844 
of the institution in order to reach a large number of stu-
dents, by carrying out 1 or more of the following activities: 
(1) Developing educational content for issues 
relating to comprehensive sleep and circadian health 
education that will be incorporated into first-year 
orientation or core courses. 
(2) Creating innovative technology-based ap-
proaches to deliver sleep health education to stu-
dents, faculty, and staff. 
(3) Developing and employing peer-outreach 
and education programs to generate discussion, edu-
cate, and raise awareness among students about 
issues relating to poor quality sleep, sleep and circa-
dian disorders, and the role sleep health plays in 
other diseases and comorbidities. 
(f) REPORT TO CONGRESS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, and annually 
thereafter for a period of 5 years, the Secretary shall 
prepare and submit to the appropriate committees of 
Congress a report on the activities to provide health 
professions students with comprehensive sleep and 
circadian health education funded under this section. 
(2) REPORT ELEMENTS.—The report described 
in paragraph (1) shall include information about— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00844
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
845 
(A) the number of eligible entities and in-
stitutions of higher education that are receiving 
grant funds; 
(B) the specific activities supported by 
grant funds; 
(C) the number of students served by 
grant programs; and 
(D) the status of program evaluations. 
SEC. 795. REPORT ON IMPACT OF SLEEP AND CIRCADIAN 
HEALTH DISORDERS IN VULNERABLE AND 
RACIAL/ETHNIC POPULATIONS. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall submit to Congress and the Presi-
dent a report on the impact of sleep and circadian health 
disorders for racial and ethnic minority communities and 
other vulnerable populations. 
(b) CONTENTS.—The report under subsection (a) 
shall include information on the— 
(1) progress that has been made in reducing 
the impact of sleep and circadian health disorders in 
such communities and populations; 
(2) opportunities that exist to make additional 
progress in reducing the impact of sleep and circa-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00845
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
846 
dian health disorders in such communities and popu-
lations; 
(3) challenges that may impede such additional 
progress; and 
(4) Federal funding necessary to achieve sub-
stantial reductions in sleep and circadian health dis-
orders in racial and ethnic minority communities. 
Subtitle 
K—Kidney 
Disease 
Re-
search, 
Surveillance, 
Preven-
tion, and Treatment 
SEC. 797. KIDNEY DISEASE, RESEARCH, SURVEILLANCE, 
PREVENTION, AND TREATMENT. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Kidney Disease Research, Surveillance, Prevention and 
Treatment Improvement Act of 2020’’. 
(b) FINDINGS.—Congress makes the following find-
ings: 
(1) Kidney diseases impact 37 million Ameri-
cans. 
(2) African Americans comprise just 13 percent 
of the United States population, but 33 percent of 
the United States dialysis patient population. Com-
pared to Caucasians, kidney failure prevalence is 
about 3.7 times greater in African Americans, 1.4 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00846
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
847 
times greater in Native Americans, and 1.5 times 
greater in Asian Americans. 
(3) Peritoneal dialysis and home hemodialysis 
use is 40–50 percent lower among African Ameri-
cans and Hispanics. 
(4) Every racial/ethnic minority group in the 
United States is significantly less likely to be treated 
with home dialysis than Whites, and demographic 
and clinical characteristics are insufficient to explain 
this differential use. 
(5) African Americans on dialysis, irrespective 
of dialysis modality, and Hispanics undergoing PD 
or in-center HD, are significantly less likely than 
their White counterparts to receive a kidney trans-
plant. 
(6) African Americans, Hispanics, and Asian 
Americans are less likely to receive living donor kid-
ney transplants than Whites. Efforts to reduce dis-
parities in live donor kidney transplantation for Afri-
can-American, Hispanic, and Asian patients with 
kidney failure have been unsuccessful. 
(7) Medicare and Medicaid patients are less 
likely to receive a preemptive transplant from a de-
ceased donor compared to private insurance patients 
(5 percent and 11 percent versus 24 percent), and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00847
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
848 
Black and Hispanic patients are less likely to receive 
a preemptive transplant from a deceased donor com-
pared with White patients even after changes to the 
kidney allocation system (5 percent of Black patients 
and 5 percent of Hispanic patients compared with 
18 percent of White patients). 
(8) Low-income populations are significantly 
more likely to progress to kidney failure. 
(9) Low socioeconomic status is associated with 
increased incidence of chronic kidney disease, pro-
gression to kidney failure, inadequate dialysis treat-
ment, and reduced access to kidney transplantation. 
(10) The three goals of the recent Executive 
Order on Advancing American Kidney Health recog-
nizes the need for more transplants, better preven-
tion and education and improved access to treatment 
modalities. 
SEC. 798. KIDNEY DISEASE RESEARCH IN MINORITY POPU-
LATIONS. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health shall expand, intensify, and support on-
going research and other activities with respect to kidney 
disease in minority populations. 
(b) RESEARCH.— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00848
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
849 
(1) DESCRIPTION.—Research under subsection 
(a) shall include investigation into— 
(A) the causes of kidney disease, including 
socioeconomic, geographic, clinical, environ-
mental, genetic, and other factors that may 
contribute to increased rates of kidney disease 
in minority populations; and 
(B) the causes of increased incidence of 
kidney disease complications in minority popu-
lations, and possible interventions to decrease 
such incidence. 
(2) INCLUSION OF MINORITY PARTICIPANTS.— 
In conducting and supporting research described in 
subsection (a), the Director of the National Insti-
tutes of Health shall seek to include minority par-
ticipants as study subjects in clinical trials. 
(c) REPORT; COMPREHENSIVE PLAN.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
(A) prepare and submit to the Congress, 
not later than 6 months after the date of enact-
ment of this section, a report on Federal re-
search and public health activities with respect 
to kidney disease in minority populations; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00849
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
850 
(B) develop and submit to Congress, not 
later than 1 year after the date of enactment of 
this section, an effective and comprehensive 
Federal plan (including all appropriate Federal 
health programs) to address kidney disease in 
minority populations. 
(2) CONTENTS.—The report under paragraph 
(1)(A) shall at minimum address each of the fol-
lowing: 
(A) Research on kidney disease in minority 
populations, including such research on— 
(i) genetic, behavioral, and environ-
mental factors; and 
(ii) 
prevention 
and 
complications 
among individuals within these populations 
who have already developed kidney disease. 
(B) Surveillance and data collection on 
kidney disease in minority populations, includ-
ing with respect to— 
(i) efforts to better determine the 
prevalence of kidney disease among Asian- 
American and Pacific Islander subgroups; 
and 
(ii) efforts to coordinate data collec-
tion on the American Indian population. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00850
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
851 
(C) Community-based interventions to ad-
dress kidney disease targeting minority popu-
lations, including— 
(i) the evidence base for such inter-
ventions; 
(ii) the cultural appropriateness of 
such interventions; and 
(iii) efforts to educate the public on 
the causes and consequences of kidney dis-
ease. 
(D) Education and training programs for 
health 
professionals 
(including 
community 
health workers) on the prevention and manage-
ment of kidney disease and its related complica-
tions that are supported by the Health Re-
sources and Services Administration, including 
such programs supported by the Bureau of 
Health Workforce, the Bureau of Primary 
Health Care, and the Healthcare Systems Bu-
reau. 
SEC. 799. KIDNEY DISEASE ACTION PLAN. 
(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention shall conduct, support, 
and expand public health strategies, prevention, diagnosis, 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00851
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
852 
surveillance, and public and professional awareness activi-
ties regarding kidney disease. 
(b) NATIONAL ACTION PLAN.— 
(1) DEVELOPMENT.—Not later than 2 years 
after the date of the enactment of this Act, the Di-
rector of the National Institute of Diabetes and Di-
gestive and Kidney Disease, in consultation with the 
Director of the Centers for Disease Control and Pre-
vention, shall develop a national action plan to ad-
dress kidney disease in the United States with par-
ticipation from patients, caregivers, health profes-
sionals, patient advocacy organizations, researchers, 
providers, public health professionals, and other 
stakeholders. 
(2) CONTENTS.—At a minimum, such plan 
shall include recommendations for— 
(A) public health interventions for the pur-
pose of implementation of the national plan; 
(B) biomedical, health services, and public 
health research on kidney disease; and 
(C) inclusion of kidney disease in the 
health data collections of all Federal agencies. 
(c) KIDNEY DISEASE PREVENTION PROGRAMS.—The 
Director of the National Institute of Diabetes and Diges-
tive and Kidney Disease shall carry out the following: 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00852
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
853 
(1) Conduct public education and awareness ac-
tivities with patient and professional organizations 
to stimulate earlier diagnosis and improve patient 
outcomes from treatment of kidney disease. To the 
extent known and relevant, such public education 
and awareness activities shall reflect differences in 
kidney disease by cause (such as hypertension, dia-
betes, and polycystic kidney disease) and include a 
focus on outreach to undiagnosed and, as appro-
priate, minority populations. 
(2) Supplement and expand upon the activities 
of the National Institute of Diabetes and Digestive 
and Kidney Disease by making grants to nonprofit 
organizations, State and local jurisdictions, and In-
dian tribes for the purpose of reducing the burden 
of kidney disease, especially in disproportionately im-
pacted communities, through public health interven-
tions and related activities. 
(3) Coordinate with the Centers for Disease 
Control and Prevention, the Indian Health Service, 
the Health Resources and Services Administration, 
and the Department of Veterans Affairs to develop 
pilot programs to demonstrate best practices for the 
diagnosis and management of kidney disease. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00853
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
854 
(4) Develop improved techniques and identify 
best practices, in coordination with the Secretary of 
Veterans Affairs, for assisting kidney disease pa-
tients. 
(d) DATA COLLECTION.—Not later than 180 days 
after the date of enactment of this Act, the Director of 
the National Institute of Diabetes and Digestive and Kid-
ney Disease and the Director of the Centers for Disease 
Control and Prevention, acting jointly, shall assess the 
depth and quality of information on kidney disease that 
is collected in surveys and population studies conducted 
by the Centers for Disease Control and Prevention, includ-
ing whether there are additional opportunities for informa-
tion to be collected in the National Health and Nutrition 
Examination Survey, the National Health Interview Sur-
vey, and the Behavioral Risk Factors Surveillance System 
surveys. The Director of the National Institute of Diabetes 
and Digestive and Kidney Disease shall include the results 
of such assessment in the national action plan under sub-
section (b). 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 
2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis-
cal year 2024, and $1,000,000 for fiscal year 2025. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00854
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
855 
SEC. 799A. HOME DIALYSIS AND INCREASING END-STAGE 
RENAL DISEASE TREATMENT MODALITIES IN 
MINORITY COMMUNITIES ACTION PLAN. 
(a) NATIONAL ACTION PLAN.— 
(1) DEVELOPMENT.—Not later than 2 years 
after the date of the enactment of this Act, the Di-
rector of the National Institute of Diabetes and Di-
gestive and Kidney Disease, in consultation with the 
Director of the Centers for Disease Control and Pre-
vention, shall develop a national action plan to in-
crease the number of home dialyzers and choice in 
dialysis treatment modality in the United States 
with participation from patients, caregivers, health 
professionals, patient advocacy organizations, re-
searchers, providers, public health professionals, and 
other stakeholders in the minority community. 
(2) CONTENTS.—At a minimum, such plan 
shall include recommendations for— 
(A) public health officials for the purpose 
of implementation of the national plan; 
(B) biomedical, health services, and public 
health research on home dialysis and modalities 
in minority communities; and 
(C) inclusion of dialysis location and mo-
dality in the health data collections of all Fed-
eral agencies. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00855
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
856 
(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$1,000,000 for fiscal year 2021, $1,000,000 for fiscal year 
2022, $1,000,000 for fiscal year 2023, $1,000,000 for fis-
cal year 2024, and $1,000,000 for fiscal year 2025. 
SEC. 799B. INCREASING KIDNEY TRANSPLANTS IN MINOR-
ITY COMMUNITIES. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health shall expand, intensify, and support on-
going research and other activities with respect to kidney 
transplants in minority populations. 
(b) RESEARCH.—Research under subsection (a) shall 
include investigation into— 
(1) the causes of lower rates of kidney trans-
plants in minority communities, including socio-
economic, geographic, clinical, environmental, ge-
netic, and other factors that may contribute to lower 
rates of kidney transplants in minority populations; 
and 
(2) possible interventions to increase kidney 
transplants. 
(c) REPORT; COMPREHENSIVE PLAN.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00856
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
857 
(A) prepare and submit to the Congress, 
not later than 6 months after the date of enact-
ment of this section, a report on Federal re-
search and public health activities with respect 
to kidney transplants as a treatment for end- 
stage renal disease in minority populations; and 
(B) develop and submit to the Congress, 
not later than 1 year after the date of enact-
ment of this section, an effective and com-
prehensive Federal plan (including all appro-
priate Federal health programs) to increase the 
number of kidney transplants in minority popu-
lations. 
(2) CONTENTS.—The report under paragraph 
(1)(A) shall at a minimum address each of the fol-
lowing: 
(A) Research on kidney transplants in mi-
nority populations, including such research on 
financial, insurance coverage, genetic, behav-
ioral, and environmental factors. 
(B) Surveillance and data collection on 
kidney transplants in minority populations, in-
cluding with respect to— 
(i) efforts to increase kidney trans-
plants disease among Asian-American and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00857
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
858 
Pacific Islander subgroups with end-stage 
renal disease; and 
(ii) efforts to increase kidney trans-
plants in the American Indian population. 
(C) Community-based efforts to increase 
kidney transplants targeting minority popu-
lations, including— 
(i) the evidence base for such in-
creases; 
(ii) the cultural appropriateness of 
such increases; and 
(iii) efforts to educate the public on 
the kidney transplants. 
(D) Education and training programs for 
health 
professionals 
(including 
community 
health workers) on the kidney transplants that 
are supported by the Health Resources and 
Services Administration, including such pro-
grams supported by the Bureau of Health 
Workforce, the Bureau of Primary Health Care, 
and the Healthcare Systems Bureau. 
SEC. 799C. ENVIRONMENTAL AND OCCUPATIONAL HEALTH 
PROGRAMS. 
The Director of the Centers for Disease Control and 
Prevention shall— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00858
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
859 
(1) support research into the environmental and 
occupational causes and biological mechanisms that 
contribute to kidney disease; and 
(2) develop and disseminate public health inter-
ventions that will lessen the impact of environmental 
and occupational causes of kidney disease. 
SEC. 799D. UNDERSTANDING THE TREATMENT PATTERNS 
ASSOCIATED WITH PROVIDING CARE AND 
TREATMENT OF KIDNEY FAILURE IN MINOR-
ITY POPULATIONS. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
shall conduct a study on treatment patterns associated 
with providing care, under the Medicare program under 
title XVIII of the Social Security Act (42 U.S.C. 1395 
et seq.), the Medicaid program under title XIX of such 
Act (42 U.S.C. 1396 et seq.), and through private health 
insurance, to minority populations that are disproportion-
ately affected by kidney failure. 
(b) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Secretary shall submit 
to Congress a report on the study conducted under sub-
section (a), together with such recommendations as the 
Secretary determines to be appropriate. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00859
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
860 
SEC. 799E. IMPROVING ACCESS IN UNDERSERVED AREAS. 
(a) DEFINITION OF PRIMARY CARE SERVICES.—Sec-
tion 331(a)(3)(D) of the Public Health Service Act (42 
U.S.C. 254d(a)(3)(D)) is amended by inserting ‘‘renal di-
alysis,’’ after ‘‘dentistry,’’. 
(b) NATIONAL HEALTH SERVICE CORPS SCHOLAR-
SHIP PROGRAM.—Section 338A(a)(2) of the Public Health 
Service Act (42 U.S.C. 254l(a)(2)) is amended by insert-
ing ‘‘, which may include nephrology health professionals’’ 
before the period at the end. 
(c) NATIONAL HEALTH SERVICE CORPS LOAN RE-
PAYMENT PROGRAM.—Section 338B(a)(2) of the Public 
Health Service Act (42 U.S.C. 254l–1(a)(2)) is amended 
by inserting ‘‘, which may include nephrology health pro-
fessionals’’ before the period at the end. 
TITLE VIII—HEALTH 
INFORMATION TECHNOLOGY 
SEC. 800. DEFINITIONS. 
In this title: 
(1) CERTIFIED ELECTRONIC HEALTH RECORD 
TECHNOLOGY.—The term ‘‘certified EHR tech-
nology’’ has the meaning given such term in section 
3000 of the Public Health Service Act (42 U.S.C. 
300jj). 
(2) EHR.—The term ‘‘EHR’’ means an elec-
tronic health record. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00860
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
862 
Subtitle A—Reducing Health 
Disparities Through Health IT 
SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 
PROMOTION OF HEALTH IT. 
The Secretary of Health and Human Services, acting 
through the Administrator of the Health Resources and 
Services Administration, shall expand and intensify the 
programs and activities of the Administration (directly or 
through grants or contracts) to provide technical assist-
ance and resources to health centers (as defined in section 
330(a) of the Public Health Service Act (42 U.S.C. 
254b(a))) to adopt and meaningfully use certified EHR 
technology for the management of chronic diseases and 
health conditions and reduction of health disparities. 
SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA-
CIAL AND ETHNIC MINORITY COMMUNITIES; 
OUTREACH AND ADOPTION OF HEALTH IT IN 
SUCH COMMUNITIES. 
(a) NATIONAL COORDINATOR FOR HEALTH INFOR-
MATION TECHNOLOGY.—Not later than 18 months after 
the date of enactment of this Act, the National Coordi-
nator for Health Information Technology (referred to in 
this section as the ‘‘National Coordinator’’) shall— 
(1) conduct an evaluation of the level of inter-
operability, access, use, and accessibility of electronic 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00862
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
863 
health records in racial and ethnic minority commu-
nities, focusing on whether patients in such commu-
nities have providers who use electronic health 
records, and the degree to which patients in such 
communities can access, exchange, and use without 
special effort their health information in those elec-
tronic health records, and indicating whether such 
providers— 
(A) are participating in the Medicare pro-
gram under title XVIII of the Social Security 
Act (42 U.S.C. 1395 et seq.) or a State plan 
under title XIX of such Act (42 U.S.C. 1396 et 
seq.) (or a waiver of such plan); 
(B) have received incentive payments or in-
centive payment adjustments under Medicare 
and Medicaid Electronic Health Records Incen-
tive Programs (as defined in subsection (c)(2)); 
(C) are MIPS eligible professionals, as de-
fined in paragraph (1)(C) of section 1848(q) of 
the Social Security Act (42 U.S.C. 1395w– 
4(q)), for purposes of the Merit-Based Incentive 
Payment System under such section; or 
(D) have been recruited by any of the 
Health Information Technology Regional Ex-
tension Centers established under section 3012 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00863
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
864 
of the Public Health Service Act (42 U.S.C. 
300jj–32); 
(2) publish the results of such evaluation in-
cluding the race and ethnicity of such providers and 
the populations served by such providers; and 
(3) not later than 12 months after the enact-
ment of this Act, shall promulgate a certification cri-
terion and module of certified EHR technology that 
stratifies quality measures by disparity characteris-
tics, including race, ethnicity, language, gender, gen-
der identity, sexual orientation, socio-economic sta-
tus, and disability status, as those characteristics 
are defined in certified EHR technology; and reports 
to Centers for Medicare & Medicaid Services the 
quality measures stratified by race and at least two 
other disparity characteristics. 
The term ‘‘quality measures’’ refers to the quality meas-
ures specified in MIPS. 
(b) NATIONAL CENTER FOR HEALTH STATISTICS.— 
As soon as practicable after the date of enactment of this 
Act, the Director of the National Center for Health Statis-
tics shall provide to Congress a more detailed analysis of 
the data presented in National Center for Health Statis-
tics data brief entitled ‘‘Adoption of Certified Electronic 
Health Record Systems and Electronic Information Shar-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00864
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
865 
ing in Physician Offices: United States, 2013 and 2014’’ 
(NCHS Data Brief No. 236). 
(c) CENTERS FOR MEDICARE & MEDICAID SERV-
ICES.— 
(1) IN GENERAL.—As part of the process of 
collecting information, with respect to a provider, at 
registration and attestation for purposes of Medicare 
and Medicaid Electronic Health Records Incentive 
Programs (as defined in paragraph (2)) or the 
Merit-Based Incentive Payment System under sec-
tion 1848(q) of the Social Security Act (42 U.S.C. 
1395w–4(q)), the Secretary of Health and Human 
Services shall collect the race and ethnicity of such 
provider. 
(2) MEDICARE
AND
MEDICAID
ELECTRONIC 
HEALTH
RECORDS
INCENTIVE
PROGRAMS
DE-
FINED.—For purposes of paragraph (1), the term 
‘‘Medicare and Medicaid Electronic Health Records 
Incentive Programs’’ means the incentive programs 
under section 1814(l)(3), subsections (a)(7) and (o) 
of section 1848, subsections (l) and (m) of section 
1853, subsections (b)(3)(B)(ix)(I) and (n) of section 
1886, and subsections (a)(3)(F) and (t) of section 
1903 of the Social Security Act (42 U.S.C. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00865
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
866 
1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 
1396b). 
(d) NATIONAL COORDINATOR’S ASSESSMENT OF IM-
PACT
OF HIT.—Section 3001(c)(6)(C) of the Public 
Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 
amended— 
(1) in the heading by inserting ‘‘, RACIAL AND 
ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 
DISPARITIES’’; 
(2) by inserting ‘‘, in communities with a high 
proportion of individuals from racial and ethnic mi-
nority groups (as defined in section 1707(g)), in-
cluding people with disabilities in these groups,’’ 
after ‘‘communities with health disparities’’; 
(3) by striking ‘‘The National Coordinator’’ and 
inserting the following: 
‘‘(i) IN GENERAL.—The National Co-
ordinator’’; and 
(4) by adding at the end the following: 
‘‘(ii) CRITERIA.—In any publication 
under clause (i), the National Coordinator 
shall include best practices for encouraging 
partnerships between the Federal Govern-
ment, States, and private entities to ex-
pand outreach for and the adoption of cer-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00866
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
868 
SEC. 803. NONDISCRIMINATION AND HEALTH EQUITY IN 
HEALTH INFORMATION TECHNOLOGY. 
Covered entities shall ensure that electronic and in-
formation technology in their health programs or activities 
does not exclude individuals from participation in, deny 
them the benefits of, or subject them to discrimination 
under any health program or activity on the basis of race, 
color, national origin, sex, age, or disability. The term 
‘‘covered entity’’ means— 
(1) an entity that operates a health program or 
activity, any part of which receives Federal financial 
assistance; 
(2) an entity established under title I of the Pa-
tient Protection and Affordable Care Act that ad-
ministers a health program or activity; and 
(3) the U.S. Department of Health and Human 
Services. 
SEC. 804. LANGUAGE ACCESS IN HEALTH INFORMATION 
TECHNOLOGY. 
The National Coordinator shall— 
(1) not later than 18 months following enact-
ment of this Act, require the Office of the National 
Coordinator to provide access to certified EHR tech-
nology to provide patients access to their personal 
health information in a computable format, includ-
ing using patient portals or third-party applications 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00868
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
869 
(as described in the 21st Century Cures Act), in the 
ten (10) most common non-English languages; 
(2) hold a public hearing to identify best prac-
tices for such a requirement listed in paragraph (1); 
and 
(3) not later than 6 months after the public 
hearing, promulgate a regulation and subsequent 
proposed rulemaking. 
Subtitle 
B—Modifications 
To 
Achieve Parity in Existing Pro-
grams 
SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 
HEALTH IT INFRASTRUCTURE IN RACIAL 
AND ETHNIC MINORITY COMMUNITIES. 
Section 3011 of the Public Health Service Act (42 
U.S.C. 300jj–31) is amended— 
(1) in subsection (a), in the matter preceding 
paragraph (1), by inserting ‘‘, including with respect 
to communities with a high proportion of individuals 
from racial and ethnic minority groups (as defined 
in section 1707(g))’’ before the colon; and 
(2) by adding at the end the following new sub-
section: 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00869
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
870 
‘‘(e) ANNUAL REPORT
ON EXPENDITURES.—The 
National Coordinator shall report annually to Congress on 
activities and expenditures under this section.’’. 
SEC. 812. EXTENDING COMPETITIVE GRANTS FOR THE DE-
VELOPMENT OF LOAN PROGRAMS TO FACILI-
TATE ADOPTION OF CERTIFIED EHR TECH-
NOLOGY BY PROVIDERS SERVING RACIAL 
AND ETHNIC MINORITY GROUPS. 
Section 3014(e) of the Public Health Service Act (42 
U.S.C. 300jj–34(e)) is amended, in the matter preceding 
paragraph (1), by inserting ‘‘, including with respect to 
communities with a high proportion of individuals from 
racial and ethnic minority groups (as defined in section 
1707(g))’’ after ‘‘health care provider to’’. 
SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 
Section 3018 of the Public Health Service Act (42 
U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 
2009 through 2013’’ and inserting ‘‘fiscal years 2021 
through 2026’’. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00870
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
871 
Subtitle C—Additional Research 
and Studies 
SEC. 821. DATA COLLECTION AND ASSESSMENTS CON-
DUCTED IN COORDINATION WITH MINORITY- 
SERVING INSTITUTIONS. 
Section 3001(c)(6) of the Public Health Service Act 
(42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 
end the following new subparagraph: 
‘‘(F) DATA
COLLECTION
AND
ASSESS-
MENTS
CONDUCTED
IN
COORDINATION
WITH 
MINORITY-SERVING INSTITUTIONS.— 
‘‘(i) IN
GENERAL.—In carrying out 
subparagraph (C) with respect to commu-
nities with a high proportion of individuals 
from racial and ethnic minority groups (as 
defined in section 1707(g)), the National 
Coordinator shall, to the greatest extent 
possible, coordinate with an entity de-
scribed in clause (ii). 
‘‘(ii) 
MINORITY-SERVING
INSTITU-
TIONS.—For purposes of clause (i), an en-
tity described in this clause is a historically 
Black college or university, a Hispanic- 
serving institution, a Tribal College or 
University, or an Asian American, Native 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00871
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
872 
American, or Pacific Islander-serving insti-
tution with an accredited public health, 
health policy, or health services research 
program.’’. 
SEC. 822. STUDY OF HEALTH INFORMATION TECHNOLOGY 
IN 
MEDICALLY 
UNDERSERVED 
COMMU-
NITIES. 
(a) IN GENERAL.—Not later than 2 years after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall— 
(1) enter into an agreement with the National 
Academies of Sciences, Engineering, and Medicine to 
conduct a study on the development, implementa-
tion, and effectiveness of health information tech-
nology within medically underserved areas (as de-
scribed in subsection (c)); and 
(2) submit a report to Congress describing the 
results of such study, including any recommenda-
tions for legislative or administrative action. 
(b) STUDY.—The study described in subsection 
(a)(1) shall— 
(1) identify barriers to successful implementa-
tion of health information technology in medically 
underserved areas; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00872
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
873 
(2) survey a cross-section of individuals in 
medically underserved areas and report their opin-
ions about the various topics of study; 
(3) examine the degree of interoperability 
among health information technology and users of 
health information technology in medically under-
served areas, including patients, providers, and com-
munity services; 
(4) examine the impact of health information 
technology on providing quality care and reducing 
the cost of care to individuals in such areas, includ-
ing the impact of such technology on improved 
health outcomes for individuals, including which 
technology worked for which population and how it 
improved health outcomes for that population; 
(5) examine the impact of health information 
technology on improving health care-related deci-
sions by both patients and providers in such areas; 
(6) identify specific best practices for using 
health information technology to foster the con-
sistent provision of physical accessibility and reason-
able policy accommodations in health care to individ-
uals with disabilities in such areas; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00873
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
874 
(7) assess the feasibility and costs associated 
with the use of health information technology in 
such areas; 
(8) evaluate whether the adoption and use of 
qualified electronic health records (as defined in sec-
tion 3000 of the Public Health Service Act (42 
U.S.C. 300jj)) is effective in reducing health dispari-
ties, including analysis of clinical quality measures 
reported by providers who are participating in the 
Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) or a State 
plan under title XIX of such Act (42 U.S.C. 1396 
et seq.) (or a waiver of such plan), pursuant to pro-
grams to encourage the adoption and use of certified 
EHR technology; 
(9) identify providers in medically underserved 
areas that are not electing to adopt and use elec-
tronic health records and determine what barriers 
are preventing those providers from adopting and 
using such records; and 
(10) examine urban and rural community 
health systems and determine the impact that health 
information technology may have on the capacity of 
primary health providers in those systems. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00874
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
875 
(c) MEDICALLY UNDERSERVED AREA.—The term 
‘‘medically underserved area’’ means— 
(1) a population that has been designated as a 
medically underserved population under section 
330(b)(3) of the Public Health Service Act (42 
U.S.C. 254b(b)(3)); 
(2) an area that has been designated as a 
health professional shortage area under section 332 
of the Public Health Service Act (42 U.S.C. 254e); 
(3) an area or population that has been des-
ignated as a medically underserved community under 
section 799B of the Public Health Service Act (42 
U.S.C. 295p); or 
(4) another area or population that— 
(A) experiences significant barriers to ac-
cessing quality health services; and 
(B) has a high prevalence of diseases or 
conditions described in title VII, with such dis-
eases or conditions having a disproportionate 
impact on racial and ethnic minority groups (as 
defined in section 1707(g) of the Public Health 
Service Act (42 U.S.C. 300u–6(g))) or a sub-
group of people with disabilities who have spe-
cific functional impairments. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00875
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
876 
SEC. 823. ASSESSMENT OF USE AND MISUSE OF DE-IDENTI-
FIED HEALTH DATA. 
(a) IN GENERAL.—Not later than 18 months after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall— 
(1) enter into an agreement with the Office of 
the National Coordinator to conduct a study on the 
impact of digital health technology on medically un-
derserved areas (as described in section 822(c) of 
the Health Equity and Accountability Act of 2020) 
in consultation with relevant stakeholders; and 
(2) submit a report to Congress describing the 
results of such study, including any recommenda-
tions for legislative or administrative action. 
(b) STUDY.—The study described in subsection 
(a)(1) shall— 
(1) examine the overall prevalence, and histor-
ical and existing practices and their respective preva-
lence, of use and misuse of de-identified protected 
health information, as it is defined in section 
160.103, title 45, Code of Federal Regulations, to 
discriminate against or benefit medically under-
served areas; 
(2) identify best practices and tools to leverage 
the benefits and prevent misuse of de-identified pro-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00876
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
877 
tected health information to discriminate against 
medically underserved areas; 
(3) examine the overall prevalence, and histor-
ical and existing practices and their respective preva-
lence, of use and misuse of de-identified personal 
health information other than protected health infor-
mation, as it is defined in section 160.103, title 45, 
Code of Federal Regulations, to discriminate against 
or benefit medically underserved areas; and 
(4) identify best practices and tools to leverage 
the benefits and prevent misuse of de-identified per-
sonal health information other than protected health 
information to discriminate against medically under-
served areas. 
Subtitle D—Closing Gaps in 
Funding To Adopt Certified EHRs 
SEC. 831. EXTENDING MEDICAID EHR INCENTIVE PAY-
MENTS 
TO 
REHABILITATION 
FACILITIES, 
LONG-TERM CARE FACILITIES, AND HOME 
HEALTH AGENCIES. 
(a) IN GENERAL.—Section 1903(t)(2)(B) of the So-
cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend-
ed— 
(1) in clause (i), by striking ‘‘, or’’ and insert-
ing a semicolon; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00877
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
878 
(2) in clause (ii), by striking the period at the 
end and inserting a semicolon; and 
(3) by inserting after clause (ii) the following 
new clauses: 
‘‘(iii) a rehabilitation facility (as defined in sec-
tion 1886(j)(1)) that furnishes acute or subacute re-
habilitation services; 
‘‘(iv) a long-term care hospital (as defined in 
section 1886(d)(1)(B)(iv)); or 
‘‘(v) a home health agency (as defined in sec-
tion 1861(o)).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to amounts ex-
pended under section 1903(a)(3)(F) of the Social Security 
Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be-
ginning on or after the date of the enactment of this Act. 
SEC. 832. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 
FOR 
MEDICAID 
ELECTRONIC 
HEALTH 
RECORD INCENTIVE PAYMENTS. 
(a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 
Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 
amended to read as follows: 
‘‘(v) physician assistant.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to amounts ex-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00878
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
879 
pended under section 1903(a)(3)(F) of the Social Security 
Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be-
ginning on or after the date of the enactment of this Act. 
TITLE IX—ACCOUNTABILITY 
AND EVALUATION 
SEC. 901. PROHIBITION ON DISCRIMINATION IN FEDERAL 
ASSISTED HEALTH CARE SERVICES AND RE-
SEARCH PROGRAMS ON THE BASIS OF SEX 
(INCLUDING 
SEX 
ORIENTATION, 
GENDER 
IDENTITY, 
AND 
PREGNANCY, 
INCLUDING 
TERMINATION 
OF 
PREGNANCY), 
RACE, 
COLOR, NATIONAL ORIGIN, MARITAL STATUS, 
FAMILIAL STATUS, SEXUAL ORIENTATION, 
GENDER IDENTITY, OR DISABILITY STATUS. 
(a) IN GENERAL.—No person in the United States 
shall, on the basis of sex (including sex orientation, gender 
identity, and pregnancy, including termination of preg-
nancy), race, color, national origin, marital status, familial 
status, sexual orientation, gender identity, or disability 
status, be excluded from participation in, be denied the 
benefits of, or be subjected to discrimination under any 
health program or activity, including any health research 
program or activity, receiving Federal financial assistance, 
including credits, subsidies, or contracts of insurance or 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00879
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
880 
any health program or activity that is administered by an 
executive agency. 
(b) DEFINITION.—In this section, the term ‘‘familial 
status’’ means, with respect to one or more individuals— 
(1) being domiciled with any individual related 
by blood or affinity whose close association with the 
individual is the equivalent of a family relationship; 
(2) being in the process of securing legal cus-
tody of any individual; or 
(3) being pregnant. 
SEC. 902. TREATMENT OF MEDICARE PAYMENTS UNDER 
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 
A payment to a provider of services, physician, or 
other supplier under part B, C, or D of title XVIII of 
the Social Security Act shall be deemed a grant, and not 
a contract of insurance or guaranty, for the purposes of 
title VI of the Civil Rights Act of 1964. 
SEC. 903. ACCOUNTABILITY AND TRANSPARENCY WITHIN 
THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES. 
Title XXXIV of the Public Health Service Act, as 
amended by titles I, II, and III of this Act, is further 
amended by inserting after subtitle C the following: 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00880
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
881 
‘‘Subtitle D—Strengthening 
Accountability 
‘‘SEC. 3441. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
within the Office for Civil Rights an Office of Health Dis-
parities, which shall be headed by a director to be ap-
pointed by the Secretary. 
‘‘(b) PURPOSE.—The Office of Health Disparities 
shall ensure that the health programs, activities, and oper-
ations of health entities that receive Federal financial as-
sistance are in compliance with title VI of the Civil Rights 
Act, including through the following activities: 
‘‘(1) The development and implementation of 
an action plan to address racial and ethnic health 
care disparities, which shall address concerns relat-
ing to the Office for Civil Rights as released by the 
United States Commission on Civil Rights in the re-
port entitled ‘Health Care Challenge: Acknowledging 
Disparity, Confronting Discrimination, and Ensur-
ing Equity’ (September 1999) in conjunction with 
the reports by the National Academy of Sciences 
(formerly known as the Institute of Medicine) enti-
tled ‘Unequal Treatment: Confronting Racial and 
Ethnic Disparities in Health Care’, ‘Crossing the 
Quality Chasm: A New Health System for the 21st 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00881
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
882 
Century’, ‘In the Nation’s Compelling Interest: En-
suring Diversity in the Health Care Workforce’, 
‘The National Partnership for Action to End Health 
Disparities’, and ‘The Health of Lesbian, Gay, Bi-
sexual, and Transgender People’, and other related 
reports by the National Academy of Sciences. This 
plan shall be publicly disclosed for review and com-
ment and the final plan shall address any comments 
or concerns that are received by the Office. 
‘‘(2) Investigative and enforcement actions 
against intentional discrimination and policies and 
practices that have a disparate impact on minorities. 
‘‘(3) The review of racial, ethnic, gender iden-
tity, sexual orientation, sex, disability status, socio-
economic status, and primary language health data 
collected by Federal health agencies to assess health 
care disparities related to intentional discrimination 
and policies and practices that have a disparate im-
pact on minorities. Such review shall include an as-
sessment of health disparities in communities with a 
combination of these classes. 
‘‘(4) Outreach and education activities relating 
to compliance with title VI of the Civil Rights Act. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00882
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
883 
‘‘(5) The provision of technical assistance for 
health entities to facilitate compliance with title VI 
of the Civil Rights Act. 
‘‘(6) Coordination and oversight of activities of 
the civil rights compliance offices established under 
section 3442. 
‘‘(7) Ensuring— 
‘‘(A) at a minimum, compliance with the 
most recent version of the Office of Manage-
ment and Budget statistical policy directive en-
titled ‘Standards for Maintaining, Collecting, 
and Presenting Federal Data on Race and Eth-
nicity’; and 
‘‘(B) consideration of available data and 
language standards such as— 
‘‘(i) the standards for collecting and 
reporting data under section 3101; and 
‘‘(ii) the National Standards on Cul-
turally 
and 
Linguistically 
Appropriate 
Services of the Office of Minority Health. 
‘‘(c) FUNDING AND STAFF.—The Secretary shall en-
sure the effectiveness of the Office of Health Disparities 
by ensuring that the Office is provided with— 
‘‘(1) adequate funding to enable the Office to 
carry out its duties under this section; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00883
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
884 
‘‘(2) staff with expertise in— 
‘‘(A) epidemiology; 
‘‘(B) statistics; 
‘‘(C) health quality assurance; 
‘‘(D) minority health and health dispari-
ties; 
‘‘(E) cultural and linguistic competency; 
‘‘(F) civil rights; and 
‘‘(G) social, behavioral, and economic de-
terminants of health. 
‘‘(d) REPORT.—Not later than December 31, 2021, 
and annually thereafter, the Secretary, in collaboration 
with the Director of the Office for Civil Rights and the 
Deputy Assistant Secretary for Minority Health, shall 
submit a report to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives 
that includes— 
‘‘(1) the number of cases filed, broken down by 
category; 
‘‘(2) the number of cases investigated and 
closed by the office; 
‘‘(3) the outcomes of cases investigated; 
‘‘(4) the staffing levels of the office including 
staff credentials; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00884
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
885 
‘‘(5) the number of other lingering and emerg-
ing cases in which civil rights inequities can be dem-
onstrated; and 
‘‘(6) the number of cases remaining open and 
an explanation for their open status. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2021 through 2026. 
‘‘SEC. 3442. ESTABLISHMENT OF HEALTH PROGRAM OF-
FICES FOR CIVIL RIGHTS WITHIN FEDERAL 
HEALTH AND HUMAN SERVICES AGENCIES. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
civil rights compliance offices in each agency within the 
Department of Health and Human Services that admin-
isters health programs. 
‘‘(b) PURPOSE OF OFFICES.—Each office established 
under subsection (a) shall ensure that recipients of Fed-
eral financial assistance under Federal health programs 
administer programs, services, and activities in a manner 
that— 
‘‘(1) does not discriminate, either intentionally 
or in effect, on the basis of race, national origin, lan-
guage, ethnicity, sex, age, disability, sexual orienta-
tion, and gender identity; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00885
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
886 
‘‘(2) promotes the reduction and elimination of 
disparities in health and health care based on race, 
national origin, language, ethnicity, sex, age, dis-
ability, sexual orientation, and gender identity. 
‘‘(c) POWERS AND DUTIES.—The offices established 
in subsection (a) shall have the following powers and du-
ties: 
‘‘(1) The establishment of compliance and pro-
gram participation standards for recipients of Fed-
eral financial assistance under each program admin-
istered by the applicable agency, including the estab-
lishment of disparity reduction standards to encom-
pass disparities in health and health care related to 
race, national origin, language, ethnicity, sex, age, 
disability, sexual orientation, and gender identity. 
‘‘(2) The development and implementation of 
program-specific guidelines that interpret and apply 
Department of Health and Human Services guid-
ance under title VI of the Civil Rights Act of 1964 
and section 1557 of the Patient Protection and Af-
fordable Care Act to each Federal health program 
administered by the agency. 
‘‘(3) The development of a disparity-reduction 
impact analysis methodology that shall be applied to 
every rule issued by the agency and published as 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00886
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
887 
part of the formal rulemaking process under sections 
555, 556, and 557 of title 5, United States Code. 
‘‘(4) Oversight of data collection, analysis, and 
publication requirements for all recipients of Federal 
financial assistance under each Federal health pro-
gram administered by the agency; compliance with, 
at a minimum, the most recent version of the Office 
of Management and Budget statistical policy direc-
tive entitled ‘Standards for Maintaining, Collecting, 
and Presenting Federal Data on Race and Eth-
nicity’; and consideration of available data and lan-
guage standards such as— 
‘‘(A) the standards for collecting and re-
porting data under section 3101; and 
‘‘(B) the National Standards on Culturally 
and Linguistically Appropriate Services of the 
Office of Minority Health. 
‘‘(5) The conduct of publicly available studies 
regarding discrimination within Federal health pro-
grams administered by the agency as well as dis-
parity reduction initiatives by recipients of Federal 
financial assistance under Federal health programs. 
‘‘(6) Annual reports to the Committee on 
Health, Education, Labor, and Pensions and the 
Committee on Finance of the Senate and the Com-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00887
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
888 
mittee on Energy and Commerce and the Committee 
on Ways and Means of the House of Representatives 
on the progress in reducing disparities in health and 
health care through the Federal programs adminis-
tered by the agency. 
‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 
IN THE DEPARTMENT OF JUSTICE.— 
‘‘(1) DEPARTMENT
OF
HEALTH
AND
HUMAN 
SERVICES.—The Office for Civil Rights of the De-
partment of Health and Human Services shall pro-
vide standard-setting and compliance review inves-
tigation support services to the Civil Rights Compli-
ance Office for each agency described in subsection 
(a), subject to paragraph (2). 
‘‘(2) DEPARTMENT
OF
JUSTICE.—The Office 
for Civil Rights of the Department of Justice may, 
as appropriate, institute formal proceedings when a 
civil rights compliance office established under sub-
section (a) determines that a recipient of Federal fi-
nancial assistance is not in compliance with the dis-
parity reduction standards of the applicable agency. 
‘‘(e) DEFINITION.—In this section, the term ‘Federal 
health programs’ mean programs— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00888
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
889 
‘‘(1) under the Social Security Act (42 U.S.C. 
301 et seq.) that pay for health care and services; 
and 
‘‘(2) under this Act that provide Federal finan-
cial assistance for health care, biomedical research, 
health services research, and programs designed to 
improve the public’s health, including health service 
programs.’’. 
SEC. 904. UNITED STATES COMMISSION ON CIVIL RIGHTS. 
(a) COORDINATION WITHIN DEPARTMENT OF JUS-
TICE
OF
ACTIVITIES
REGARDING
HEALTH
DISPARI-
TIES.—Section 3(a) of the Civil Rights Commission Act 
of 1983 (42 U.S.C. 1975a(a)) is amended— 
(1) in paragraph (1), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (2), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(3) shall, with respect to activities carried out 
in health care and correctional facilities toward the 
goal of eliminating health disparities between the 
general population and members of minority groups 
based on race or color, promote coordination of such 
activities of— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00889
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
890 
‘‘(A) the Office for Civil Rights within the 
Office of Justice Programs of the Department 
of Justice; 
‘‘(B) the Office of Justice Programs within 
the Department of Justice; 
‘‘(C) the Office for Civil Rights within the 
Department of Health and Human Services; 
and 
‘‘(D) the Office of Minority Health within 
the Department of Health and Human Services 
(headed by the Deputy Assistant Secretary for 
Minority Health).’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 
1975c) is amended by striking the first sentence and in-
serting the following: ‘‘For the purpose of carrying out 
this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2021, and such sums as may 
be necessary for each of the fiscal years 2022 through 
2026.’’. 
SEC. 905. SENSE OF CONGRESS CONCERNING FULL FUND-
ING OF ACTIVITIES TO ELIMINATE RACIAL 
AND ETHNIC HEALTH DISPARITIES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00890
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
891 
(1) The health status of the population of the 
United States is declining and the United States 
currently ranks below most industrialized nations in 
health status measured by longevity, sickness, and 
mortality. 
(2) Racial and ethnic minority populations tend 
to have the poorest health status and face substan-
tial cultural, social, and economic barriers to obtain-
ing quality health care. 
(3) Lesbian, gay, bisexual, transgender, queer, 
and questioning populations experience significant 
personal and structural barriers to obtaining high- 
quality health care. 
(4) Efforts to improve minority health have 
been limited by inadequate resources (funding, staff-
ing, and stewardship) and lack of accountability. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) health disparities negatively impact out-
comes for health and human security of the Nation; 
(2) reducing racial, ethnic, sexual, and gender 
disparities in prevention and treatment are unique 
civil and human rights challenges and, as such, Fed-
eral agencies and health care entities and systems 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00891
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
892 
receiving Federal funds should be accountable for 
their role in causing disparities and inequity; 
(3) funding for the National Institute on Mi-
nority Health and Health Disparities, the Office of 
Civil Rights in the Department of Health and 
Human Services, the National Institute of Nursing 
Research, and the Office of Minority Health should 
be doubled by fiscal year 2022; 
(4) adequate funding by fiscal year 2022, and 
subsequent funding increases, should be provided for 
health and human service professions training pro-
grams, the Racial and Ethnic Approaches to Com-
munity Health Initiative at the Centers for Disease 
Control and Prevention, the Minority HIV/AIDS 
Initiative, and the Excellence Centers to Eliminate 
Ethnic/Racial Disparities Program at the Agency for 
Healthcare Research and Quality; 
(5) funding should be fully restored to the Ra-
cial and Ethnic Approaches to Community Health 
Initiative at the Centers for Disease Control and 
Prevention, which has been a successful program at 
the community health level, and efforts should con-
tinue to place a strong emphasis on building commu-
nity capacity to secure financial resources and tech-
nical assistance to eliminate health disparities; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00892
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
893 
(6) adequate funding for fiscal year 2022 and 
increased funding for future years should be pro-
vided for the Racial and Ethnic Approaches to Com-
munity Health Initiative’s United States Risk Fac-
tor Survey to ensure adequate data collection to 
track health disparities, and there should be appro-
priate avenues provided to disseminate findings to 
the general public; 
(7) current and newly created health disparity 
elimination incentives, programs, agencies, and de-
partments under this Act (and the amendments 
made by this Act) should receive adequate staffing 
and funding by fiscal year 2022; and 
(8) stewardship and accountability should be 
provided to the Congress and the President for 
measurable and sustainable progress toward health 
disparity elimination. 
SEC. 906. GAO AND NIH REPORTS. 
(a) GAO REPORT ON NIH GRANT RACIAL AND ETH-
NIC DIVERSITY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study on the racial 
and ethnic diversity among the following groups: 
(A) All applicants for grants, contracts, 
and cooperative agreements awarded by the Na-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00893
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
894 
tional Institutes of Health during the period be-
ginning on January 1, 2009, and ending De-
cember 31, 2019. 
(B) All recipients of such grants, con-
tracts, and cooperative agreements during such 
period. 
(C) All members of the peer review panels 
of such applicants and recipients, respectively. 
(2) REPORT.—Not later than 6 months after 
the date of the enactment of this Act, the Comp-
troller General shall complete the study under para-
graph (1) and submit to Congress a report con-
taining the results of such study. 
(b) NIH REPORT ON CERTAIN AUTHORITY OF NA-
TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 
DISPARITIES.—Not later than 6 months after the date of 
the enactment of this Act, and biennially thereafter, the 
Director of the National Institutes of Health, in collabora-
tion with the Director of the National Institute on Minor-
ity Health and Health Disparities, shall submit to Con-
gress a report that details and evaluates— 
(1) the steps taken during the applicable report 
period by the Director of the National Institutes of 
Health to enforce the expanded planning, coordina-
tion, review, and evaluation authority provided the 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00894
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
895 
National Institute on Minority Health and Health 
Disparities under section 464z–3(h) of the Public 
Health Service Act (42 U.S.C. 285(h)) over all mi-
nority health and health disparity research that is 
conducted or supported by the Institutes and Cen-
ters at the National Institutes of Health; and 
(2) the outcomes of such steps. 
(c) GAO REPORT RELATED
TO RECIPIENTS
OF 
PPACA FUNDING.—Not later than one year after the 
date of the enactment of this Act and biennially thereafter 
until 2024, the Comptroller General of the United States 
shall submit to Congress a report that identifies— 
(1) the racial and ethnic diversity of commu-
nity-based organizations that applied for Federal en-
rollment funding provided pursuant to the Patient 
Protection and Affordable Care Act (Public Law 
111–148) (including the amendments made by such 
Act); 
(2) the percentage of such organizations that 
were awarded such funding; and 
(3) the impact of such community-based organi-
zations’ enrollment efforts on the insurance status of 
their communities. 
(d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 
INSTITUTE ON MINORITY HEALTH AND HEALTH DIS-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00895
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
896 
PARITIES.—The Director of the National Institute on Mi-
nority Health and Health Disparities shall prepare an an-
nual report on the activities carried out or to be carried 
out by such institute, and shall submit each such report 
to the Committee on Health, Education, Labor, and Pen-
sions of the Senate, the Committee on Energy and Com-
merce of the House of Representatives, the Secretary of 
Health and Human Services, and the Director of the Na-
tional Institutes of Health. With respect to the fiscal year 
involved, the report shall— 
(1) describe and evaluate the progress made in 
health disparities research conducted or supported 
by institutes and centers of the National Institutes 
of Health; 
(2) summarize and analyze expenditures made 
for activities with respect to health disparities re-
search conducted or supported by the National Insti-
tutes of Health; 
(3) include a separate statement applying the 
requirements of paragraphs (1) and (2) specifically 
to minority health disparities research; and 
(4) contain such recommendations as the Direc-
tor of the Institute considers appropriate. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00896
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
897 
TITLE X—ADDRESSING SOCIAL 
DETERMINANTS 
AND 
IM-
PROVING 
ENVIRONMENTAL 
JUSTICE 
Subtitle A—In General 
SEC. 1001. DEFINITIONS. 
In this title: 
(1) DETERMINANTS
OF
HEALTH.—The term 
‘‘determinants of health’’— 
(A) means the range of personal, social, 
economic, and environmental factors that influ-
ence health status; and 
(B) includes social determinants of health 
(which are sometimes referred to as ‘‘social and 
economic determinants of health’’, ‘‘socio-
economic determinants of health’’, ‘‘environ-
mental determinants of health’’, ‘‘social drivers 
of inequality’’, and ‘‘personal determinants of 
health’’). 
(2) 
ENVIRONMENTAL
DETERMINANTS
OF 
HEALTH.—The term ‘‘environmental determinants 
of health’’ means the broad physical (including man-
made and natural environments), psychological, so-
cial, spiritual, cultural and aesthetic environment. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00897
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
898 
(3) BUILT
ENVIRONMENT.—The term ‘‘built 
environment’’ means the components of the environ-
ment, and the location of these components in a geo-
graphically defined space, that are created or modi-
fied by individuals to form the physical and social 
characteristics of a community or enhance quality of 
human life, including— 
(A) homes, schools, and places of work and 
worship; 
(B) parks, recreation areas, and green-
ways; 
(C) transportation systems; 
(D) business, industry, and agriculture; 
and 
(E) land-use plans, projects, and policies 
that impact the physical or social characteris-
tics of a community, including access to services 
and amenities. 
(4) PERSONAL DETERMINANTS OF HEALTH.— 
The term ‘‘personal determinants of health’’ means 
an individual’s behavior, biology, and genetics. 
(5) SOCIAL DETERMINANTS OF HEALTH.—The 
term ‘‘social determinants of health’’ means a subset 
of determinants of the health of individuals and en-
vironments (such as communities, neighborhoods, 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00898
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
899 
and societies) that describe an individual’s or group 
of people’s social identity, describe the social and 
economic resources to which such individual or 
group has access, and describe the conditions in 
which an individual or group of people works, lives, 
and plays. 
(6) ECONOMIC DETERMINANTS OF HEALTH.— 
The term ‘‘economic determinants of health’’ refers 
to income and social status. Higher income and so-
cioeconomic status (SES) are linked to decreased 
rates of morbidity and mortality. The higher your 
SES, the healthier you are the longer you’ll live. 
Low SES leads to an increased risk of illness and 
death. 
SEC. 1002. FINDINGS. 
Congress finds as follows: 
(1) Social determinants of health are the larg-
est predictors of health outcomes. 
(2) Social determinants of health, including 
health-related behaviors, social and economic factors, 
and physical environment factors account for 80 per-
cent of health outcomes, whereas clinical care ac-
counts for 20 percent of improved health outcomes. 
Yet, in 2017, public health spending only rep-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00899
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
900 
resented 2.5 percent of all health spending in the 
United States. 
(3) There are more opportunities to improve 
health for everyone when we understand that health 
starts, first, not in a medical setting, but in our 
families, in our schools and workplaces, in our 
neighborhoods, in the air we breathe, and in the 
water we drink. 
(4)(A) Healthy People 2020 identifies health 
and health care quality as a function of not only ac-
cess to health care, but also the social determinants 
of health, categorized into the following: neighbor-
hoods and the built environment; social and commu-
nity context; education; and economic stability. 
(B) The following examples illustrate the nexus 
between the unequal distribution of the social deter-
minants of health and health disparities: 
(i) The built environment influences resi-
dents’ level of physical activity. Neighborhoods 
with high levels of poverty are significantly less 
likely to have places where children can be 
physically active, such as parks, green spaces, 
and bike paths and lanes. Neighborhoods and 
communities can provide opportunities for phys-
ical activity and support active lifestyles 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00900
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
901 
through accessible and safe parks and open 
spaces and through land use policy, zoning, and 
healthy community design. 
(ii) Emotional and physical health and 
well-being are directly impacted by perceived 
levels of safety, such as unlit streets at night. 
Community members have expressed that safety 
is not only a barrier to accessing programs and 
services that increase quality of life but they 
are also not able to access physical activity in 
their community through the built environment. 
(iii) In many workplace environments. 
(iv) Historical and institutional racism in 
the United States has shaped the way in which 
social and economic resources and exposure to 
health promoting environments are distributed. 
Income, education, occupation, neighborhood 
conditions, schools, workplaces, the use of 
health and social services, and experiences with 
the criminal justice system are all highly pat-
terned by race, with people of color experiencing 
more that is health harming. Finding ways to 
uncouple the link between race and access to re-
sources and healthy environments is a principal 
means of reducing health disparities. Addition-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00901
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
902 
ally, the anticipation of racism itself causes 
higher psychological and cardiovascular stress 
levels that are linked to poor health outcomes. 
Remedying discriminatory practices at the indi-
vidual and systemic levels will likely reduce 
health disparities caused by this unequal dis-
tribution of stress. 
(v) Poor health among Native Americans 
has largely been driven by post-colonial oppres-
sion and historical trauma. The expropriation of 
native lands and territories to the American 
state had severe consequences on Native Amer-
ican health. This resulted in the deprivation of 
traditional food sources—and nutrients—for 
Native Americans and also the destruction of 
traditional economies and community organiza-
tion. Today, Native Americans have twice the 
rate of diabetes of non-Hispanic Whites. Rec-
ognition of the origins of the diabetes as having 
a social and community context, rather than 
just individual responsibility and genetic pre-
disposition, will shape better policy to provide 
food security. 
(vi) In the context of prisons, overcrowding 
has led to the deterioration of the physical and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00902
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
903 
mental health of individuals after they leave 
prison. In particular, the mass incarceration of 
African-American males as a result of unequal 
contact with and treatment in the criminal jus-
tice system has contributed to an overburdening 
of certain infectious diseases within the African- 
American community. As a social institution, 
incarceration amplifies existing adverse health 
conditions by concentrating diseases and harm-
ful health behaviors such as tobacco use, drug 
use, and violence. 
(vii) Educational attainment is the strong-
est predictor of adult mortality. It is a basic 
component of socioeconomic status that shapes 
earning potential to access resources that pro-
mote health. People with more education are 
less likely to report that they are in poor health, 
and are also less likely to have diabetes and 
other chronic diseases. 
(viii) Individuals with lower levels of edu-
cational attainment are much more likely to re-
port to be current smokers. In 2017, smoking 
prevalence was 36.8 percent among adults with 
a GED diploma, 23.1 percent with less than a 
high school diploma, and 18.7 percent with a 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00903
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
904 
high school diploma, while dropping signifi-
cantly to 7.1 percent among adults with an un-
dergraduate college degree and 4.1 percent with 
a postgraduate college degree. 
(ix) Income inequality differences account 
for a large part of health disparities. For exam-
ple, children living in poverty experience poorer 
housing conditions, increased exposure to in-
door allergens and toxins (such as pesticides, 
lead, mercury, radon, air pollution, and carcino-
gens), increased food insecurity, and more psy-
chological stress. These experiences culminate 
in worse adult health as compared with children 
with higher socioeconomic status. Specifically, 
children living in lower socioeconomic neighbor-
hoods have higher rates of asthma due to high-
er rates of psychological stress resulting from 
higher rates of violence. Food insecurity is asso-
ciated with obesity and racial and ethnic mi-
norities have higher rates of food insecurity. 
(x) Lesbian, gay, bisexual, transgender, 
queer, questioning and intersex (LGBTQIA) in-
dividuals face health disparities linked to soci-
etal stigma, discrimination, and denial of their 
civil and human rights. Discrimination against 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00904
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
905 
LGBTQIA individuals has been associated with 
high rates of psychiatric disorders, substance 
abuse, and suicide. Experiences of violence and 
victimization are frequent for LGBTQIA indi-
viduals, and have long-lasting effects on the in-
dividual and the community. Personal, family, 
and social acceptance of sexual orientation and 
gender identity affects the mental health and 
personal safety of LGBTQIA individuals. 
(xi) Individuals in older and cheaper hous-
ing are at higher risks to be exposed to lead, 
particularly in housing built prior to 1960. The 
threat of lead poisoning disproportionally af-
fects vulnerable populations, with children living 
in poverty (5.6 percent) and Black children 
(5.6) experiencing the highest rates. According 
to the Department of Housing and Urban De-
velopment, about 3,600,000 homes nationwide 
that house young children have lead hazards 
such as contaminated drinking water, peeling 
paint, contaminated dust, or toxic soil. The 
combined cost of medical treatment and special 
education for lead poisoned children averages 
about $5,600 per child per year, and lead-poi-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00905
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
906 
soning costs the United States an estimated 
$50,000,000,000 annually. 
(xii) Individuals with disabilities, as a 
group, experience health disparities in routine 
public health arenas such as health behaviors, 
clinical preventive services, and chronic condi-
tions. Compared with individuals without dis-
abilities, individuals with disabilities are— 
(I) less likely to receive recommended 
preventive health care services, such as 
routine 
teeth 
cleanings 
and 
cancer 
screenings; 
(II) at a high risk for poor health out-
comes such as obesity, hypertension, falls- 
related injuries, and mood disorders such 
as depression; and 
(III) 
more 
likely 
to 
engage 
in 
unhealthy behaviors that put their health 
at risk, such as cigarette smoking and in-
adequate physical activity (from Healthy 
People 2020). 
(5) Laws and regulations that improve opportu-
nities to live in safe neighborhoods, with more social 
cohesion, attain higher education, sustain stable em-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00906
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
907 
ployment, and bridge class differences help foster 
the health and safety of individuals. 
(6) The global public health community has 
reached consensus through the Rio Political Declara-
tion of Social Determinants of Health adopted by 
the World Health Organization in October 2011 that 
‘‘[c]ollaboration in coordinated and intersectoral pol-
icy actions has proven to be effective. Health in All 
Policies, an initiative of the American Public Health 
Association, together with intersectoral cooperation 
and action, is one promising approach to enhance 
accountability in other sectors of health, as well as 
the promotion of health equity and more inclusive 
and productive societies.’’. 
SEC. 1003. HEALTH IMPACT ASSESSMENTS. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Health Impact Assessment is a tool to help 
planners, health officials, decisionmakers, and the 
public make more informed decisions about the po-
tential health effects of proposed plans, policies, pro-
grams, and projects in order to maximize health 
benefits and minimize harms. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00907
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
908 
(2) Health Impact Assessments fosters commu-
nity leadership, ownership and participation in deci-
sion-making processes. 
(3) Health Impact Assessments can build com-
munity support and reduce opposition to a project or 
policy, thereby facilitating economic growth by aid-
ing the development of consensus regarding new de-
velopment proposals. 
(4) Health Impact Assessments facilitate col-
laboration across sectors. 
(b) PURPOSES.—It is the purpose of this section to— 
(1) provide more information about the poten-
tial human health effects of policy decisions and the 
distribution of those effects; 
(2) improve how health is considered in plan-
ning and decision-making processes; and 
(3) 
build 
stronger, 
healthier 
communities 
through the use of Health Impact Assessment. 
(c) HEALTH IMPACT ASSESSMENTS.—Part P of title 
III of the Public Health Service Act (42 U.S.C. 280g et 
seq.), as amended by section 796A, is further amended 
by adding at the end the following: 
‘‘SEC. 399V–12. HEALTH IMPACT ASSESSMENTS. 
‘‘(a) DEFINITIONS.—In this section: 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00908
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
909 
‘‘(1) ADMINISTRATOR.—The term ‘Adminis-
trator’ means the Administrator of the Environ-
mental Protection Agency. 
‘‘(2) DIRECTOR.—The term ‘Director’ means 
the Director of the Centers for Disease Control and 
Prevention. 
‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 
‘health impact assessment’ means a systematic proc-
ess that uses an array of data sources and analytic 
methods and considers input from stakeholders to 
determine the potential effects of a proposed policy, 
plan, program, or project on the health of a popu-
lation and the distribution of those effects within the 
population. Such term includes identifying and rec-
ommending appropriate actions on monitoring and 
maximizing potential benefits and minimizing the 
potential harms. 
‘‘(4) HEALTH
DISPARITY.—The term ‘health 
disparity’ means a particular type of health dif-
ference that is closely linked with social, economic, 
or environmental disadvantage and that adversely 
affects groups of people who have systematically ex-
perienced greater obstacles to health based on their 
racial or ethnic group; religion; socioeconomic status; 
gender; age; mental health; cognitive, sensory, or 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00909
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
910 
physical disability; sexual orientation or gender iden-
tity; geographic location; citizenship status; or other 
characteristics historically linked to discrimination 
or exclusion. 
‘‘(b) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director and in collaboration with the Admin-
istrator, shall— 
‘‘(1) in consultation with the Director of the 
National Center for Chronic Disease Prevention and 
Health Promotion and relevant offices within the 
Department of Housing and Urban Development, 
the Department of Transportation, and the Depart-
ment of Agriculture, establish a program at the Na-
tional Center for Environmental Health at the Cen-
ters for Disease Control and Prevention focused on 
advancing the field of health impact assessment that 
includes— 
‘‘(A) collecting and disseminating best 
practices; 
‘‘(B) 
administering 
capacity 
building 
grants to States to support grantees in initi-
ating health impact assessments, in accordance 
with subsection (d); 
‘‘(C) providing technical assistance; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00910
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
911 
‘‘(D) developing training tools and pro-
viding training on conducting health impact as-
sessment and the implementation of built envi-
ronment and health indicators; 
‘‘(E) making information available, as ap-
propriate, regarding the existence of other com-
munity healthy living tools, checklists, and indi-
ces that help connect public health to other sec-
tors, and tools to help examine the effect of the 
indoor built environment and building codes on 
population health; 
‘‘(F) conducting research and evaluations 
of health impact assessments; and 
‘‘(G) awarding competitive extramural re-
search grants; 
‘‘(2) develop guidance and guidelines to conduct 
health impact assessments in accordance with sub-
section (c); and 
‘‘(3) establish a grant program to allow States 
to fund eligible entities to conduct health impact as-
sessments. 
‘‘(c) GUIDANCE.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of the Health Equity and Ac-
countability Act of 2020, the Secretary, acting 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00911
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
912 
through the Director, shall issue final guidance for 
conducting the health impact assessments. In devel-
oping such guidance the Secretary shall— 
‘‘(A) consult with the Director of the Na-
tional Center for Environmental Health and the 
Director of the National Center for Chronic 
Disease Prevention and Health Promotion, and 
relevant offices within the Department of Hous-
ing and Urban Development, the Department of 
Transportation, and the Department of Agri-
culture; and 
‘‘(B) consider available international health 
impact assessment guidance, North American 
health impact assessment practice standards, 
and recommendations from the National Acad-
emy of Science. 
‘‘(2) CONTENT.—The guidance under this sub-
section shall include— 
‘‘(A) background on national and inter-
national efforts to bridge urban planning, cli-
mate forecasting, and public health institutions 
and disciplines, including a review of health im-
pact assessment best practices internationally; 
‘‘(B) evidence-based direct and indirect 
pathways that link land-use planning, transpor-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00912
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
913 
tation, and housing policy and objectives to 
human health outcomes; 
‘‘(C) data resources and quantitative and 
qualitative forecasting methods to evaluate both 
the status of health determinants and health ef-
fects, including identification of existing pro-
grams that can disseminate these resources; 
‘‘(D) best practices for inclusive public in-
volvement in conducting health impact assess-
ments; and 
‘‘(E) technical assistance for other agen-
cies seeking to develop their own guidelines and 
procedures for health impact assessment. 
‘‘(d) GRANT PROGRAM.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director and in collaboration with the 
Administrator, shall— 
‘‘(A) award grants to States to fund eligi-
ble entities for capacity building or to prepare 
health impact assessments; and 
‘‘(B) ensure that States receiving a grant 
under this subsection further support training 
and technical assistance for grantees under the 
program by funding and overseeing appropriate 
local, State, Tribal, Federal, institution of high-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00913
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
914 
er education, or nonprofit health impact assess-
ment experts to provide such technical assist-
ance. 
‘‘(2) APPLICATIONS.— 
‘‘(A) IN GENERAL.—To be eligible to re-
ceive a grant under this section, an eligible enti-
ty shall— 
‘‘(i) be a State, Indian tribe, or tribal 
organization that includes individuals or 
populations the health of which are, or will 
be, affected by an activity or a proposed 
activity; and 
‘‘(ii) submit to the Secretary an appli-
cation in accordance with this subsection, 
at such time, in such manner, and con-
taining such additional information as the 
Secretary may require. 
‘‘(B) INCLUSION.—An application under 
this subsection shall include a list of proposed 
activities that require or would benefit from 
conducting a health impact assessment within 
six months of awarding funds. The list should 
be accompanied by supporting documentation, 
including letters of support, from potential con-
ductors of health impact assessments for the 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00914
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
915 
listed proposed activities. Each application 
should also include an assessment by the eligi-
ble entity of the health of the population of its 
jurisdiction and describe potential adverse or 
positive effects on health that the proposed ac-
tivities may create. 
‘‘(C) PREFERENCE.—Preference in award-
ing funds under this section may be given to el-
igible entities that demonstrate the potential to 
significantly improve population health or lower 
health care costs as a result of potential health 
impact assessment work. 
‘‘(3) USE OF FUNDS.— 
‘‘(A) IN GENERAL.—An entity receiving a 
grant under this section shall use such grant 
funds to conduct health impact assessment ca-
pacity building or to fund subgrantees in con-
ducting a health impact assessment for a pro-
posed activity in accordance with this sub-
section. 
‘‘(B) PURPOSES.—The purposes of a 
health impact assessment under this subsection 
are— 
‘‘(i) to facilitate the involvement of 
tribal, State, and local public health offi-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00915
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
916 
cials in community planning, transpor-
tation, housing, and land use decisions and 
other decisions affecting the built environ-
ment to identify any potential health con-
cern or health benefit relating to an activ-
ity or proposed activity; 
‘‘(ii) to provide for an investigation of 
any health-related issue of concern raised 
in a planning process, an environmental 
impact assessment process, or policy ap-
praisal relating to a proposed activity; 
‘‘(iii) to describe and compare alter-
natives (including no-action alternatives) to 
a proposed activity to provide clarification 
with respect to the potential health out-
comes associated with the proposed activity 
and, where appropriate, to the related ben-
efit-cost or cost-effectiveness of the pro-
posed activity and alternatives; 
‘‘(iv) to contribute, when applicable, 
to the findings of a planning process, pol-
icy appraisal, or an environmental impact 
statement with respect to the terms and 
conditions of implementing a proposed ac-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00916
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
917 
tivity or related mitigation recommenda-
tions, as necessary; 
‘‘(v) to ensure that the dispropor-
tionate distribution of negative impacts 
among vulnerable populations is minimized 
as much as possible; 
‘‘(vi) to engage affected community 
members and ensure adequate opportunity 
for public comment on all stages of the 
health impact assessment; 
‘‘(vii) where appropriate, to consult 
with local and county health departments 
and appropriate organizations, including 
planning, transportation, and housing or-
ganizations and providing them with infor-
mation and tools regarding how to conduct 
and integrate health impact assessment 
into their work; and 
‘‘(viii) to inspect homes, water sys-
tems, and other elements that pose risks to 
lead exposure, with an emphasis on areas 
that pose a higher risk to children. 
‘‘(4) ASSESSMENTS.—Health impact assess-
ments carried out using grant funds under this sec-
tion shall— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00917
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
918 
‘‘(A) take appropriate health factors into 
consideration as early as practicable during the 
planning, review, or decision-making processes; 
‘‘(B) assess the effect on the health of in-
dividuals and populations of proposed policies, 
projects, or plans that result in modifications to 
the built environment; and 
‘‘(C) assess the distribution of health ef-
fects across various factors, such as race, in-
come, ethnicity, age, disability status, gender, 
and geography. 
‘‘(5) ELIGIBLE ACTIVITIES.— 
‘‘(A) IN GENERAL.—Eligible entities fund-
ed under this subsection shall conduct an eval-
uation of any proposed activity to determine 
whether it will have a significant adverse or 
positive effect on the health of the affected pop-
ulation in the jurisdiction of the eligible entity, 
based on the criteria described in subparagraph 
(B). 
‘‘(B) CRITERIA.—The criteria described in 
this subparagraph include, as applicable to the 
proposed activity, the following: 
‘‘(i) Any substantial adverse effect or 
significant health benefit on health out-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00918
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
919 
comes or factors known to influence health, 
including the following: 
‘‘(I) Physical activity. 
‘‘(II) Injury. 
‘‘(III) Mental health. 
‘‘(IV) Accessibility to health-pro-
moting goods and services. 
‘‘(V) Respiratory health. 
‘‘(VI) Chronic disease. 
‘‘(VII) Nutrition. 
‘‘(VIII) Land use changes that 
promote 
local, 
sustainable 
food 
sources. 
‘‘(IX) Infectious disease. 
‘‘(X) Health disparities. 
‘‘(XI) 
Existing 
air 
quality, 
ground or surface water quality or 
quantity, or noise levels. 
‘‘(XII) Lead exposure. 
‘‘(XIII) Drinking water quality 
and accessibility. 
‘‘(ii) Other factors that may be con-
sidered, including— 
‘‘(I) the potential for a proposed 
activity to result in systems failure 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00919
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
920 
that leads to a public health emer-
gency; 
‘‘(II) the probability that the pro-
posed activity will result in a signifi-
cant increase in tourism, economic de-
velopment, or employment in the ju-
risdiction of the eligible entity; 
‘‘(III) any other significant po-
tential hazard or enhancement to 
human health, as determined by the 
eligible entity; or 
‘‘(IV) whether the evaluation of a 
proposed activity would duplicate an-
other analysis or study being under-
taken in conjunction with the pro-
posed activity. 
‘‘(C) FACTORS FOR CONSIDERATION.—In 
evaluating a proposed activity under subpara-
graph (A), an eligible entity may take into con-
sideration any reasonable, direct, indirect, or 
cumulative effect that can be clearly related to 
potential health effects and that is related to 
the proposed activity, including the effect of 
any action that is— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00920
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
921 
‘‘(i) included in the long-range plan 
relating to the proposed activity; 
‘‘(ii) likely to be carried out in coordi-
nation with the proposed activity; 
‘‘(iii) dependent on the occurrence of 
the proposed activity; or 
‘‘(iv) likely to have a disproportionate 
impact on high-risk or vulnerable popu-
lations. 
‘‘(6) REQUIREMENTS.—A health impact assess-
ment prepared with funds awarded under this sub-
section shall incorporate the following, after con-
ducting the screening phase (identifying projects or 
policies for which a health impact assessment would 
be valuable and feasible) through the application 
process: 
‘‘(A) SCOPING.—Identifying which health 
effects to consider and the research methods to 
be utilized. 
‘‘(B) ASSESSING RISKS AND BENEFITS.— 
Assessing the baseline health status and factors 
known to influence the health status in the af-
fected community, which may include aggre-
gating and synthesizing existing health assess-
ment evidence and data from the community. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00921
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
922 
‘‘(C) DEVELOPING RECOMMENDATIONS.— 
Suggesting changes to proposals to promote 
positive or mitigate adverse health effects. 
‘‘(D) REPORTING.—Synthesizing the as-
sessment and recommendations and commu-
nicating the results to decisionmakers. 
‘‘(E) MONITORING
AND
EVALUATING.— 
Tracking the decision and implementation effect 
on health determinants and health status. 
‘‘(7) PLAN.—An eligible entity that is awarded 
a grant under this section shall develop and imple-
ment a plan, to be approved by the Director, for 
meaningful and inclusive stakeholder involvement in 
all phases of the health impact assessment. Stake-
holders may include community leaders, community- 
based organizations, youth-serving organizations, 
planners, public health experts, State and local pub-
lic health departments and officials, health care ex-
perts or officials, housing experts or officials, and 
transportation experts or officials. 
‘‘(8) SUBMISSION
OF
FINDINGS.—An eligible 
entity that is awarded a grant under this section 
shall submit the findings of any funded health im-
pact assessment activities to the Secretary and make 
these findings publicly available. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00922
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
923 
‘‘(9) ASSESSMENT OF IMPACTS.—An eligible en-
tity that is awarded a grant under this section shall 
ensure the assessment of the distribution of health 
impacts (related to the proposed activity) across 
race, ethnicity, income, age, gender, disability status, 
and geography. 
‘‘(10) CONDUCT
OF
ASSESSMENT.—To the 
greatest extent feasible, a health impact assessment 
shall be conducted under this section in a manner 
that respects the needs and timing of the decision- 
making process it evaluates. 
‘‘(11) METHODOLOGY.—In preparing a health 
impact assessment under this subsection, an eligible 
entity or partner shall follow the guidance published 
under subsection (c). 
‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 
The Secretary, acting through the Director and in collabo-
ration with the Administrator, shall establish, maintain, 
and make publicly available a health impact assessment 
database, including— 
‘‘(1) a catalog of health impact assessments re-
ceived under this section; 
‘‘(2) an inventory of tools used by eligible enti-
ties to conduct health impact assessments; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00923
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
924 
‘‘(3) guidance for eligible entities with respect 
to the selection of appropriate tools described in 
paragraph (2). 
‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 
Secretary shall award competitive grants to Prevention 
Research Centers, or nonprofit organizations or academic 
institutions with expertise in health impact assessments 
to— 
‘‘(1) assist grantees with the provision of train-
ing and technical assistance in the conducting of 
health impact assessments; 
‘‘(2) evaluate the activities carried out with 
grants under subsection (d); and 
‘‘(3) assist the Secretary in disseminating evi-
dence, best practices, and lessons learned from 
grantees. 
‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 
after the date of enactment of the Health Equity and Ac-
countability Act of 2020, the Secretary shall submit to 
Congress a report concerning the evaluation of the pro-
grams under this section, including recommendations as 
to how lessons learned from such programs can be incor-
porated into future guidance documents developed and 
provided by the Secretary and other Federal agencies, as 
appropriate. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00924
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
925 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary. 
‘‘SEC. 399V–13. IMPLEMENTATION OF RESEARCH FINDINGS 
TO IMPROVE HEALTH OUTCOMES THROUGH 
THE BUILT ENVIRONMENT. 
‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 
in collaboration with the Administrator of the Environ-
mental Protection Agency (referred to in this section as 
the ‘Administrator’), shall award grants to public agencies 
or private nonprofit institutions to implement evidence- 
based programming to improve human health through im-
provements to the built environment and subsequently 
human health, by addressing— 
‘‘(1) levels of physical activity; 
‘‘(2) consumption of nutritional foods; 
‘‘(3) rates of crime; 
‘‘(4) air, water, and soil quality; 
‘‘(5) risk or rate of injury; 
‘‘(6) accessibility to health-promoting goods and 
services; 
‘‘(7) chronic disease rates; 
‘‘(8) community design; 
‘‘(9) housing; or transportation options; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00925
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
926 
‘‘(10) other factors, as the Secretary determines 
appropriate. 
‘‘(b) APPLICATIONS.—A public agency or private 
nonprofit institution desiring a grant under this section 
shall submit to the Secretary an application at such time, 
in such manner, and containing such agreements, assur-
ances, and information as the Secretary, in consultation 
with the Administrator, may require. 
‘‘(c) RESEARCH.—The Secretary, in consultation 
with the Administrator, shall support, through grants 
awarded under this section, research that— 
‘‘(1) uses evidence-based research to improve 
the built environment and human health; 
‘‘(2) examines— 
‘‘(A) the scope and intensity of the impact 
that the built environment (including the var-
ious characteristics of the built environment) 
has on the human health; or 
‘‘(B) the distribution of such impacts by— 
‘‘(i) location; and 
‘‘(ii) population subgroup; 
‘‘(3) is used to develop— 
‘‘(A) measures and indicators to address 
health impacts and the connection of health to 
the built environment; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00926
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
927 
‘‘(B) efforts to link the measures to trans-
portation, land use, and health databases; and 
‘‘(C) efforts to enhance the collection of 
built environment surveillance data; 
‘‘(4) distinguishes carefully between personal 
attitudes and choices and external influences on be-
havior to determine how much the association be-
tween the built environment and the health of resi-
dents, versus the lifestyle preferences of the people 
that choose to live in the neighborhood, reflects the 
physical characteristics of the neighborhood; and 
‘‘(5)(A) identifies or develops effective interven-
tion strategies focusing on enhancements to the built 
environment that promote increased use physical ac-
tivity, access to nutritious foods, or other health-pro-
moting activities by residents; and 
‘‘(B) in developing the intervention strategies 
under subparagraph (A), ensures that the interven-
tion strategies will reach out to high-risk or vulner-
able populations, including low-income urban and 
rural communities and aging populations, in addi-
tion to the general population. 
‘‘(d) SURVEYS.—The Secretary may allow recipients 
of grants under this section to use such grant funds to 
support the expansion of national surveys and data track-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00927
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
928 
ing systems to provide more detailed information about 
the connection between the built environment and health. 
‘‘(e) PRIORITY.—In awarding grants under this sec-
tion, the Secretary and the Administrator shall give pri-
ority to entities with programming that incorporates— 
‘‘(1) interdisciplinary approaches; or 
‘‘(2) the expertise of the public health, physical 
activity, urban planning, land use, and transpor-
tation research communities in the United States 
and abroad. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. The Secretary may al-
locate not more than 20 percent of the amount so appro-
priated for a fiscal year for purposes of conducting re-
search under subsection (c).’’. 
SEC. 1004. IMPLEMENTATION OF RECOMMENDATIONS BY 
ENVIRONMENTAL PROTECTION AGENCY. 
(a) INSPECTOR GENERAL RECOMMENDATIONS.—The 
Administrator of the Environmental Protection Agency 
(referred to in this section as the ‘‘Administrator’’) shall, 
as promptly as practicable, carry out each of the following 
recommendations of the Inspector General of the Environ-
mental Protection Agency as described in the report enti-
tled ‘‘EPA needs to conduct environmental justice reviews 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00928
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
929 
of its programs, policies and activities’’ (Report No. 2006– 
P–00034): 
(1) The recommendation that the program and 
regional offices of the Environmental Protection 
Agency identify which programs, policies, and activi-
ties need environmental justice reviews and the Ad-
ministrator require those offices to establish a plan 
to complete the necessary reviews. 
(2) The recommendation that the Administrator 
ensure that the reviews described in paragraph (1) 
determine whether the programs, policies, and activi-
ties may have a disproportionately high and adverse 
health or environmental impact on minority and low- 
income populations. 
(3) The recommendation that each program 
and regional office of the Environmental Protection 
Agency develop specific environmental justice review 
guidance for conducting environmental justice re-
views. 
(4) The recommendation that the Administrator 
designate a responsible office to compile results of 
environmental justice reviews and recommend appro-
priate actions. 
(b) GAO RECOMMENDATIONS.—In promulgating reg-
ulations of the Environmental Protection Agency, the Ad-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00929
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
931 
(4) The recommendation that the Administrator 
direct appropriate officers and employees of the En-
vironmental Protection Agency, if feasible, to re-
spond fully to public comments on environmental 
justice, including by— 
(A) improving the explanation by the Ad-
ministrator of the basis for any conclusions re-
lating to environmental justice; and 
(B) including in an explanation under sub-
paragraph (A) supporting data. 
(c) 2004 INSPECTOR GENERAL REPORT.— 
(1) IN GENERAL.—The Administrator shall, as 
promptly as practicable, carry out each of the fol-
lowing recommendations of the Inspector General of 
the Environmental Protection Agency as described 
in the report entitled ‘‘EPA Needs to Consistently 
Implement the Intent of the Executive Order on En-
vironmental Justice’’ (Report No. 2004–P–00007): 
(A) The recommendation that the Admin-
istrator clearly define the mission of the Office 
of Environmental Justice and provide Environ-
mental Protection Agency staff with an under-
standing of the roles and responsibilities of that 
Office. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00931
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
932 
(B) The recommendation that the Admin-
istrator— 
(i) establish, through the issuance of 
guidance or a policy statement, specific 
timeframes for the development of defini-
tions, goals, and measurements regarding 
environmental justice; and 
(ii) provide the regions and program 
offices a standard and consistent definition 
for a minority and low-income community, 
with instructions on how the Environ-
mental Protection Agency will implement 
and put into operation environmental jus-
tice in the daily activities of the Environ-
mental Protection Agency. 
(C) The recommendation that the Adminis-
trator ensure that the comprehensive training 
program under development (as of the date of 
enactment of this Act) includes standard and 
consistent definitions of the key environmental 
justice concepts, such as ‘‘low-income’’, ‘‘minor-
ity’’, and ‘‘disproportionately impacted’’, and 
instructions for implementation of those con-
cepts. 
(2) REPORTS.— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00932
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
933 
(A) INITIAL REPORT.—Not later than 180 
days after the date of enactment of this Act, 
the Administrator shall submit to Congress an 
initial report on the strategy of the Adminis-
trator for implementing the recommendations 
described in subparagraphs (A), (B), and (C) of 
paragraph (1). 
(B) SUBSEQUENT
REPORTS.—After sub-
mitting the initial report under subparagraph 
(A), the Administrator shall submit to Congress 
semiannual reports on the progress of the Ad-
ministrator in— 
(i) implementing the recommendations 
referred to in subparagraph (A); and 
(ii) modifying the emergency manage-
ment procedures of the Administrator to 
incorporate environmental justice in the 
Incident Command Structure of the Envi-
ronmental Protection Agency, in accord-
ance with the December 18, 2006, letter 
from the Deputy Administrator to the Act-
ing Inspector General of the Environ-
mental Protection Agency. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00933
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
934 
(d) FEDERAL ACTION PLAN
FOR SAVING LIVES, 
PROTECTING
PEOPLE
AND
THEIR
FAMILIES
FROM 
RADON.— 
(1) FINDINGS.—Congress finds that radon is a 
naturally occurring radioactive gas that is— 
(A) recognized as the leading cause of lung 
cancer among nonsmokers; and 
(B) a particular environmental threat for 
low-income and minority individuals because of 
the lack of information about radon levels in 
the homes of those individuals. 
(2) IMPLEMENTATION.—Not later than 180 
days after the date of the enactment of this Act, the 
Administrator shall implement the action plan enti-
tled ‘‘Protecting People and Families from Radon: A 
Federal Action Plan for Saving Lives’’ (June 20, 
2011), in consultation with the Director of the Cen-
ters for Disease Control and Prevention and any 
other Federal agencies referred to in the action plan. 
(3) SPECIFIC
STEPS.—In carrying out para-
graph (2), the Administrator shall ensure that— 
(A) the workgroup comprised of the Fed-
eral agencies participating in the development 
of the action plan referred to in paragraph (2) 
implements specific steps within the existing 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00934
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
935 
authority and activities of each Federal agency 
to reduce exposure to radon; and 
(B) not later than the date that is 1 year 
after the date on which the Administrator be-
gins implementation of the action plan de-
scribed in paragraph (2), the workgroup de-
scribed in subparagraph (A) meets to assess 
and recognize achievements of the plan. 
(4) REPORT.—After the progress meeting of 
the workgroup under paragraph (3)(B), the Admin-
istrator shall submit to Congress a report on the im-
plementation of the action plan described in para-
graph (2), including the challenges remaining and 
the progress in reducing radon exposure, particularly 
for low-income and minority families. 
(e) FEDERAL
ACTION
PLAN
FOR
PREVENTING 
CHILDHOOD LEAD POISONING.— 
(1) FINDINGS.—Congress finds that— 
(A) the effects of lead poisoning are irre-
versible and cost the United States millions an-
nually in medical and education costs; 
(B) the cognitive effects suffered by chil-
dren exposed to lead result in a lifetime of 
health and behavioral problems, which makes 
prevention efforts more critical; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00935
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
936 
(C) the risk is especially high for vulner-
able minority populations who are more likely 
to live in older homes, where lead-based paint 
is more likely to be present. 
(2) ACTION PLAN.—Not later than 180 days 
after the date of enactment of this Act, the Adminis-
trator, in consultation with the Director of the Cen-
ters for Disease Control and Prevention and other 
relevant Federal agencies, shall develop an action 
plan to reduce exposure to lead. 
(3) SPECIFIC
STEPS.—In carrying out para-
graph (2), the Administrator shall— 
(A) establish a working group, comprised 
of representatives of the Federal agencies par-
ticipating in the development of the action plan 
described in paragraph (2), to make rec-
ommendations for the implementation of spe-
cific steps within the existing authority and ac-
tivities of each Federal agency to reduce expo-
sure to lead; and 
(B) assist other Federal agencies in the de-
velopment of materials on the hazards of lead- 
based paint for the purpose of educating ten-
ants and landlords, how to recognize potential 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00936
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
937 
sources of exposure, and how to remediate those 
sources. 
SEC. 1005. GRANT PROGRAM TO CONDUCT ENVIRON-
MENTAL HEALTH IMPROVEMENT ACTIVITIES 
AND TO IMPROVE SOCIAL DETERMINANTS OF 
HEALTH. 
(a) DEFINITIONS.—In this section: 
(1) DIRECTOR.—The term ‘‘Director’’ means 
the Director of the Centers for Disease Control and 
Prevention, acting in collaboration with the Adminis-
trator of the Environmental Protection Agency and 
the Director of the National Institute of Environ-
mental Health Sciences. 
(2) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a State or local community that— 
(A) bears a disproportionate burden of ex-
posure to environmental health hazards; 
(B) bears a disproportionate burden of ex-
posure to unhealthy living conditions, low 
standard housing conditions, low socioeconomic 
status, poor nutrition, less opportunity for edu-
cational attainment, disproportionately high un-
employment rates, or lower literacy levels and 
access to information; 
(C) has established a coalition— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00937
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
938 
(i) with not less than 1 community- 
based organization or demonstration pro-
gram; and 
(ii) with not less than 1— 
(I) public health entity; 
(II) health care provider organi-
zation; 
(III) academic institution, includ-
ing any minority-serving institution 
(including a Hispanic-serving institu-
tion, a historically Black college or 
university, or a Tribal College or Uni-
versity); 
(IV) child-serving institution; or 
(V) landlord or housing provider 
working on lead remediation; 
(D) ensures planned activities and funding 
streams are coordinated to improve community 
health; and 
(E) submits an application in accordance 
with subsection (c). 
(b) ESTABLISHMENT.—The Director shall establish a 
grant program under which eligible entities shall receive 
grants to conduct environmental health improvement ac-
tivities and to improve social determinants of health. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00938
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
939 
(c) APPLICATION.—To receive a grant under this sec-
tion, an eligible entity shall submit an application to the 
Director at such time, in such manner, and accompanied 
by such information as the Director may require. 
(d) USE OF GRANT FUNDS.—An eligible entity may 
use a grant under this section— 
(1) to promote environmental health; 
(2) to address environmental health disparities 
among all populations, including children; and 
(3) to address racial and ethnic disparities in 
social determinants of health. 
(e) AMOUNT OF COOPERATIVE AGREEMENT.—The 
Director shall award grants to eligible entities at the fol-
lowing 3 funding levels: 
(1) LEVEL 1 COOPERATIVE AGREEMENTS.— 
(A) IN
GENERAL.—An eligible entity 
awarded a grant under this paragraph shall use 
the funds to identify environmental health prob-
lems and solutions by— 
(i) 
establishing 
a 
planning 
and 
prioritizing council in accordance with sub-
paragraph (B); and 
(ii) 
conducting 
an 
environmental 
health assessment in accordance with sub-
paragraph (C). 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00939
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
940 
(B) PLANNING AND PRIORITIZING COUN-
CIL.— 
(i) IN GENERAL.—A prioritizing and 
planning council established under sub-
paragraph (A)(i) (referred to in this para-
graph as a ‘‘PPC’’) shall assist the envi-
ronmental health assessment process and 
environmental health promotion activities 
of the eligible entity. 
(ii) MEMBERSHIP.—Membership of a 
PPC shall consist of representatives from 
various organizations within public health, 
planning, development, and environmental 
services and shall include stakeholders 
from vulnerable groups such as children, 
the elderly, disabled, and minority ethnic 
groups that are often not actively involved 
in democratic or decision-making proc-
esses. 
(iii) DUTIES.—A PPC shall— 
(I) identify key stakeholders and 
engage and coordinate potential part-
ners in the planning process; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00940
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
941 
(II) establish a formal advisory 
group to plan for the establishment of 
services; 
(III) conduct an in-depth review 
of the nature and extent of the need 
for an environmental health assess-
ment, including a local epidemiological 
profile, an evaluation of the service 
provider capacity of the community, 
and a profile of any target popu-
lations; and 
(IV) define the components of 
care and form essential programmatic 
linkages with related providers in the 
community. 
(C) ENVIRONMENTAL
HEALTH
ASSESS-
MENT.— 
(i) IN GENERAL.—A PPC shall carry 
out an environmental health assessment to 
identify environmental health concerns. 
(ii) 
ASSESSMENT
PROCESS.—The 
PPC shall— 
(I) define the goals of the assess-
ment; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00941
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
943 
(i) IN GENERAL.—The Director shall 
award grants under this paragraph to eli-
gible entities that have already— 
(I) established broad-based col-
laborative partnerships; and 
(II) completed environmental as-
sessments. 
(ii) NO LEVEL 1 REQUIREMENT.—To 
be eligible to receive a grant under this 
paragraph, an eligible entity is not re-
quired to have successfully completed a 
Level 1 Cooperative Agreement (as de-
scribed in paragraph (1)). 
(B) USE OF GRANT FUNDS.—An eligible 
entity awarded a grant under this paragraph 
shall use the funds to further activities to carry 
out environmental health improvement activi-
ties, including— 
(i) addressing community environ-
mental health priorities in accordance with 
paragraph (1)(C)(ii), including— 
(I) geography; 
(II) the built environment; 
(III) air quality; 
(IV) water quality; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00943
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
945 
(iii) establishing programs to ad-
dress— 
(I) how environmental and social 
conditions of work and living choices 
influence physical activity and dietary 
intake; or 
(II) how the conditions described 
in subclause (I) influence the concerns 
and needs of people who have im-
paired mobility and use assistance de-
vices, including wheelchairs, lower 
limb prostheses, and hip, knee, and 
other joint replacements; and 
(iv) convening intervention and dem-
onstration programs that examine the role 
of the social environment in connection 
with the physical and chemical environ-
ment in— 
(I) determining access to nutri-
tional food; 
(II) improving physical activity to 
reduce overweight, obesity, and co- 
morbidities and increase quality of 
life; and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00945
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
946 
(III) location and access to med-
ical facilities. 
(3) LEVEL 3 COOPERATIVE AGREEMENTS.— 
(A) IN
GENERAL.—An eligible entity 
awarded a grant under this paragraph shall use 
the funds to identify and address racial and 
ethnic disparities in social determinants of 
health by creating demonstration programs that 
assess the feasibility of establishing a federally 
funded comprehensive program and describe 
key outcomes that address racial and ethnic dis-
parities in social determinants of health. 
(B) PROGRAM DESIGN.— 
(i) EVALUATION.—No later than 1 
year after enactment of this Act, the Di-
rector shall evaluate the best practices of 
existing programs from the private, public, 
community-based, and academically sup-
ported initiatives focused on reducing dis-
parities in the social determinants of 
health for racial and ethnic populations. 
(ii) 
DEMONSTRATION
PROJECTS.— 
Not later than two years after the date of 
enactment of this Act, the Director shall 
implement at least ten demonstration 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00946
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
947 
projects including at least one project for 
each major racial and ethnic minority 
group, each of which is unique to the cul-
tural and linguistic needs of each of the 
following groups: 
(I) Native Americans and Alaska 
Natives. 
(II) Asian Americans. 
(III) African Americans/Blacks. 
(IV) Hispanic/Latino Americans. 
(V) Native Hawaiians and Pacific 
Islanders. 
(iii) REPORT TO CONGRESS.—No later 
than 2 years after the implementation of 
the initial demonstration projects, the Di-
rector shall submit to Congress a report 
which includes— 
(I) a description of each dem-
onstration project and design; 
(II) an evaluation of the cost-ef-
fectiveness of each project’s preven-
tion and treatment efforts; 
(III) an evaluation of the cultural 
and linguistic appropriateness of each 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00947
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
948 
project by racial and ethnic group; 
and 
(IV) an evaluation of the bene-
ficiary’s health status improvement 
under the demonstration project. 
(iv) 
ANY
OTHER
INFORMATION 
DEEMED
APPROPRIATE
BY
THE
DIREC-
TOR.—The Director shall require eligible 
entities awarded a grant under this para-
graph to report any other information the 
Director determines appropriate to be 
shared by or developed by such entity, in-
cluding the following: 
(I) Developing models and evalu-
ating methods that improve the cul-
tural and linguistically appropriate 
services provided through the Centers 
for Disease Control and Prevention to 
target individuals impacted by health 
disparities based on their race, eth-
nicity, and gender. 
(II) Promoting the collaboration 
between primary and specialty care 
health care providers and patients, to 
ensure patients impacted by health 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00948
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
949 
disparities based on race, ethnicity, 
and gender are receiving comprehen-
sive and organized treatment and 
care. 
(III) Educating health care pro-
fessionals on the causes and effects of 
disparities in the social determinants 
of health as it relates to minority and 
racial and ethnic communities and the 
need for culturally and linguistically 
appropriate care in the prevention and 
treatment of high-impact diseases. 
(IV) Encouraging collaboration 
among community and patient-based 
organizations which work to address 
disparities in the social determinants 
of health as it relates to high-impact 
diseases in minority and racial and 
ethnic populations. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
(1) $25,000,000 for fiscal year 2021; and 
(2) such sums as may be necessary for fiscal 
years 2022 through 2024. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00949
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
950 
SEC. 1006. ADDITIONAL RESEARCH ON THE RELATIONSHIP 
BETWEEN THE BUILT ENVIRONMENT AND 
THE HEALTH OF COMMUNITY RESIDENTS. 
(a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 
section, the term ‘‘eligible institution’’ means a public or 
private nonprofit institution that submits to the Secretary 
of Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) and the Administrator of the Envi-
ronmental Protection Agency (in this section referred to 
as the ‘‘Administrator’’) an application for a grant under 
the grant program authorized under subsection (b)(2) at 
such time, in such manner, and containing such agree-
ments, assurances, and information as the Secretary and 
Administrator may require. 
(b) RESEARCH GRANT PROGRAM.— 
(1) DEFINITION OF HEALTH.—In this section, 
the term ‘‘health’’ includes— 
(A) levels of physical activity; 
(B) degree of mobility due to factors such 
as musculoskeletal diseases, arthritis, and obe-
sity; 
(C) consumption of nutritional foods; 
(D) rates of crime; 
(E) air, water, and soil quality; 
(F) risk of injury; 
(G) accessibility to health care services; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00950
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
951 
(H) levels of educational attainment; and 
(I) other indicators as determined appro-
priate by the Secretary. 
(2) GRANTS.—The Secretary, in collaboration 
with the Administrator, shall provide grants to eligi-
ble institutions to conduct and coordinate research 
on the built environment and its influence on indi-
vidual and population-based health. 
(3) RESEARCH.—The Secretary shall support 
research that— 
(A) investigates and defines the causal 
links between all aspects of the built environ-
ment and the health of residents; 
(B) examines— 
(i) the extent of the impact of the 
built environment (including the various 
characteristics of the built environment) on 
the health of residents; 
(ii) the variance in the health of resi-
dents by— 
(I) location (such as inner cities, 
inner suburbs, and outer suburbs); 
and 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00951
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
952 
(II) population subgroup (includ-
ing children, the elderly, the disadvan-
taged); or 
(iii) the importance of the built envi-
ronment to the total health of residents, 
which is the primary variable of interest 
from a public health perspective; 
(C) is used to develop— 
(i) measures to address health and the 
connection of health to the built environ-
ment; and 
(ii) efforts to link the measures to 
travel and health databases; 
(D) distinguishes carefully between per-
sonal attitudes and choices and external influ-
ences on observed behavior to determine how 
much an observed association between the built 
environment and the health of residents, versus 
the lifestyle preferences of the people that 
choose to live in the neighborhood, reflects the 
physical characteristics of the neighborhood; 
and 
(E)(i) identifies or develops effective inter-
vention strategies to promote better health 
among residents with a focus on behavioral 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00952
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
953 
interventions and enhancements of the built en-
vironment that promote increased use by resi-
dents; and 
(ii) in developing the intervention strate-
gies under clause (i), ensures that the interven-
tion strategies will reach out to high-risk popu-
lations, including racial and ethnic minorities, 
low-income urban and rural communities, and 
children. 
(4) PRIORITY.—In providing assistance under 
the grant program authorized under paragraph (2), 
the Secretary and the Administrator shall give pri-
ority to research that incorporates— 
(A) minority-serving institutions as grant-
ees; 
(B) interdisciplinary approaches; or 
(C) the expertise of the public health, 
physical activity, nutrition and health care (in-
cluding child health), urban planning, and 
transportation research communities in the 
United States and abroad. 
SEC. 1007. ENVIRONMENT AND PUBLIC HEALTH RESTORA-
TION. 
(a) FINDINGS.— 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00953
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
954 
(1) 
GENERAL
FINDINGS.—Congress 
finds 
that— 
(A) humans share an environment with a 
wide variety of habitats and ecosystems that 
nurture and sustain a diversity of species; 
(B) the abundance of natural resources in 
the environment forms the basis for the econ-
omy and has greatly contributed to human de-
velopment throughout history; 
(C) the accelerated pace of human develop-
ment over the last several hundred years has 
significantly impacted— 
(i) the natural environment and its re-
sources; 
(ii) the health and diversity of plant 
and animal life; 
(iii) the availability of critical habi-
tats; 
(iv) the quality of the air and water; 
and 
(v) the global climate; 
(D) the intervention of the Federal Gov-
ernment is necessary to minimize and mitigate 
human impact on the environment— 
(i) for the benefit of public health; 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00954
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
955 
(ii) to maintain air quality and water 
quality; 
(iii) to sustain the diversity of plants 
and animals; 
(iv) to combat global climate change; 
and 
(v) to protect the environment; 
(E) laws and regulations in the United 
States have been enacted and promulgated to 
minimize and mitigate human impact on the en-
vironment for the benefit of public health, to 
maintain air quality and water quality, to sus-
tain wildlife, and to protect the environment, in-
cluding— 
(i) chapter 3203 of title 54, United 
States Code (commonly known as the ‘‘An-
tiquities Act of 1906’’), which was initiated 
by President Theodore Roosevelt to create 
the National Park System; 
(ii) the National Environmental Policy 
Act of 1969 (42 U.S.C. 4321 et seq.); 
(iii) the Clean Air Act (42 U.S.C. 
7401 et seq.); 
(iv) the Federal Water Pollution Con-
trol Act (33 U.S.C. 1251 et seq.); 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00955
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
956 
(v) the Comprehensive Environmental 
Response, Compensation, and Liability Act 
of 1980 (42 U.S.C. 9601 et seq.); 
(vi) the Endangered Species Act of 
1973 (16 U.S.C. 1531 et seq.); and 
(vii) the National Forest Management 
Act of 1976 (Public Law 94–588; 90 Stat. 
2949) and the amendments made by that 
Act; and 
(F) attempts to repeal or weaken key envi-
ronmental safeguards pose dangers to the pub-
lic health, air quality, water quality, wildlife, 
and the environment. 
(2) FINDINGS
ON
CHANGES
AND
PROPOSED 
CHANGES IN LAW.—Congress finds that, since 2001, 
the following changes and proposed changes to exist-
ing law or regulations have negatively impacted or 
will negatively impact the environment and public 
health: 
(A) CLEAN WATER.— 
(i) FILL MATERIAL.— 
(I) On May 9, 2002, the Envi-
ronmental Protection Agency and the 
Corps of Engineers issued a final rule, 
entitled ‘‘Final Revisions to the Clean 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00956
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
957 
Water Act Regulatory Definitions of 
‘Fill Material’ and ‘Discharge of Fill 
Material’ ’’ (67 Fed. Reg. 31129), 
that 
reconciled 
regulations 
imple-
menting section 404 of the Federal 
Water Pollution Control Act (33 
U.S.C. 1344) by redefining the term 
‘‘fill material’’ and amending the defi-
nition of the term ‘‘discharge of fill 
material’’, reversing a 25-year-old reg-
ulation. 
(II) The rule described in sub-
clause (I)— 
(aa) fails to restrict the 
dumping of hardrock mining 
waste, construction debris, and 
other industrial wastes into riv-
ers, streams, lakes, and wetlands; 
and 
(bb) 
allows 
destructive 
mountaintop removal coal mining 
companies to dump waste into 
streams and lakes, polluting the 
surrounding natural habitat and 
poisoning plants and animals 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00957
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
958 
that depend on those water 
sources. 
(ii) 
LIVESTOCK
WASTE
REGULA-
TIONS.— 
(I) On February 12, 2003, the 
Environmental 
Protection 
Agency 
published the rule entitled ‘‘National 
Pollutant Discharge Elimination Sys-
tem Permit Regulation and Effluent 
Limitation Guidelines and Standards 
for Concentrated Animal Feeding Op-
erations (CAFOs)’’ (68 Fed. Reg. 
7176), new livestock waste regulations 
that aimed to control factory farm 
pollution but which would severely un-
dermine 
then-existing 
protections 
under the Federal Water Pollution 
Control Act (33 U.S.C. 1251 et seq.). 
(II) The regulation described in 
subclause (I) allows large-scale animal 
factories to foul waters in the United 
States with animal waste, allows live-
stock owners to draft their own pollu-
tion-management plans and avoid 
ground water monitoring, legalizes the 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00958
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
959 
discharge 
of 
contaminated 
runoff 
water rich in nitrogen, phosphorus, 
bacteria, and metals, and ensures that 
large factory farms are not held liable 
for the environmental damage they 
cause. 
(III) In a 2005 Federal court de-
cision, Waterkeeper Alliance, et al. v. 
Environmental 
Protection 
Agency, 
399 F.3d 486 (2nd Cir. 2005), major 
parts of the rule were upheld, others 
vacated, and still others remanded 
back to the Environmental Protection 
Agency. 
(IV) On November 20, 2008, the 
Environmental 
Protection 
Agency 
published a revised final rule, entitled 
‘‘Revised 
National 
Pollutant 
Dis-
charge Elimination System Permit 
Regulation and Effluent Limitations 
Guidelines for Concentrated Animal 
Feeding Operations in Response to 
the Waterkeeper Decision’’ (73 Fed. 
Reg. 70418), that undermines envi-
ronmental protection provisions by re-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00959
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
960 
moving mandatory permitting require-
ments and allowing large animal 
farms to self-certify the absence of 
pollutant discharge activity. 
(iii) TOTAL MAXIMUM DAILY LOAD.— 
(I) On March 19, 2003, the En-
vironmental Protection Agency pub-
lished a new rule regarding the total 
maximum daily load program under 
section 303(d) of the Federal Water 
Pollution Control Act (33 U.S.C. 
1313(d)), entitled ‘‘Withdrawal of Re-
visions to the Water Quality Planning 
and Management Regulation and Re-
visions to the National Pollutant Dis-
charge Elimination System Program 
in Support of Revisions to the Water 
Quality Planning and Management 
Regulation’’ (68 Fed. Reg. 13608), 
that regulates the maximum amount 
of a particular pollutant that can be 
present in a body of water and still 
meet water quality standards. 
(II) The new rule described in 
subclause (I) withdrew the then-exist-
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00960
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
961 
ing regulation issued on July 13, 
2000, and entitled ‘‘Revisions to the 
Water Quality Planning and Manage-
ment Regulation and Revisions to the 
National Pollutant Discharge Elimi-
nation System Program in Support of 
Revisions to the Water Quality Plan-
ning and Management Regulation’’ 
(65 Fed. Reg. 43586) and halted mo-
mentum in cleaning up polluted wa-
terways throughout the United States. 
(III) By abandoning the then-ex-
isting rule, the Environmental Protec-
tion Agency is undermining the effec-
tiveness of cleanup plans and is allow-
ing States to avoid cleaning polluted 
waters entirely by dropping them from 
their cleanup lists. 
(IV) Waterways play a crucial 
role in the lives of the people of the 
United States and are critical to the 
livelihood of fish and wildlife. 
(V) The result of dropping the 
rule described in subclause (II) is that 
the restoration of polluted rivers, 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00961
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
962 
shorelines, and lakes will be delayed, 
harming more fish and wildlife and 
worsening the quality of drinking 
water. 
(iv) 
WATERS
OF
THE
UNITED 
STATES.— 
(I) On December 2, 2008, the 
Environmental Protection Agency and 
the Corps of Engineers jointly issued 
a guidance document, entitled ‘‘Clean 
Water Act Jurisdiction Following the 
U.S. Supreme Court’s Decision in 
Rapanos v. United States & Carabell 
v. United States’’. 
(II) The guidance described in 
subclause (I) dictates enforcement ac-
tions under the Federal Water Pollu-
tion Control Act (33 U.S.C. 1251 et 
seq.) and calls for a complicated 
‘‘case-by-case’’ analysis to determine 
jurisdiction for waterways that do not 
flow all year. 
(III) Enforcement actions de-
scribed in subclause (II) endanger 
small streams and wetlands that serve 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00962
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
963 
as important habitats for aquatic life, 
which play a fundamental role in safe-
guarding sources of clean drinking 
water and mitigate the risks and ef-
fects of floods and droughts. 
(IV) The definition provided in 
the guidance described in subclause 
(I) for ‘‘waters of the United States’’ 
is applicable to the Federal Water 
Pollution Control Act (33 U.S.C. 
1251 et seq.) as a whole, potentially 
affecting programs that control indus-
trial pollution and sewage levels, pre-
vent oil spills, and set water quality 
standards for all waters in the United 
States protected under that Act. 
(B) FORESTS AND LAND MANAGEMENT.— 
(i) HEALTHY FORESTS RESTORATION 
ACT OF 2003.— 
(I) On December 3, 2003, the 
President signed into law the Healthy 
Forests Restoration Act of 2003 (16 
U.S.C. 6501 et seq.) (referred to in 
this clause as the ‘‘law’’). 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00963
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS
964 
(II) Although the law attempts to 
reduce the risk of catastrophic forest 
fires, the law provides a boon to tim-
ber companies by accelerating the ag-
gressive thinning of backcountry for-
ests that are located far from at-risk 
communities. 
(III) The law allows for increased 
logging of large, fire-resistant trees 
that are not in close proximity to 
homes and communities. 
(IV) The law undermines critical 
protections for endangered species by 
exempting Federal land management 
agencies from consulting with the 
United States Fish and Wildlife Serv-
ice before approving any action that 
could harm endangered plants or wild-
life. 
(V) The law limits public partici-
pation by reducing the number of en-
vironmental reviews for projects car-
ried out under the law. 
VerDate Sep 11 2014 
23:08 Jul 08, 2020
Jkt 099200
PO 00000
Frm 00964
Fmt 6652
Sfmt 6201
E:\BILLS\H6637.IH
H6637
pbinns on DSKJLVW7X2PROD with BILLS