ELIGIBLE ENTITY DEFINED.—For purposes of 
this section, the term ‘‘eligible entity’’ means a State or 
community-based organization that employs, and serves, 
minority populations. 
(c) APPLICATION.—An eligible entity may apply for 
a grant under this section by submitting such information 
as the Secretary may require and in such form and man-
ner as the Secretary may require. 
(d) USE OF GRANT.—As a condition of receiving a 
grant under this section, an eligible entity shall— 
(1) develop and implement a plan for assuring 
the availability of ESL instruction that effectively 
integrates information about the nature of the 
United States health care system, how to access 
care, and any special language skills that may be re-
quired for them to access and regularly negotiate the 
system effectively; 
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(2) develop a plan, including, where appro-
priate, public-private partnerships, for making ESL 
instruction progressively available to all individuals 
seeking instruction; and 
(3) maintain current ESL instruction efforts by 
using the additional funds to supplement rather 
than supplant any funds expended for ESL instruc-
tion in the State as of January 1, 2017. 
(e) ADDITIONAL DUTIES OF THE SECRETARY.—The 
Secretary of Education shall— 
(1) collect and publicize annual data on how 
much Federal, State, and local governments spend 
on ESL instruction; 
(2) collect data from State and local govern-
ments to identify the unmet needs of English lan-
guage learners for appropriate ESL instruction, in-
cluding— 
(A) the preferred written and spoken lan-
guage of such English language learners; 
(B) the extent of waiting lists including 
how many programs maintain waiting lists and, 
for programs that do not have waiting lists, the 
reasons why not; 
(C) the availability of programs to geo-
graphically isolated communities; 
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(D) the impact of course enrollment poli-
cies, including open enrollment, on the avail-
ability of ESL instruction; 
(E) the number individuals in the State 
and each participating locality; 
(F) the effectiveness of the instruction in 
meeting the needs of individuals receiving in-
struction and those needing instruction; 
(G) as assessment of the need for pro-
grams that integrate job training and ESL in-
struction, to assist individuals to obtain better 
jobs; and 
(H) the availability of ESL slots by State 
and locality; 
(3) determine the cost and most appropriate 
methods of making ESL instruction available to all 
English language learners seeking instruction; and 
(4) within 1 year of the date of enactment of 
this Act, issue a report to Congress that assesses the 
information collected in paragraphs (1), (2), and (3) 
and makes recommendations on steps that should be 
taken to progressively realize the goal of making 
ESL instruction available to all English language 
learners seeking instruction. 
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(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of Edu-
cation for each of fiscal years 2017 through 2020 
$250,000,000 to carry out this section. 
SEC. 210. IMPLEMENTATION. 
(a) GENERAL PROVISIONS.— 
(1) A State shall not be immune under the 
Eleventh Amendment of the Constitution of the 
United States from suit in Federal court for failing 
to provide the language access funded pursuant to 
this title. 
(2) In a suit against a State for a violation of 
this title, remedies (including remedies at both at 
law and in equity) are available for such a violation 
to the same extent as such remedies are available for 
such a violation in the suit against any public or pri-
vate entity other than a State. 
(b) RULE OF CONSTRUCTION.—Nothing in this title 
shall be construed to limit otherwise existing obligations 
of recipients of Federal financial assistance under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 
seq.) or any other statute. 
SEC. 211. LANGUAGE ACCESS SERVICES. 
(a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 
the Patient Protection and Affordable Care Act (42 
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U.S.C. 18022(b)(1)) is amended by adding at the end the 
following: 
‘‘(K) Language access services, including 
oral interpretation and written translations.’’. 
(b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 
COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following: 
‘‘(v) COVERAGE MUST INCLUDE LAN-
GUAGE ACCESS AND SERVICES.—Except as 
provided in clause (iii), an employee shall 
not be treated as eligible for minimum es-
sential coverage if such coverage consists 
of an eligible employer-sponsored plan (as 
defined in section 5000A(f)(2)) and the 
plan does not provide coverage for lan-
guage access services, including oral inter-
pretation and written translations.’’. 
(c) QUALITY REPORTING.—Section 2717(a)(1) of the 
Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 
amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (C); 
(2) by striking the period at the end of sub-
paragraph (D) and inserting ‘‘; and’’; and 
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(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) reduce health disparities through the 
provision of language access services, including 
oral interpretation and written translations.’’. 
(d) REGULATIONS REGARDING INTERNAL CLAIMS 
AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 
HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 
The Secretary of the Treasury, the Secretary of Labor, 
and the Secretary of Health and Human Services shall 
amend the regulations in section 54.9815–2719T(e) of 
title 26, Code of Federal Regulations, section 2590.715– 
2719(e) of title 29, Code of Federal Regulations, and sec-
tion 147.136(e) of title 45, Code of Federal Regulations, 
respectively, to require group health plans and health in-
surance issuers offering group or individual health insur-
ance coverage to which such sections apply— 
(1) to provide oral interpretation services with-
out any threshold requirements; 
(2) to provide in the English versions of all no-
tices a statement prominently displayed in not less 
than 15 non-English languages clearly indicating 
how to access the language services provided by the 
plan or issuer; and 
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(3) with respect to written translations of no-
tices, to apply a threshold that 5 percent of the pop-
ulation or at least 500 individuals per service area 
are literate only in the same non-English language 
in lieu of 10 percent or more residing in a county. 
(e) DATA COLLECTION AND REPORTING.—The Sec-
retary of Health and Human Services shall— 
(1) amend the single streamlined application 
form developed pursuant to section 1413 of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18083) to collect the preferred spoken and written 
language for each household member applying for 
coverage under a qualified health plan through an 
Exchange under title I of the Patient Protection and 
Affordable Care Act; 
(2) require navigators, certified application 
counselors, and other enrollment assisters to collect 
and report requests for language assistance; and 
(3) require the Federal and State call centers 
established pursuant to section 1311(d)(4)(b) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18031(d)(4)(b)) to submit an annual report 
documenting the number of language assistance re-
quests, the types of languages requested, the range 
and average wait time for a consumer to speak with 
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an interpreter, and any steps the call center and lan-
guage line have taken to actively address some of 
the consumer complaints. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to plan years beginning after the 
date of the enactment of this Act. 
TITLE III—HEALTH WORKFORCE 
DIVERSITY 
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXIV of the Public Health Service Act, as 
added by section 202, is amended by adding at the end 
the following: 
‘‘Subtitle A—Diversifying the 
Health Care Workplace 
‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 
DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Bureau of Health Workforce within the Health Re-
sources and Services Administration, shall award a grant 
to an entity determined appropriate by the Secretary for 
the establishment of a national working group on work-
force diversity. 
‘‘(b) REPRESENTATION.—In establishing the national 
working group under subsection (a): 
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‘‘(1) The grantee shall ensure that the group 
has representatives of the following: 
‘‘(A) The Health Resources and Services 
Administration. 
‘‘(B) The Department of Health and 
Human Services Data Council. 
‘‘(C) The Office of Minority Health of the 
Department of Health and Human Services. 
‘‘(D) The Substance Abuse and Mental 
Health Services Administration. 
‘‘(E) The Bureau of Labor Statistics of 
the Department of Labor. 
‘‘(F) The Public Health Practice Program 
Office—Office of Workforce Policy and Plan-
ning. 
‘‘(G) The National Institute on Minority 
Health and Health Disparities. 
‘‘(H) The Agency for Healthcare Research 
and Quality. 
‘‘(I) The Institute of Medicine Study Com-
mittee for the 2004 workforce diversity report. 
‘‘(J) The Indian Health Service. 
‘‘(K) The Department of Education. 
‘‘(L) Minority-serving academic institu-
tions. 
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‘‘(M) Consumer organizations. 
‘‘(N) Health professional associations, in-
cluding those that represent underrepresented 
minority populations. 
‘‘(O) Researchers in the area of health 
workforce. 
‘‘(P) Health workforce accreditation enti-
ties. 
‘‘(Q) Private (including nonprofit) founda-
tions that have sponsored workforce diversity 
initiatives. 
‘‘(R) Local and State health departments. 
‘‘(S) Representatives of community mem-
bers to be included on admissions committees 
for health profession schools pursuant to sub-
section (c)(8). 
‘‘(T) National community-based organiza-
tions that serve as a national intermediary to 
their urban affiliate members and have dem-
onstrated capacity to train health care profes-
sionals. 
‘‘(U) Other entities determined appropriate 
by the Secretary. 
‘‘(2) The grantee shall ensure that, in addition 
to the representatives under paragraph (1), the 
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group has not less than 5 health professions stu-
dents representing various health profession fields 
and levels of training. 
‘‘(c) ACTIVITIES.—The working group established 
under subsection (a) shall convene at least twice each year 
to complete the following activities: 
‘‘(1) Review current public and private health 
workforce diversity initiatives. 
‘‘(2) Identify successful health workforce diver-
sity programs and practices. 
‘‘(3) Examine challenges relating to the devel-
opment and implementation of health workforce di-
versity initiatives. 
‘‘(4) Draft a national strategic work plan for 
health workforce diversity, including recommenda-
tions for public and private sector initiatives. 
‘‘(5) Develop a framework and methods for the 
evaluation of current and future health workforce di-
versity initiatives. 
‘‘(6) Develop recommended standards for work-
force diversity that could be applicable to all health 
professions programs and programs funded under 
this Act. 
‘‘(7) Develop guidelines to train health profes-
sionals to care for a diverse population. 
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‘‘(8) Develop a strategy for the inclusion of 
community members on admissions committees for 
health profession schools. 
‘‘(9) Helping with monitoring and implementa-
tion of standards for diversity, equity, and inclusion. 
‘‘(10) Other activities determined appropriate 
by the Secretary. 
‘‘(d) ANNUAL REPORT.—Not later than 1 year after 
the establishment of the working group under subsection 
(a), and annually thereafter, the working group shall pre-
pare and make available to the general public for com-
ment, an annual report on the activities of the working 
group. Such report shall include the recommendations of 
the working group for improving health workforce diver-
sity. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 
WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Deputy Assistant Secretary for Minority Health, and 
in collaboration with the Bureau of Health Workforce 
within the Health Resources and Services Administration, 
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the National Institute on Minority Health and Health Dis-
parities, shall establish a technical clearinghouse on health 
workforce diversity within the Office of Minority Health 
and coordinate current and future clearinghouses. 
‘‘(b) INFORMATION AND SERVICES.—The clearing-
house established under subsection (a) shall offer the fol-
lowing information and services: 
‘‘(1) Information on the importance of health 
workforce diversity. 
‘‘(2) Statistical information relating to under-
represented minority representation in health and al-
lied health professions and occupations. 
‘‘(3) Model health workforce diversity practices 
and programs, including integrated models of care. 
‘‘(4) Admissions policies that promote health 
workforce diversity and are in compliance with Fed-
eral and State laws. 
‘‘(5) Retainment policies that promote comple-
tion of health profession degrees for underserved 
populations. 
‘‘(6) Lists of scholarship, loan repayment, and 
loan cancellation grants as well as fellowship infor-
mation for underserved populations for health pro-
fessions schools. 
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‘‘(7) Foundation and other large organizational 
initiatives relating to health workforce diversity. 
‘‘(c) CONSULTATION.—In carrying out this section, 
the Secretary shall consult with non-Federal entities which 
may include minority health professional associations and 
minority sections of major health professional associations 
to ensure the adequacy and accuracy of information. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 
WORKFORCE DIVERSITY, EQUITY, AND IN-
CLUSION. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration and the Centers for Disease Control and 
Prevention, shall award grants to eligible entities that 
demonstrate a commitment to health workforce diversity. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be an educational institution or entity that 
historically produces or trains meaningful numbers 
of underrepresented minority health professionals, 
including— 
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‘‘(A) historically Black colleges and univer-
sities; 
‘‘(B) Hispanic-serving health professions 
schools; 
‘‘(C) Hispanic-serving institutions; 
‘‘(D) tribal colleges and universities; 
‘‘(E) Asian-American, Native American, 
and Pacific Islander-serving institutions; 
‘‘(F) institutions that have programs to re-
cruit and retain underrepresented minority 
health professionals, in which a significant 
number of the enrolled participants are under-
represented minorities; 
‘‘(G) 
health 
professional 
associations, 
which may include underrepresented minority 
health professional associations; and 
‘‘(H) institutions, including national and 
regional community-based organizations with 
demonstrated commitment to a diversified 
workforce— 
‘‘(i) located in communities with pre-
dominantly underrepresented minority pop-
ulations; 
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‘‘(ii) with whom partnerships have 
been formed for the purpose of increasing 
workforce diversity; and 
‘‘(iii) in which at least 20 percent of 
the enrolled participants are underrep-
resented minorities; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant under subsection (a) shall be used to expand existing 
workforce diversity programs, implement new workforce 
diversity programs, or evaluate existing or new workforce 
diversity programs, including with respect to mental 
health care professions. Such programs shall enhance di-
versity by considering minority status as part of an indi-
vidualized consideration of qualifications. Possible activi-
ties may include— 
‘‘(1) educational outreach programs relating to 
opportunities in the health professions; 
‘‘(2) scholarship, fellowship, grant, loan repay-
ment, and loan cancellation programs; 
‘‘(3) postbaccalaureate programs; 
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‘‘(4) academic enrichment programs, particu-
larly targeting those who would not be competitive 
for health professions schools; 
‘‘(5) kindergarten through 12th grade and 
other health pipeline programs; 
‘‘(6) mentoring programs; 
‘‘(7) internship or rotation programs involving 
hospitals, health systems, health plans, and other 
health entities; 
‘‘(8) community partnership development for 
purposes relating to workforce diversity; or 
‘‘(9) leadership training. 
‘‘(d) REPORTS.—Not later than 1 year after receiving 
a grant under this section, and annually for the term of 
the grant, a grantee shall submit to the Secretary a report 
that summarizes and evaluates all activities conducted 
under the grant. 
‘‘(e) DEFINITION.—In this section, the term ‘Asian- 
American, Native American, and Pacific Islander-serving 
institutions’ has the same meaning as the term ‘Asian 
American and Native American Pacific Islander-serving 
institution’ as defined in section 371(c) of the Higher 
Education Act of 1965 (20 U.S.C. 1067q(c)). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
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such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 
RESEARCHERS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the National Institutes of Health, the Di-
rector of the Centers for Disease Control and Prevention, 
the Commissioner of Food and Drugs, the Director of the 
Agency for Healthcare Research and Quality, and the Ad-
ministrator of the Health Resources and Services Admin-
istration, shall award grants that expand existing opportu-
nities for scientists and researchers and promote the inclu-
sion of underrepresented minorities in the health profes-
sions. 
‘‘(b) RESEARCH FUNDING.—The head of each entity 
within the Department of Health and Human Services 
shall establish or expand existing programs to provide re-
search funding to scientists and researchers in training. 
Under such programs, the head of each such entity shall 
give priority in allocating research funding to support 
health research in traditionally underserved communities, 
including underrepresented minority communities, and re-
search classified as community or participatory. 
‘‘(c) DATA COLLECTION.—The head of each entity 
within the Department of Health and Human Services 
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shall collect data on the number (expressed as an absolute 
number and a percentage) of underrepresented minority 
and nonminority applicants who receive and are denied 
agency funding at every stage of review. Such data shall 
be reported annually to the Secretary and the appropriate 
committees of Congress. 
‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec-
retary shall establish a student loan reimbursement pro-
gram to provide student loan reimbursement assistance to 
researchers who focus on racial and ethnic disparities in 
health. The Secretary shall promulgate regulations to de-
fine the scope and procedures for the program under this 
subsection. 
‘‘(e) STUDENT LOAN CANCELLATION.—The Sec-
retary shall establish a student loan cancellation program 
to provide student loan cancellation assistance to research-
ers who focus on racial and ethnic disparities in health. 
Students participating in the program shall make a min-
imum 5-year commitment to work at an accredited health 
profession school. The Secretary shall promulgate addi-
tional regulations to define the scope and procedures for 
the program under this subsection. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
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such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 
PROFESSIONALS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, the Administrator of the Substance Abuse and 
Mental Health Services Administration, the Administrator 
of the Health Resources and Services Administration, and 
the Administrator of the Centers for Medicare & Medicaid 
Services, shall establish a program to award grants to eli-
gible individuals for career support in nonresearch-related 
health and wellness professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an individual shall— 
‘‘(1) be a student in a health professions school, 
a graduate of such a school who is working in a 
health profession, an individual working in a health 
or wellness profession (including mental and behav-
ioral health), or a faculty member of such a school; 
and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
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‘‘(c) USE
OF
FUNDS.—An individual shall use 
amounts received under a grant under this section to— 
‘‘(1) support the individual’s health activities or 
projects that involve underserved communities, in-
cluding racial and ethnic minority communities; 
‘‘(2) support health-related career advancement 
activities; 
‘‘(3) to pay, or as reimbursement for payments 
of, student loans or training or credentialing costs 
for individuals who are health professionals and are 
focused on health issues affecting underserved com-
munities, including racial and ethnic minority com-
munities; and 
‘‘(4) to establish and promote leadership train-
ing programs to decrease health disparities and to 
increase cultural competence with the goal of in-
creasing diversity in leadership positions. 
‘‘(d) DEFINITION.—In this section, the term ‘career 
in nonresearch-related health and wellness professions’ 
means employment or intended employment in the field 
of public health, health policy, health management, health 
administration, medicine, nursing, pharmacy, psychology, 
social work, psychiatry, other mental and behavioral 
health, allied health, community health, social work, or 
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other fields determined appropriate by the Secretary, 
other than in a position that involves research. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI-
VERSITY ON QUALITY. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
the Deputy Assistant Secretary for Minority Health and 
the Director of the National Institute on Minority Health 
and Health Disparities, shall award grants to eligible enti-
ties to expand research on the link between health work-
force diversity and quality health care. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a clinical, public health, or health serv-
ices research entity or other entity determined ap-
propriate by the Director; and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
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port research that investigates the effect of health work-
force diversity on— 
‘‘(1) language access; 
‘‘(2) cultural competence; 
‘‘(3) patient satisfaction; 
‘‘(4) timeliness of care; 
‘‘(5) safety of care; 
‘‘(6) effectiveness of care; 
‘‘(7) efficiency of care; 
‘‘(8) patient outcomes; 
‘‘(9) community engagement; 
‘‘(10) resource allocation; 
‘‘(11) organizational structure; 
‘‘(12) compliance of care; or 
‘‘(13) other topics determined appropriate by 
the Director. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give individualized consider-
ation to all relevant aspects of the applicant’s background. 
Consideration of prior research experience involving the 
health of underserved communities shall be such a factor. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
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‘‘SEC. 3417. HEALTH DISPARITIES EDUCATION PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the National Institute on Minority Health and 
Health Disparities and in collaboration with the Office of 
Minority Health, the Office for Civil Rights, the Centers 
for Disease Control and Prevention, the Centers for Medi-
care & Medicaid Services, the Health Resources and Serv-
ices Administration, and other appropriate public and pri-
vate entities, shall establish and coordinate a health and 
health care disparities education program to support, de-
velop, and implement educational initiatives and outreach 
strategies that inform health care professionals and the 
public about the existence of and methods to reduce racial 
and ethnic disparities in health and health care. 
‘‘(b) ACTIVITIES.—The Secretary, through the edu-
cation program established under subsection (a), shall, 
through the use of public awareness and outreach cam-
paigns targeting the general public and the medical com-
munity at large— 
‘‘(1) disseminate scientific evidence for the ex-
istence and extent of racial and ethnic disparities in 
health care, including disparities that are not other-
wise attributable to known factors such as access to 
care, patient preferences, or appropriateness of 
intervention, as described in the 2002 Institute of 
Medicine Report entitled ‘Unequal Treatment: Con-
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fronting Racial and Ethnic Disparities in Health 
Care’, as well as the impact of disparities related to 
age, disability status, socioeconomic status, sex, gen-
der identity, and sexual orientation on racial and 
ethnic minorities; 
‘‘(2) disseminate new research findings to 
health care providers and patients to assist them in 
understanding, reducing, and eliminating health and 
health care disparities; 
‘‘(3) disseminate information about the impact 
of linguistic and cultural barriers on health care 
quality and the obligation of health providers who 
receive Federal financial assistance to ensure that 
people with limited-English proficiency have access 
to language access services; 
‘‘(4) disseminate information about the impor-
tance and legality of racial, ethnic, disability status, 
socioeconomic status, sex, gender identity, and sex-
ual orientation, and primary language data collec-
tion, analysis, and reporting; 
‘‘(5) design and implement specific educational 
initiatives to health care providers relating to health 
and health care disparities; 
‘‘(6) assess the impact of the programs estab-
lished under this section in raising awareness of 
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health and health care disparities and providing in-
formation on available resources; and 
‘‘(7) design and implement specific educational 
initiatives to educate the health care workforce relat-
ing to unconscious bias. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022.’’. 
SEC. 
302. 
HISPANIC-SERVING 
HEALTH 
PROFESSIONS 
SCHOOLS. 
Part B of title VII of the Public Health Service Act 
(42 U.S.C. 293 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 
742. 
HISPANIC-SERVING 
HEALTH 
PROFESSIONS 
SCHOOLS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall award grants to Hispanic-serving 
health professions schools for the purpose of carrying out 
programs to recruit Hispanic individuals to enroll in and 
graduate from such schools, which may include providing 
scholarships and other financial assistance as appropriate. 
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‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His-
panic-serving health professions school’ means an entity 
that— 
‘‘(1) is a school or program under section 
799B; 
‘‘(2) has an enrollment of full-time equivalent 
students that is made up of at least 9 percent His-
panic students; 
‘‘(3) has been effective in carrying out pro-
grams to recruit Hispanic individuals to enroll in 
and graduate from the school; 
‘‘(4) has been effective in recruiting and retain-
ing Hispanic faculty members; 
‘‘(5) has a significant number of graduates who 
are providing health services to medically under-
served populations or to individuals in health profes-
sional shortage areas; and 
‘‘(6) is a Regional Hispanic Center of Excel-
lence.’’. 
SEC. 303. LOAN REPAYMENT PROGRAM OF CENTERS FOR 
DISEASE CONTROL AND PREVENTION. 
Section 317F(c) of the Public Health Service Act (42 
U.S.C. 247b–7(c)) is amended— 
(1) by striking ‘‘and’’ after ‘‘1994,’’; and 
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(2) by inserting before the period at the end the 
following: ‘‘, $750,000 for fiscal year 2017, and such 
sums as may be necessary for each of the fiscal 
years 2018 through 2022’’. 
SEC. 304. COOPERATIVE AGREEMENTS FOR ONLINE DE-
GREE PROGRAMS AT SCHOOLS OF PUBLIC 
HEALTH AND SCHOOLS OF ALLIED HEALTH. 
Part B of title VII of the Public Health Service Act 
(42 U.S.C. 293 et seq.), as amended by section 302, is 
further amended by adding at the end the following: 
‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE-
GREE PROGRAMS. 
‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 
acting through the Administrator of the Health Resources 
and Services Administration, in consultation with the Di-
rector of the Centers for Disease Control and Prevention, 
the Director of the Agency for Healthcare Research and 
Quality, and the Deputy Assistant Secretary for Minority 
Health, shall award cooperative agreements to schools of 
public health and schools of allied health to design and 
implement online degree programs. 
‘‘(b) PRIORITY.—In awarding cooperative agreements 
under this section, the Secretary shall give priority to any 
school of public health or school of allied health that has 
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an established track record of serving medically under-
served communities. 
‘‘(c) REQUIREMENTS.—Recipients of cooperative 
agreements under this section shall design and implement 
an online degree program that meets the following restric-
tions: 
‘‘(1) Enrollment of individuals who have ob-
tained a secondary school diploma or its recognized 
equivalent. 
‘‘(2) Maintaining a significant enrollment of 
underrepresented minority or disadvantaged stu-
dents. 
‘‘(3) Achieving a high completion rate of en-
rolled underrepresented minority or disadvantaged 
students. 
‘‘(d) 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 
2017 through 2022.’’. 
SEC. 305. SENSE OF CONGRESS ON THE MISSION OF THE 
NATIONAL HEALTH CARE WORKFORCE COM-
MISSION. 
It is the sense of Congress that the National Health 
Care Workforce Commission established by section 5101 
of the Patient Protection and Affordable Care Act (42 
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U.S.C. 294q) should, in carrying out its assigned duties 
under that section, give attention to the needs of racial 
and ethnic minorities, individuals with lower socio-
economic status, individuals with mental, developmental, 
and 
physical 
disabilities, 
lesbian, 
gay, 
bisexual, 
transgender, queer, and questioning populations, and indi-
viduals who are members of multiple minority or special 
population groups. 
SEC. 306. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 
Subtitle A of title XXXIV of the Public Health Serv-
ice Act, as added by section 301, is further amended by 
inserting after section 3417 the following: 
‘‘SEC. 3418. DAVID SATCHER PUBLIC HEALTH AND HEALTH 
SERVICES CORPS. 
‘‘(a) IN GENERAL.—The Administrator of the Health 
Resources and Services Administration and the Director 
of the Centers for Disease Control and Prevention, in col-
laboration with the Deputy Assistant Secretary for Minor-
ity Health, shall award grants to eligible entities to in-
crease awareness among postprimary and postsecondary 
students of career opportunities in the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a clinical, public health, or health serv-
ices organization, community-based or nonprofit en-
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tity, or other entity determined appropriate by the 
Director of the Centers for Disease Control and Pre-
vention; 
‘‘(2) serve a health professional shortage area, 
as determined by the Secretary; 
‘‘(3) work with students, including those from 
racial and ethnic minority backgrounds, that have 
expressed an interest in the health professions; and 
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE
OF FUNDS.—Grant awards under sub-
section (a) shall be used to support internships that will 
increase awareness among students of non-research-based, 
career opportunities in the following health professions: 
‘‘(1) Medicine. 
‘‘(2) Nursing. 
‘‘(3) Public Health. 
‘‘(4) Pharmacy. 
‘‘(5) Health administration and management. 
‘‘(6) Health policy. 
‘‘(7) Psychology. 
‘‘(8) Dentistry. 
‘‘(9) International health. 
‘‘(10) Social work. 
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‘‘(11) Allied health. 
‘‘(12) Psychiatry. 
‘‘(13) Hospice care. 
‘‘(14) Other professions deemed appropriate by 
the Director of the Centers for Disease Control and 
Prevention. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
trol and Prevention shall give priority to those entities 
that— 
‘‘(1) serve a high proportion of individuals from 
disadvantaged backgrounds; 
‘‘(2) have experience in health disparity elimi-
nation programs; 
‘‘(3) facilitate the entry of disadvantaged indi-
viduals into institutions of higher education; and 
‘‘(4) provide counseling or other services de-
signed to assist disadvantaged individuals in success-
fully completing their education at the postsecondary 
level. 
‘‘(e) STIPENDS.—The Secretary may approve sti-
pends under this section for individuals for any period of 
education in student-enhancement programs (other than 
regular courses) at health professions schools, programs, 
or entities, except that such a stipend may not be provided 
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to an individual for more than 6 months, and such a sti-
pend may not exceed $20 per day (notwithstanding any 
other provision of law regarding the amount of stipends). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3419. LOUIS STOKES PUBLIC HEALTH SCHOLARS 
PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Deputy Assistant Secretary for Minority Health, shall 
award scholarships to postsecondary students who seek a 
career in public health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a schol-
arship under subsection (a), an individual shall— 
‘‘(1) have interest, knowledge, or skill in public 
health research or public health practice, or other 
health professions as determined appropriate by the 
Director of the Centers for Disease Control and Pre-
vention; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) demonstrate promise for becoming a leader 
in public health; 
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‘‘(4) secure admission to a 4-year institution of 
higher education; 
‘‘(5) comply with subsection (e); and 
‘‘(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become public health professionals. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those stu-
dents that— 
‘‘(1) are from disadvantaged backgrounds; 
‘‘(2) have secured admissions to a minority- 
serving institution; and 
‘‘(3) have identified a health professional as a 
mentor at their school or institution and an aca-
demic advisor to assist in the completion of their 
baccalaureate degree. 
‘‘(e) SCHOLARSHIPS.—The Secretary may approve 
payment of scholarships under this section for such indi-
viduals for any period of education in student under-
graduate tenure, except that such a scholarship may not 
be provided to an individual for more than 4 years, and 
such scholarships may not exceed $10,000 per academic 
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year (notwithstanding any other provision of law regard-
ing the amount of scholarship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3420. PATSY MINK HEALTH AND GENDER RESEARCH 
FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Deputy Assistant Secretary for Minority Health, the Ad-
ministrator of the Substance Abuse and Mental Health 
Services Administration, and the Director of the Indian 
Health Services, shall award research fellowships to post- 
baccalaureate students to conduct research that will exam-
ine gender and health disparities and to pursue a career 
in the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall— 
‘‘(1) have experience in health research or pub-
lic health practice; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) have expressed an interest in the health 
professions; 
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‘‘(4) demonstrate promise for becoming a leader 
in the field of women’s health; 
‘‘(5) secure admission to a health professions 
school or graduate program with an emphasis in 
gender studies; 
‘‘(6) comply with subsection (f); and 
‘‘(7) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become researchers and advance 
the research base on the intersection between gender and 
health. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
trol and Prevention shall give priority to those applicants 
that— 
‘‘(1) are from disadvantaged backgrounds; and 
‘‘(2) have identified a mentor and academic ad-
visor who will assist in the completion of their grad-
uate or professional degree and have secured a re-
search assistant position with a researcher working 
in the area of gender and health. 
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‘‘(e) FELLOWSHIPS.—The Director of the Centers for 
Disease Control and Prevention may approve fellowships 
for individuals under this section for any period of edu-
cation in the student’s graduate or health profession ten-
ure, except that such a fellowship may not be provided 
to an individual for more than 3 years, and such a fellow-
ship may not exceed $18,000 per academic year (notwith-
standing any other provision of law regarding the amount 
of fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3420A. PAUL DAVID WELLSTONE INTERNATIONAL 
HEALTH FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
the Deputy Assistant Secretary for Minority Health, shall 
award research fellowships to college students or recent 
graduates to advance their understanding of international 
health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall— 
‘‘(1) have educational experience in the field of 
international health; 
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‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) demonstrate promise for becoming a leader 
in the field of international health; 
‘‘(4) be a college senior or recent graduate of 
a four-year higher education institution; 
‘‘(5) comply with subsection (e); and 
‘‘(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become health professionals and 
to advance their knowledge about international issues re-
lating to health care access and quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those appli-
cants that— 
‘‘(1) are from a disadvantaged background; and 
‘‘(2) have identified a mentor at a health pro-
fessions school or institution, an academic advisor to 
assist in the completion of their graduate or profes-
sional degree, and an advisor from an international 
health non-governmental organization, private volun-
teer organization, or other international institution 
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or program that focuses on increasing health care 
access and quality for residents in developing coun-
tries. 
‘‘(e) FELLOWSHIPS.—The Secretary shall approve 
fellowships for college seniors or recent graduates, except 
that such a fellowship may not be provided to an indi-
vidual for more than 6 months, may not be awarded to 
a graduate that has not been enrolled in school for more 
than 1 year, and may not exceed $4,000 per academic year 
(notwithstanding any other provision of law regarding the 
amount of fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2017 through 2022. 
‘‘SEC. 3420B. EDWARD R. ROYBAL HEALTH SCHOLAR PRO-
GRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, the Director of the Cen-
ters for Medicare and Medicaid Services, and the Adminis-
trator for Health Resources and Services Administration, 
in collaboration with the Deputy Assistant Secretary for 
Minority Health, shall award grants to eligible entities to 
expose entering graduate students to the health profes-
sions. 
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‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be a clinical, public health, or health serv-
ices organization, community-based, academic, or 
nonprofit entity, or other entity determined appro-
priate by the Director of the Agency for Healthcare 
Research and Quality; 
‘‘(2) serve in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) work with students obtaining a degree in 
the health professions; and 
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
port opportunities that expose students to non-research- 
based health professions, including— 
‘‘(1) public health policy; 
‘‘(2) health care and pharmaceutical policy; 
‘‘(3) health care administration and manage-
ment; 
‘‘(4) health economics; and 
‘‘(5) other professions determined appropriate 
by the Director of the Agency for Healthcare Re-
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search and Quality, the Director of the Centers for 
Medicare and Medicaid Services, and the Adminis-
trator for Health Resources and Services Adminis-
tration. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Agency for Healthcare Re-
search and Quality shall give priority to those entities 
that— 
‘‘(1) have experience with health disparity elimi-
nation programs; 
‘‘(2) facilitate training in the fields described in 
subsection (c); and 
‘‘(3) provide counseling or other services de-
signed to assist such individuals in successfully com-
pleting their education at the postsecondary level. 
‘‘(e) STIPENDS.—The Secretary may approve the 
payment of stipends for individuals under this section for 
any period of education in student-enhancement programs 
(other than regular courses) at health professions schools 
or entities, except that such a stipend may not be provided 
to an individual for more than 2 months, and such a sti-
pend may not exceed $100 per day (notwithstanding any 
other provision of law regarding the amount of stipends). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
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such sums as may be necessary for each of fiscal years 
2017 through 2022.’’. 
SEC. 307. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 
PROGRAM. 
Section 402E of the Higher Education Act of 1965 
(20 U.S.C. 1070a–15) is amended by striking subsection 
(g) and inserting the following: 
‘‘(g) COLLABORATION IN HEALTH PROFESSION DI-
VERSITY TRAINING PROGRAMS.—The Secretary shall co-
ordinate with the Secretary of Health and Human Serv-
ices to ensure that there is collaboration between the goals 
of the program under this section and programs of the 
Health Resources and Services Administration that pro-
mote health workforce diversity. The Secretary of Edu-
cation shall take such measures as may be necessary to 
encourage students participating in projects assisted 
under this section to consider health profession careers. 
‘‘(h) FUNDING.—From amounts appropriated pursu-
ant to the authority of section 402A(g), the Secretary 
shall, to the extent practicable, allocate funds for projects 
authorized by this section in an amount which is not less 
than $31,000,000 for each of the fiscal years 2017 
through 2023.’’. 
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SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 
EQUIVALENT RESIDENTS FOR COST-REPORT-
ING PERIODS. 
(a) DGME DETERMINATIONS.—Section 1886(h)(4) 
of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 
amended by section 204(a), is amended— 
(1) in subparagraph (E), by striking ‘‘Subject 
to subparagraphs (J) and (K), such rules’’ and in-
serting ‘‘Subject to subparagraphs (J), (K), and 
(M), such rules’’; 
(2) in subparagraph (J), by striking ‘‘Such 
rules’’ and inserting ‘‘Subject to subparagraph (M), 
such rules’’; 
(3) in subparagraph (K), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subparagraph 
(M), in determining’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(M) TREATMENT OF CERTAIN RESIDENTS 
AND INTERNS.—For purposes of cost-reporting 
periods beginning on or after October 1, 2016, 
in determining the hospital’s number of full- 
time equivalent residents for purposes of this 
paragraph, all the time spent by an intern or 
resident in an approved medical residency train-
ing program shall be counted toward the deter-
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mination of full-time equivalency if the hos-
pital— 
‘‘(i) is recognized as a subsection (d) 
hospital; 
‘‘(ii) is recognized as a subsection (d) 
Puerto Rico hospital; 
‘‘(iii) is reimbursed under a reim-
bursement system authorized under section 
1814(b)(3); or 
‘‘(iv) is a provider-based hospital out-
patient department.’’. 
(b) 
IME 
DETERMINATIONS.—Section 
1886(d)(5)(B)(x) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)(x)) is amended— 
(1) in subclause (II), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subclause (IV), in 
determining’’; 
(2) in subclause (III), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subclause (IV), in 
determining’’; and 
(3) by inserting after subclause (III) the fol-
lowing new subclause: 
‘‘(IV) The provisions of subparagraph (L) 
of subsection (h)(4) shall apply under this sub-
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paragraph in the same manner as they apply 
under such subsection.’’. 
SEC. 309. DEVELOPING AND IMPLEMENTING STRATEGIES 
FOR LOCAL HEALTH EQUITY. 
(a) GRANTS.—The Secretaries of Health and Human 
Services, Education, and Labor, acting jointly, shall make 
grants to academic institutions for the purposes of— 
(1) in accordance with subsection (b), devel-
oping capacity— 
(A) to build an evidence base for successful 
strategies for increasing local health equity; and 
(B) to serve as national models of driving 
local health equity; 
(2) in accordance with subsection (c), devel-
oping a strategic partnership with the community in 
which the academic institution is located; and 
(3) collecting data on, and periodically evalu-
ating, the effectiveness of the institution’s programs 
funded through this section to enable the institution 
to adapt accordingly for maximum efficiency and 
success. 
(b) DEVELOPING CAPACITY FOR INCREASING LOCAL 
HEALTH EQUITY.—As a condition on receipt of a grant 
under subsection (a), an academic institution shall agree 
to use the grant to build an evidence base for successful 
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strategies for increasing local health equity, and to serve 
as a national model of driving local health equity, by sup-
porting— 
(1) resources to strengthen institutional metrics 
and capacity to execute institutionwide health work-
force goals that can serve as models for increasing 
health equity in communities across the country; 
(2) collaborations among a cohort of institu-
tions in implementing systemic change, partnership 
development, and programmatic efforts supportive of 
health equity goals across disciplines and popu-
lations; and 
(3) enhanced or newly developed data systems 
and research infrastructure capable of informing 
current and future workforce efforts and building a 
foundation for a broader research agenda targeting 
urban health disparities. 
(c) STRATEGIC PARTNERSHIPS.—As a condition on 
receipt of a grant under subsection (a), an academic insti-
tution shall agree to use the grant to develop a strategic 
partnership with the community in which the institution 
is located for the purposes of— 
(1) strengthening connections between the insti-
tution and the community— 
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(A) to improve evaluation of and address 
the community’s health and health workforce 
needs; and 
(B) to engage the community in health 
workforce development; 
(2) developing, enhancing, or accelerating inno-
vative undergraduate and graduate programs in the 
biomedical sciences and health professions; and 
(3) strengthening pipeline programs in the bio-
medical sciences and health professions, including by 
developing partnerships between institutions of high-
er education and elementary and secondary schools 
to recruit the next generation of health professionals 
earlier in the pipeline to a health care career. 
SEC. 310. LOAN FORGIVENESS FOR MENTAL AND BEHAV-
IORAL HEALTH SOCIAL WORKERS. 
Section 455 of the Higher Education Act of 1965 (20 
U.S.C. 1087e) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(r) REPAYMENT PLAN FOR MENTAL AND BEHAV-
IORAL HEALTH SOCIAL WORKERS.— 
‘‘(1) IN GENERAL.—The Secretary shall cancel 
the balance of interest and principal due on any eli-
gible Federal Direct Loan not in default for a bor-
rower who— 
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‘‘(A) has made 120 monthly payments on 
the eligible Federal Direct Loan after October 
1, 2016, pursuant to any one or a combination 
of the following— 
‘‘(i) payments under an income-based 
repayment plan under section 493C; 
‘‘(ii) payments under a standard re-
payment plan under subsection (d)(1)(A), 
based on a 10-year repayment period; 
‘‘(iii) monthly payments under a re-
payment plan under subsection (d)(1) or 
(g) of not less than the monthly amount 
calculated 
under 
subsection 
(d)(1)(A), 
based on a 10-year repayment period; or 
‘‘(iv) payments under an income con-
tingent repayment plan under subsection 
(d)(1)(D); and 
‘‘(B)(i) is employed as a mental health or 
behavioral health social worker, as defined by 
the Secretary by regulation, at the time of such 
forgiveness; and 
‘‘(ii) has been employed as such a mental 
health or behavioral health social worker during 
the period in which the borrower makes each of 
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the 120 payments as described in subparagraph 
(A). 
‘‘(2) LOAN CANCELLATION AMOUNT.—After the 
conclusion of the employment period described in 
paragraph (1), the Secretary shall cancel the obliga-
tion to repay the balance of principal and interest 
due as of the time of such cancellation, on the eligi-
ble Federal Direct Loans made to the borrower 
under this part. 
‘‘(3) INELIGIBILITY FOR DOUBLE BENEFITS.— 
No borrower may, for the same employment as a 
mental heath or behavioral health social worker, re-
ceive a reduction of loan obligations under both this 
subsection and section 455(m), 428J, 428K, 428L, 
or 460. 
‘‘(4) DEFINITION
OF
ELIGIBLE
FEDERAL
DI-
RECT LOAN.—In this subsection, the term ‘eligible 
Federal Direct Loan’ means a Federal Direct Staf-
ford Loan, Federal Direct PLUS Loan, Federal Di-
rect Unsubsidized Stafford Loan, or a Federal Di-
rect Consolidation Loan.’’. 
SEC. 311. HEALTH PROFESSIONS WORKFORCE FUND. 
(a) PURPOSE.—It is the purpose of this section to 
establish a Health Professions Workforce Fund to be ad-
ministered through the Health Resources and Services Ad-
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ministration within the Department of Health and Human 
Services to provide for expanded and sustained national 
investment in the health professions and nursing work-
force development programs under title VII and title VIII 
of the Public Health Service Act. 
(b) ESTABLISHING
THE
HEALTH
PROFESSIONS 
WORKFORCE FUND.—There is authorized to be appro-
priated, and there is appropriated, out of any monies in 
the Treasury not otherwise appropriated, to the Health 
Professions Workforce Fund— 
(1) $355,000,000 for fiscal year 2017; 
(2) $375,000,000 for fiscal year 2018; 
(3) $392,000,000 for fiscal year 2019; 
(4) $412,000,000 for fiscal year 2020; 
(5) $432,000,000 for fiscal year 2021; 
(6) $454,000,000 for fiscal year 2022; 
(7) $476,000,000 for fiscal year 2023; 
(8) $500,000,000 for fiscal year 2024; 
(9) $525,000,000 for fiscal year 2025; and 
(10) $552,000,000 for fiscal year 2026. 
(c) FUNDING.— 
(1) For the purpose of carrying out health pro-
fessions education programs authorized under title 
VII of the Public Health Service Act, in addition to 
any other amounts authorized to be appropriated for 
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(F) $147,000,000 for fiscal year 2022. 
(G) $154,000,000 for fiscal year 2023. 
(H) $162,000,000 for fiscal year 2024. 
(I) $170,000,000 for fiscal year 2025. 
(J) $179,000,000 for fiscal year 2026. 
SEC. 312. FINDINGS; SENSE OF CONGRESS RELATING TO 
GRADUATE MEDICAL EDUCATION. 
(a) FINDINGS.—Congress finds the following: 
(1) Projections by the Association of American 
Medical Colleges (AAMC) and other expert entities, 
such as the Health Resources and Services Adminis-
tration (HRSA), have indicated a nationwide short-
age of up to 90,400 physicians, split evenly between 
primary care and specialists, by 2025. 
(2) Primarily due to the growing and aging 
population, over the next decade, physician demand 
is expected to grow up to 17 percent. 
(3) The United States Census Bureau estimates 
that the United States population will grow from 
321 million in 2015 to 347 million in 2025. Further, 
the number of Medicare beneficiaries is estimated to 
increase from 47.8 million in 2015 to approximately 
66 million in 2025. 
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(4) Approximately 36 percent of practicing phy-
sicians are over the age of 55 and are likely to retire 
within the next decade. 
(5) A nationwide physician shortage will result 
in many Americans waiting longer and traveling far-
ther for health care; seeking nonemergent care in 
emergency departments; and delaying treatment 
until their health care needs become more serious, 
complex, and costly. 
(6) Changing demographics (such as an aging 
population), new health care delivery models (such 
as medical homes), and other factors (such as dis-
aster preparedness) are contributing to a shortage of 
both generalist and specialist physicians. 
(7) These shortages will have the most severe 
impact on vulnerable and underserved populations, 
including racial/ethnic minorities and the approxi-
mately 20 percent of Americans who live in rural or 
inner-city locations designated as health professional 
shortage areas. 
(8) United States medical schools have com-
mitted to and have initiated a 30 percent increase 
in enrollment by 2017 to help reduce the Nation’s 
shortage of quality physicians. 
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(9) An increase in United States medical school 
graduates must be accompanied by an increase of 
4,000 graduate medical education (GME) training 
positions each year. 
(10) Graduate medical education programs and 
teaching hospitals provide venues in which the next 
generation of physicians learns to work collabo-
ratively with other physicians and health profes-
sionals, adopt more efficient care delivery models 
(such as care coordination and medical homes), in-
corporate health information technology and elec-
tronic health records in every aspect of their work, 
apply new methods of assuring quality and safety, 
and participate in groundbreaking clinical and public 
health research. 
(11) The Medicare Program under title XVIII 
of the Social Security Act (having more beneficiaries 
than any other health care program), supports its 
‘‘fair share’’ of the costs associated with graduate 
medical education (GME). 
(12) In general, the level of support of graduate 
medical education by the Medicare Program has 
been capped since 1997 and has not been increased 
to support the expansion of graduate medical edu-
cation programs needed to avert the projected physi-
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cian shortage or to accommodate the increase in 
United States medical school graduates. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that eliminating the limit of the number of residency 
positions that receive some level of Medicare support 
under section 1886(h) of the Social Security Act (42 
U.S.C. 1395ww(h)), also referred to as the Medical grad-
uate medical education cap, is critical to— 
(1) ensuring an appropriate supply of physi-
cians to meet the Nation’s health care needs; 
(2) facilitating equitable access for all who seek 
health care; and 
(3) mitigating disparities in health and health 
care. 
SEC. 313. CAREER SUPPORT FOR SKILLED, INTERNATION-
ALLY EDUCATED HEALTH PROFESSIONALS. 
(a) FINDINGS.—Congress finds the following: 
(1) According to the Association of Schools of 
Public Health, projections indicate a nationwide 
shortage of up to 250,000 public health workers 
needed by 2020. 
(2) Similar trends are projected for other health 
professions indicating shortages across disciplines, 
including within the fields of nursing (500,000 by 
2025), dentistry (15,000 by 2025), pharmacy 
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(38,000 by 2030), mental and behavioral health, pri-
mary care (46,000 by 2025), and community and al-
lied health. 
(3) A nationwide health workforce shortage will 
result in serious health threats and more severe and 
costly health care needs, due to, in part, a delayed 
response to food-borne outbreaks, emerging infec-
tious diseases, natural disasters, fewer cancer 
screenings, and delayed treatment. 
(4) Vulnerable and underserved populations and 
health professional shortage areas will be most se-
verely impacted by the health workforce shortage. 
(5) According to the Migration Policy Institute, 
over 2,000,000 college-educated immigrants in the 
United States today are unemployed or under-
employed in low- or semi-skilled jobs that fail to 
draw on their education and expertise. 
(6) Approximately 2 out of every 5 internation-
ally educated immigrants are unemployed or under-
employed. 
(7) According to Drexel University Center for 
Labor Markets and Policy, underemployment for 
internationally educated immigrant women is 28 per-
cent higher than for their male counterparts. 
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