407 
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-
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) 
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408 
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. 
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 
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409 
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-
tified EHR technology in communities with 
a high proportion of individuals from racial 
and ethnic minority groups (as so defined), 
while also maintaining the accessibility re-
quirements of section 508 of the Rehabili-
tation Act of 1973 to encourage patient in-
volvement in patient health care. The Na-
tional Coordinator shall— 
‘‘(I) not later than 6 months 
after the submission of the report re-
quired under section 822 of the End-
ing 
Health 
Disparities 
During 
COVID–19 Act of 2020, establish cri-
teria for evaluating the impact of 
health information technology on com-
munities with a high proportion of in-
dividuals from racial and ethnic mi-
nority groups (as so defined) taking 
into account the findings in such re-
port; and 
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‘‘(II) not later than 1 year after 
the submission of such report, conduct 
and publish the results of an evalua-
tion of such impact.’’. 
SEC. 903. 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: 
‘‘(e) ANNUAL REPORT
ON EXPENDITURES.—The 
National Coordinator shall report annually to Congress on 
activities and expenditures under this section.’’. 
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SEC. 904. 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. 905. 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’’. 
SEC. 906. 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.— 
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‘‘(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 Histori-
cally Black College or University, a His-
panic-serving institution, a tribal college or 
university, or an Asian-American-, Native 
American-, or Pacific Islander-serving in-
stitution with an accredited public health, 
health policy, or health services research 
program.’’. 
SEC. 907. 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— 
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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; 
(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-
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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. 
(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— 
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(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. 
SEC. 908. STUDY ON THE EFFECTS OF CHANGES TO TELE-
HEALTH UNDER THE MEDICARE AND MED-
ICAID PROGRAMS DURING THE COVID-19 
EMERGENCY. 
(a) IN GENERAL.—Not later than 1 year after the 
end of the emergency period described in section 
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 
1320b–5(g)(1)(B)), the Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
shall conduct a study and submit to the Committee on 
Energy and Commerce and the Committee on Ways and 
Means of the House of Representatives and the Committee 
on Finance of the Senate an interim report on any 
changes made to the provision or availability of telehealth 
services under part A or B of title XVIII of the Social 
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Security Act (42 U.S.C. 1395 et seq.) during such period. 
Such report shall include the following: 
(1) A summary of utilization of all health care 
services furnished under such part A or B during 
such period, including the number of— 
(A) in-person outpatient visits, inpatient 
admissions, and in-person emergency depart-
ment visits; and 
(B) telehealth visits, broken down by— 
(i) the number of such visits furnished 
via audio-visual technology compared to 
the number of such visits furnished via 
audio-only technology; 
(ii) the number of such visits fur-
nished by each type of provider of services 
or supplier (as defined in section 1861 of 
such Act (42 U.S.C. 1395x) and including 
a Federally qualified health center or rural 
health clinic (as so defined)), including a 
specification of the specialty of each such 
provider or supplier (if applicable); and 
(iii) the type of service provided, in-
cluding level of service and diagnoses asso-
ciated with the telehealth visit. 
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(2) A description of any changes in utilization 
patterns for the care settings described in paragraph 
(1) over the course of such period compared to such 
patterns prior to such period. 
(3) An analysis of utilization of telehealth serv-
ices under such part A or B during such period, bro-
ken down by age, sex (including sexual orientation 
and gender identity where possible), race and eth-
nicity, disability status, primary language, geo-
graphic region (including by rural health areas (as 
defined by the Health Resources & Services Admin-
istration), non-rural health areas, health professional 
shortage areas (as defined in section 332(a)(1) of 
the 
Public 
Health 
Service 
Act 
(42 
U.S.C. 
254e(a)(1))), medically underserved communities (as 
defined in section 799B(6) of such Act (42 U.S.C. 
295p(6))), areas with medically underserved popu-
lations (as defined in section 330(b)(3) of such Act 
(42 U.S.C. 254b(b)(3))), and by State), and income 
level (as measured directly or indirectly, such as by 
patient’s zip code tabulation area median income as 
publicly reported by the United States Census Bu-
reau), and of any trends in such utilization during 
such period, so broken down. Such analysis shall in-
clude the number of telehealth visits performed by 
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providers of services or suppliers licensed in a State 
different from the State where the individual receiv-
ing such telehealth services is located at the time 
such services are furnished. Such analysis may not 
include any individually identifiable information or 
protected health information. 
(4) A description of expenditures and any sav-
ings under such part A or B attributable to use of 
such telehealth services during such period. 
(5) A description of any instances of fraud 
identified by the Secretary, acting through the Office 
of the Inspector General or other relevant agencies 
and departments, with respect to such telehealth 
services furnished under such part A or B during 
such period and a comparison of the number of such 
instances with the number of instances of fraud so 
identified with respect to in-person services so fur-
nished during such period. 
(6) A description of any privacy concerns with 
respect to the furnishing of such telehealth services 
(such as cybersecurity or ransomware concerns), in-
cluding a description of any actions taken by the 
Secretary, 
acting 
through 
the 
Health 
Sector 
Cybersecurity Coordination Center or other relevant 
agencies and departments, during such period to as-
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sist health care providers secure telecommunications 
systems. 
(7) An analysis of health care quality related to 
telehealth (which may include patient health out-
comes (such as morbidity, mortality, healthcare utili-
zation, and disease-specific management metrics), 
safety metrics, quality measures, health equity fo-
cused measures, patient satisfaction, provider satis-
faction, and other inputs and sources as determined 
by the Secretary). 
(8) An analysis of any other outcomes or 
metrics related to telehealth, as determined appro-
priate by the Secretary. 
(b) INPUT.—In conducting the study and submitting 
the report under subsection (a), the Secretary— 
(1)(A) consult with relevant stakeholders (such 
as patients, caregivers, patient advocacy groups, mi-
nority or tribal groups (including Urban Indian Or-
ganization (UIOs)), health care professionals (in-
cluding behavioral health professionals), hospitals, 
State medical boards, State nursing boards, the 
Federation of State Medical Boards, National Coun-
cil of State Boards of Nursing, medical professional 
employers (such as hospitals, medical groups, staff-
ing companies), telehealth groups, health profes-
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sional liability providers, public and private payers, 
and State leaders); and 
(B) solicit public comments on such report be-
fore the submission of such report; and 
(2) shall endeavor to include as many racially, 
ethnically, geographically, linguistically, and profes-
sionally diverse perspectives as possible. 
(c) FINAL REPORT.—Not later than December 31, 
2024, the Secretary shall— 
(1) update and finalize the interim report under 
subsection (a); and 
(2) submit such updated and finalized report to 
the committees specified in such subsection. 
(d) GRANTS FOR MEDICAID REPORTS.— 
(1) IN GENERAL.—Not later than 2 years after 
the end of the emergency period described in section 
1135(g)(1)(B) of the Social Security Act (42 U.S.C. 
1320b–5(g)(1)(B)), the Secretary shall award grants 
to States with a State plan (or waiver of such plan) 
in effect under title XIX of the Social Security Act 
(42 U.S.C. 1396r) that submit an application under 
this subsection for purposes of enabling such States 
to study and submit reports to the Secretary on any 
changes made to the provision or availability of tele-
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health services under such plans (or such waivers) 
during such period. 
(2) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1), a State shall— 
(A) provide benefits for telehealth services 
under the State plan (or waiver of such plan) 
in effect under title XIX of the Social Security 
Act (42 U.S.C. 1396r); 
(B) be able to differentiate telehealth from 
in-person visits within claims data submitted 
under such plan (or such waiver) during such 
period; and 
(C) submit to the Secretary an application 
at such time, in such manner, and containing 
such information (including the amount of the 
grant requested) as the Secretary may require. 
(3) USE
OF
FUNDS.—An State shall use 
amounts received under a grant under this sub-
section to conduct a study and report findings re-
garding the effects of changes to telehealth services 
offered under the State plan (or waiver of such plan) 
of such State under title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.) during such period in 
accordance with paragraph (4). 
(4) REPORTS.— 
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(A) INTERIM REPORT.—Not later 1 year 
after the date a State receives a grant under 
this subsection, the State shall submit to the 
Secretary an interim report that— 
(i) details any changes made to the 
provision or availability of telehealth bene-
fits (such as eligibility, coverage, or pay-
ment changes) under the State plan (or 
waiver of such plan) of the State under 
title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) during the emergency 
period described in paragraph (1); and 
(ii) contains— 
(I) a summary and description of 
the type described in paragraphs (1) 
and (2), respectively, of subsection 
(a); and 
(II) to the extent practicable, an 
analysis of the type described in para-
graph (3) of subsection (a), 
except that any reference in such sub-
section to ‘‘such part A or B’’ shall, for 
purposes of subclauses (I) and (II), be 
treated as a reference to such State plan 
(or waiver). 
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(B) FINAL
REPORT.—Not later than 3 
years after the date a State receives a grant 
under this subsection, the State shall update 
and finalize the interim report and submit such 
final report to the Secretary. 
(C) REPORT
BY
SECRETARY.—Not later 
than the earlier of the date that is 1 year after 
the submission of all final reports under sub-
paragraph (B) and December 31, 2028, the 
Secretary shall submit to Congress a report on 
the grant program, including a summary of the 
reports received from States under this para-
graph. 
(5) MODIFICATION AUTHORITY.—The Secretary 
may modify any deadline described in paragraph (4) 
or any information required to be included in a re-
port made under this subsection to provide flexibility 
for States to modify the scope of the study and 
timeline for such reports. 
(6) TECHNICAL
ASSISTANCE.—The Secretary 
shall provide such technical assistance as may be 
necessary to a State receiving a grant under this 
subsection in order to assist such state in conducting 
studies and submitting reports under this sub-
section. 
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(7) STATE.—For purposes of this subsection, 
the term ‘‘State’’ means each of the several States, 
the District of Columbia, and each territory of the 
United States. 
(e) AUTHORIZATION OF APPROPRIATIONS.— 
(1) MEDICARE.—For the purpose of carrying 
out subsections (a) through (c), there are authorized 
to be appropriated such sums as may be necessary 
for each of the fiscal years 2020 through 2024. 
(2) MEDICAID.—For the purpose of carrying 
out subsection (d), there are authorized to be appro-
priated such sums as may be necessary for each of 
the fiscal years 2022 through 2028. 
SEC. 909. COVID–19 DESIGNATION OF IMMEDIATE SPECIAL 
AUTHORITY 
OF 
SPECTRUM 
FOR 
TRIBES’ 
EMERGENCY RESPONSE IN INDIAN COUNTRY. 
(a) FINDINGS.—Congress finds the following: 
(1) The immediate grant of emergency special 
temporary authority of available spectrum that will 
efficiently support temporary wireless broadband 
networks and allow Indian Tribes to provide Tribal 
members with wireless broadband service over Tribal 
lands or Hawaiian Home Lands during the COVID– 
19 crisis due to the increased demand for tele-
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communications and disproportionate impacts of the 
COVID–19 pandemic in Indian Country is essential. 
(2) Reservations are the most digitally discon-
nected areas in the United States that lack basic ac-
cess to broadband and wireless services at rates 
comparable to, and in some cases lower than, third- 
world countries. 
(3) In 2018, the Government Accountability Of-
fice and the Federal Communications Commission 
reported that only 65 percent of American Indian 
and Alaska Natives (AI/ANs) living on Tribal lands 
had access to fixed broadband services, and only 68 
percent of AI/AN households on rural Tribal lands 
had telephone services. This is a stark comparison to 
only 8 percent of the national average that lacks ac-
cess to fixed broadband services. 
(4) Indian Tribes have previously encountered 
substantial barriers to accessing broadband and 
other communications services on Tribal lands to de-
ploy telecommunication services for the safety and 
well-being of Tribal members and to decrease the 
alarming rates of unnecessary loss of lives that AI/ 
ANs 
disproportionately 
experience, 
especially 
through the lack of access to health care services 
and emergency resources, as demonstrated during 
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the COVID–19 pandemic that continues to dis-
proportionately impact Indian Country. 
(5) Indian Tribes’ lack of access to broadband 
services on Tribal lands and Hawaiian Home Lands 
during the COVID–19 pandemic further highlights 
the digital divide in Indian Country. 
(6) The Government Accountability Office 
found that health information technology systems at 
the Indian Health Service rank as the Federal Gov-
ernment’s third-highest need for agency system mod-
ernization, since 50 percent of Indian Health Service 
facilities depend on outdated circuit connections 
based on one or two TI circuit lines (3 Mbps), cre-
ating slower response times than any other health 
facility system in the United States. 
(7) A 2018 Tribal health reform comment filed 
with the Federal Communications Commission has 
further stated that approximately 1.5 million people 
living on Tribal lands lack access to broadband and, 
of the 75 percent of rural Indian Health Service fa-
cilities, many still lack reliable broadband networks 
for American Indians and Alaska Natives (AI/ANs) 
to access telehealth or clinical health care services, 
which is a critical need in the most geographically 
isolated areas of the country with some of the high-
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est poverty rates, and lack of access to reliable 
transportation. 
(8) The Bureau of Indian Education has stated 
that recent estimates from 142 out of 174 schools 
have indicated that approximately 15 to 95 percent 
of students do not have access to internet services 
at home depending on Bureau school location and 
limitations on data caps during the COVID–19 cri-
sis. 
(b) DEPLOYMENT OF WIRELESS BROADBAND SERV-
ICE ON TRIBAL LANDS AND HAWAIIAN HOME LANDS.— 
(1) FUNDING OF GRANTS FOR IMMEDIATE DE-
PLOYMENT OF WIRELESS BROADBAND SERVICE ON 
TRIBAL
LANDS
AND
HAWAIIAN
HOME
LANDS.—In 
addition to any other amounts made available, out of 
any money in the Treasury of the United States not 
otherwise appropriated, there are appropriated— 
(A) $297,500,000 for grants under the 
community facilities grant program under sec-
tion 306(a)(19) of the Consolidated Farm and 
Rural Development Act to Indian Tribes, quali-
fying Tribal entities, and the Director of the 
Department of Hawaiian Home Lands, for the 
immediate deployment of wireless broadband 
service on Tribal lands and Hawaiian Home 
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Lands, respectively, through the use of emer-
gency special temporary authority granted 
under paragraph (2) of this subsection, includ-
ing backhaul costs, repairs to damaged infra-
structure, the cost of the repairs to which would 
be less expensive than the cost of new infra-
structure and would support the emergency spe-
cial temporary use, and the Federal share appli-
cable to grants from such amount shall be 100 
percent, which amount shall remain available 
for one year from the enactment of this Act; 
and 
(B) $3,000,000 for grants under the com-
munity facilities technical assistance and train-
ing grant program under section 306(a)(26) of 
such 
Act, 
without 
regard 
to 
sections 
306(a)(26)(B) and 306(a)(26)(C) of such Act, 
to assist Indian Tribes, qualifying Tribal enti-
ties, and the Director of the Department of Ha-
waiian Home Lands in preparing applications 
for the grants referred to in subparagraph (B) 
of this paragraph, which amount shall remain 
available for one year from the enactment of 
this Act. 
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Grants referred to under subparagraph (B) shall be 
available to Indian Tribes, qualifying Tribal entities 
and shall also be available to inter-Tribal govern-
ment organizations, universities, and colleges with 
Tribal serving institutions for the purposes stated 
herein. 
(2) EMERGENCY SPECIAL TEMPORARY AUTHOR-
ITY TO USE AVAILABLE AND EFFICIENT SPECTRUM 
ON TRIBAL LANDS AND HAWAIIAN HOME LANDS.— 
(A) GRANT
OF
AUTHORITY.—Not later 
than 10 days after receiving a request from an 
Indian Tribe, a qualifying Tribal entity, or the 
Director of the Department of Hawaiian Home 
Lands for emergency special temporary author-
ity to use electromagnetic spectrum described in 
subparagraph (C) for the provision of wireless 
broadband service over the Tribal lands over 
which the Indian Tribe or qualifying Tribal en-
tity has jurisdiction or (in the case of a request 
from the Director of the Department of Hawai-
ian Home Lands) over the Hawaiian Home 
Lands, allowing unlicensed radio transmitters 
to operate for such provision on such spectrum 
at locations on such Tribal lands or Hawaiian 
Home Lands where such spectrum is not being 
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used, the Commission shall grant such request 
on a secondary non-interference basis. 
(B) DURATION.—A grant of emergency 
special temporary authority under subpara-
graph (A) shall be for a period of operation to 
begin not later than 6 months after the date of 
the enactment of this Act and to remain in op-
eration for not longer than 6 months, absent 
extensions granted by the Commission pursuant 
to the procedures of the Commission relating to 
special temporary authority. 
(C) ELECTROMAGNETIC
SPECTRUM
DE-
SCRIBED.—The electromagnetic spectrum de-
scribed in this subparagraph for utilization on 
the temporary basis is any portion of the elec-
tromagnetic spectrum— 
(i) that is— 
(I) between the frequencies of 
2496 megahertz and 2690 megahertz, 
inclusive; 
(II) in the white spaces of the 
television broadcast spectrum between 
the frequencies of 470 megahertz and 
790 megahertz, inclusive, excluding 
those frequencies utilized for other 
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purposes under subpart H of part 15 
of title 47, Code of Federal Regula-
tions; 
(III) between the frequencies of 
5925 megahertz and 7125 megahertz, 
inclusive; or 
(IV) between frequencies of 3550 
megahertz and 3700 megahertz, inclu-
sive; and 
(ii) with respect to the Tribal lands or 
Hawaiian Home Lands over which author-
ity to use such spectrum is requested 
under subparagraph (A), is not assigned to 
any licensee. 
(3) DEFINITIONS.—In this subsection: 
(A) COMMISSION.—The term ‘‘Commis-
sion’’ means the Federal Communications Com-
mission. 
(B) HAWAIIAN HOME LANDS.—The term 
‘‘Hawaiian Home Lands’’ means lands held in 
trust for Native Hawaiians by Hawaii pursuant 
to the Hawaiian Homes Commission Act, 1920. 
(C) INDIAN
TRIBE.—The term ‘‘Indian 
Tribe’’ means the governing body of any indi-
vidually identified and federally recognized In-
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dian or Alaska Native Tribe, band, nation, 
pueblo, village, community, affiliated tribal 
group, or component reservation in the list pub-
lished pursuant to section 104(a) of the Feder-
ally Recognized Indian Tribe List Act of 1994 
(25 U.S.C. 5131(a)). 
(D) QUALIFYING
TRIBAL
ENTITY.—The 
term ‘‘qualifying Tribal entity’’ means an entity 
designated by the Indian Tribe with jurisdiction 
over particular Tribal lands for which the spec-
trum access is sought. The following may be 
designated as a qualifying Tribal entity: 
(i) Indian Tribes. 
(ii) Tribal consortia which consists of 
two or more Indian Tribes, or an Indian 
Tribe and an entity that is more than 50 
percent owned and controlled by one or 
more Indian Tribes. 
(iii) Federally chartered Tribal cor-
porations created under section 17 of the 
Indian Reorganization Act (25 U.S.C. 
5124), and created under section 4 of the 
Oklahoma Indian Welfare Act (25 U.S.C. 
5204). 
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(iv) Entities that are more than 50 
percent owned and controlled by an Indian 
Tribe or Indian Tribes. 
(E) ENTITY THAT IS MORE THAN 50 PER-
CENT OWNED AND CONTROLLED BY ONE OR 
MORE INDIAN TRIBES.—The term ‘‘entity that 
is more than 50 percent owned and controlled 
by one or more Indian Tribes’’ means an entity 
over which one or more Indian Tribes have both 
de facto and de jure control of the entity. De 
jure control of the entity is evidenced by owner-
ship of greater than 50 percent of the voting 
stock of a corporation, or in the case of a part-
nership, general partnership interests. De facto 
control of an entity is determined on a case-by- 
case basis. An Indian Tribe or Indian Tribes 
must demonstrate indicia of control to establish 
that such Indian Tribe or Indian Tribes retain 
de facto control of the applicant seeking eligi-
bility as a ‘‘qualifying Tribal entity’’, including 
the following: 
(i) The Indian Tribe or Indian Tribes 
constitute or appoint more than 50 percent 
of the board of directors or management 
committee of the entity. 
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(ii) The Indian Tribe or Indian Tribes 
have authority to appoint, promote, de-
mote, and fire senior executives who con-
trol the day-to-day activities of the entity. 
(iii) The Indian Tribe or Indian 
Tribes play an integral role in the manage-
ment decisions of the entity. 
(iv) The Indian Tribe or Indian 
Tribes have the authority to make deci-
sions or otherwise engage in practices or 
activities that determine or significantly in-
fluence— 
(I) the nature or types of services 
offered by such an entity; 
(II) the terms upon which such 
services are offered; or 
(III) the prices charged for such 
services. 
(F) TRIBAL
LANDS.—The term ‘‘Tribal 
lands’’ has the meaning given that term in sec-
tion 73.7000 of title 47, Code of Federal Regu-
lations, as of April 16, 2020, and includes the 
definition ‘‘Indian Country’’ as defined in sec-
tion 1151 of title 18, United States Code, and 
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includes fee simple and restricted fee land held 
by an Indian Tribe. 
(G) WIRELESS
BROADBAND
SERVICE.— 
The term ‘‘wireless broadband service’’ means 
wireless broadband internet access service that 
is delivered— 
(i) with a download speed of not less 
than 25 megabits per second and an 
upload speed of not less than 3 megabits 
per second; and 
(ii) through— 
(I) mobile service; 
(II) 
fixed 
point-to-point 
multipoint service; 
(III) fixed point-to-point service; 
or 
(IV) broadcast service. 
SEC. 910. FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES. 
(a) IN GENERAL.—For purposes of expediting the 
provision of telehealth services, for which payment is made 
under the Medicare Program, across State lines, the Sec-
retary of Health and Human Services shall, in consulta-
tion with representatives of States, physicians, health care 
practitioners, and patient advocates, encourage and facili-
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tate the adoption of provisions allowing for multistate 
practitioner practice across State lines. 
(b) DEFINITIONS.—In subsection (a): 
(1) TELEHEALTH
SERVICE.—The term ‘‘tele-
health service’’ has the meaning given that term in 
subparagraph (F) of section 1834(m)(4) of the So-
cial Security Act (42 U.S.C. 1395m(m)(4)). 
(2) PHYSICIAN, 
PRACTITIONER.—The terms 
‘‘physician’’ and ‘‘practitioner’’ have the meaning 
given those terms in subparagraphs (D) and (E), re-
spectively, of such section. 
(3) MEDICARE PROGRAM.—The term ‘‘Medicare 
Program’’ means the program of health insurance 
administered by the Secretary of Health and Human 
Services under title XVIII of the Social Security Act 
(42 U.S.C. 1395 et seq.). 
TITLE X—PUBLIC AWARENESS 
SEC. 1001. AWARENESS CAMPAIGNS. 
The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control 
and Prevention and in coordination with other offices and 
agencies, as appropriate, shall award competitive grants 
or contracts to one or more public or private entities, in-
cluding faith-based organizations, to carry out multi-
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lingual and culturally appropriate awareness campaigns. 
Such campaigns shall— 
(1) be based on available scientific evidence; 
(2) increase awareness and knowledge of 
COVID–19, including countering stigma associated 
with COVID–19; 
(3) improve information on the availability of 
COVID–19 diagnostic testing; and 
(4) promote cooperation with contact tracing ef-
forts. 
SEC. 1002. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity with respect to grants under subsection (c)(1) and 
through the Administrator of the Health Resources and 
Services Administration with respect to grants under sub-
section (c)(2), in consultation with the Director of the Na-
tional Institute on Minority Health and Health Disparities 
and the Deputy Assistant Secretary for Minority Health, 
shall award grants to eligible entities to improve health 
care for patient populations that have low functional 
health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
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(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may rea-
sonably require. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—A grant awarded under subsection (a) 
through the Director of the Agency for Healthcare 
Research and Quality shall be used— 
(A) to define and increase the under-
standing of health literacy; 
(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
(D) for any other activity determined ap-
propriate by the Director. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—A grant awarded under subsection (a) 
through the Administrator of the Health Resources 
and Services Administration shall be used to conduct 
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demonstration projects for interventions for patients 
with low health literacy that may include— 
(A) the development of new disease man-
agement programs for patients with low health 
literacy; 
(B) the tailoring of disease management 
programs addressing mental, physical, oral, and 
behavioral health conditions for patients with 
low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; 
(F) the conduct of educational campaigns 
concerning health directed specifically at pa-
tients with mental disabilities, including those 
with cognitive and intellectual disabilities, de-
signed to reduce the incidence of low health lit-
eracy among these populations, which shall 
have instructional materials in the plain lan-
guage standards promulgated under the Plain 
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Writing Act of 2010 (5 U.S.C. 301 note) for 
Federal agencies; and 
(G) other activities determined appropriate 
by the Administrator. 
(d) DEFINITIONS.—In this section, the term ‘‘low 
health literacy’’ means the inability of an individual to ob-
tain, process, and understand basic health information 
and services needed to make appropriate health decisions. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2021 through 2025. 
SEC. 1003. ENGLISH FOR SPEAKERS OF OTHER LAN-
GUAGES. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to eligible entities 
for the provision of English as a second language (in this 
section referred to ‘‘ESL’’) instruction and shall deter-
mine, after consultation with appropriate stakeholders, the 
mechanism for administering and distributing such 
grants. 
(b) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State or community- 
based organization that employs and serves minority popu-
lations. 
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(c) APPLICATION.—An eligible entity may apply for 
a grant under this section by submitting such information 
as the Secretary of Education may require and in such 
form and manner as the Secretary may require. 
(d) USE OF GRANT.—As a condition of receiving a 
grant under this section, an eligible entity shall— 
(1) develop and implement a plan for assuring 
the availability of ESL instruction that effectively 
integrates information about the nature of the 
United States health care system, how to access 
care, and any special language skills that may be re-
quired for individuals to access and regularly nego-
tiate the system effectively; 
(2) develop a plan, including, where appro-
priate, public-private partnerships, for making ESL 
instruction progressively available to all individuals 
seeking instruction; and 
(3) maintain current ESL instruction efforts by 
using funds available under this section to supple-
ment rather than supplant any funds expended for 
ESL instruction in the State as of January 1, 2020. 
(e) ADDITIONAL DUTIES OF THE SECRETARY.—The 
Secretary of Education shall— 
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(1) collect and publicize annual data on how 
much Federal, State, and local governments spend 
on ESL instruction; 
(2) collect data from State and local govern-
ments to identify the unmet needs of English lan-
guage learners for appropriate ESL instruction, in-
cluding— 
(A) the preferred written and spoken lan-
guage of such English language learners; 
(B) the extent of waiting lists for ESL in-
struction, including how many programs main-
tain waiting lists and, for programs that do not 
have waiting lists, the reasons why not; 
(C) the availability of programs to geo-
graphically isolated communities; 
(D) the impact of course enrollment poli-
cies, including open enrollment, on the avail-
ability of ESL instruction; 
(E) the number individuals in the State 
and each participating locality; 
(F) the effectiveness of the instruction in 
meeting the needs of individuals receiving in-
struction and those needing instruction; 
(G) as assessment of the need for pro-
grams that integrate job training and ESL in-
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struction, to assist individuals to obtain better 
jobs; and 
(H) the availability of ESL slots by State 
and locality; 
(3) determine the cost and most appropriate 
methods of making ESL instruction available to all 
English language learners seeking instruction; and 
(4) not later than 1 year after the date of en-
actment of this Act, issue a report to Congress that 
assesses the information collected in paragraphs (1), 
(2), and (3) and makes recommendations on steps 
that should be taken to progressively realize the goal 
of making ESL instruction available to all English 
language learners seeking instruction. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of Edu-
cation $250,000,000 for each of fiscal years 2021 through 
2024 to carry out this section. 
SEC. 1004. INFLUENZA, COVID–19, AND PNEUMONIA VAC-
CINATION CAMPAIGN. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
(1) enhance the annual campaign by the De-
partment of Health and Human Services to increase 
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the number of people vaccinated each year for influ-
enza, pneumonia, and COVID–19; and 
(2) include in such campaign the use of written 
educational materials, public service announcements, 
physician education, and any other means which the 
Secretary deems effective. 
(b) MATERIALS AND ANNOUNCEMENTS.—In carrying 
out the annual campaign described in subsection (a), the 
Secretary of Health and Human Services shall ensure 
that— 
(1) educational materials and public service an-
nouncements are readily and widely available in 
communities experiencing disparities in the incidence 
and mortality rates of influenza, pneumonia, and 
COVID–19; and 
(2) the campaign uses targeted, culturally ap-
propriate messages and messengers to reach under-
served communities. 
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2021 through 2025. 
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TITLE XI—RESEARCH 
SEC. 1101. RESEARCH AND DEVELOPMENT. 
The Secretary of Health and Human Services, in co-
ordination with the Director of the Centers for Disease 
Control and Prevention and in collaboration with the Di-
rector of the National Institutes of Health, the Director 
of the Agency for Healthcare Research and Quality, the 
Commissioner of Food and Drugs, and the Administrator 
of the Centers for Medicare & Medicaid Services, shall 
support research and development on more efficient and 
effective strategies— 
(1) for the surveillance of SARS–CoV–2 and 
COVID–19; 
(2) for the testing and identification of individ-
uals infected with COVID–19; and 
(3) for the tracing of contacts of individuals in-
fected with COVID–19. 
SEC. 1102. CDC FIELD STUDIES PERTAINING TO SPECIFIC 
HEALTH INEQUITIES. 
(a) IN GENERAL.—Not later than 90 days after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Centers for Disease Control 
and Prevention, in collaboration with State, local, Tribal, 
and territorial health departments, shall complete (by the 
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reporting deadline in subsection (b)) field studies to better 
understand health inequities that are not currently 
tracked by the Secretary. Such studies shall include an 
analysis of— 
(1) the impact of socioeconomic status on 
health care access and disease outcomes, including 
COVID–19 outcomes; 
(2) the impact of disability status on health 
care access and disease outcomes, including COVID– 
19 outcomes; 
(3) the impact of language preference on health 
care access and disease outcomes, including COVID– 
19 outcomes; 
(4) factors contributing to disparities in health 
outcomes for the COVID–19 pandemic; and 
(5) other topics related to disparities in health 
outcomes for the COVID–19 pandemic, as deter-
mined by the Secretary. 
(b) REPORT.—Not later than December 31, 2021, 
the Secretary shall submit to the Committee on Energy 
and Commerce of the House of Representatives and the 
Committee on Health, Education, Labor, and Pensions of 
the Senate an initial report on the results of the field stud-
ies under this section. 
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(c) FINAL REPORT.—Not later than December 31, 
2023, the Secretary shall— 
(1) update and finalize the initial report under 
subsection (b); and 
(2) submit such final report to the committees 
specified in such subsection. 
(d) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$25,000,000, to remain available until expended. 
SEC. 1103. EXPANDING CAPACITY FOR HEALTH OUTCOMES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’), acting through the Administrator of the Health 
Resources and Services Administration, shall award 
grants to eligible entities to develop and expand the use 
of technology-enabled collaborative learning and capacity 
building models to respond to ongoing and real-time learn-
ing, health care information sharing, and capacity building 
needs related to COVID–19. 
(b) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall have experience 
providing technology-enabled collaborative learning and 
capacity building health care services— 
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(1) in rural areas, frontier areas, health profes-
sional shortage areas, or medically underserved area; 
or 
(2) to medically underserved populations or In-
dian Tribes. 
(c) USE OF FUNDS.—An eligible entity receiving a 
grant under this section shall use funds received through 
the grant— 
(1) to advance quality of care in response to 
COVID–19, with particular emphasis on rural and 
underserved areas and populations; 
(2) to protect medical personnel and first re-
sponders through sharing real-time learning through 
virtual communities of practice; 
(3) to improve patient outcomes for conditions 
affected or exacerbated by COVID–19, including im-
provement of care for patients with complex chronic 
conditions; and 
(4) to support rapid uptake by health care pro-
fessionals of emerging best practices and treatment 
protocols around COVID–19. 
(d) OPTIONAL ADDITIONAL USES OF FUNDS.—An 
eligible entity receiving a grant under this section may use 
funds received through the grant for— 
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(1) equipment to support the use and expansion 
of technology-enabled collaborative learning and ca-
pacity building models, including hardware and soft-
ware that enables distance learning, health care pro-
vider support, and the secure exchange of electronic 
health information; 
(2) the participation of multidisciplinary expert 
team members to facilitate and lead technology-en-
abled collaborative learning sessions, and profes-
sionals and staff assisting in the development and 
execution of technology-enabled collaborative learn-
ing; 
(3) the development of instructional program-
ming and the training of health care providers and 
other professionals that provide or assist in the pro-
vision of services through technology-enabled collabo-
rative learning and capacity building models; and 
(4) other activities consistent with achieving the 
objectives of the grants awarded under this section. 
(e) 
TECHNOLOGY-ENABLED
COLLABORATIVE 
LEARNING AND CAPACITY BUILDING MODEL DEFINED.— 
In this section, the term ‘‘technology-enabled collaborative 
learning and capacity building model’’ has the meaning 
given that term in section 2(7) of the Expanding Capacity 
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for Health Outcomes Act (Public Law 114–270; 130 Stat. 
1395). 
(f) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section 
$20,000,000, to remain available until expended. 
SEC. 1104. DATA COLLECTION AND ANALYSIS GRANTS TO 
MINORITY-SERVING INSTITUTIONS. 
(a) AUTHORITY.—The Secretary of Health and 
Human Services, acting through the Director of the Na-
tional Institute on Minority Health and Health Disparities 
and the Deputy Assistant Secretary for Minority Health, 
shall award grants to eligible entities to access and analyze 
racial and ethnic data on disparities in health and health 
care, and where possible other data on disparities in health 
and health care, to monitor and report on progress to re-
duce and eliminate disparities in health and health care. 
(b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
igible entity’’ means an entity that has an accredited pub-
lic health, health policy, or health services research pro-
gram and is any of the following: 
(1) A part B institution, as defined in section 
322 of the Higher Education Act of 1965 (20 
U.S.C. 1061). 
(2) A Hispanic-serving institution, as defined in 
section 502 of such Act (20 U.S.C. 1101a). 
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(3) A Tribal College or University, as defined in 
section 316 of such Act (20 U.S.C. 1059c). 
(4) An Asian American and Native American 
Pacific Islander-serving institution, as defined in 
section 371(c) of such Act (20 U.S.C. 1067q(c)). 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2021 
through 2025. 
SEC. 1105. SAFETY AND EFFECTIVENESS OF DRUGS WITH 
RESPECT TO RACIAL AND ETHNIC BACK-
GROUND. 
(a) IN GENERAL.—Chapter V of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend-
ed by adding after section 505F the following: 
‘‘SEC. 505G. SAFETY AND EFFECTIVENESS OF DRUGS WITH 
RESPECT TO RACIAL AND ETHNIC BACK-
GROUND. 
‘‘(a) PREAPPROVAL STUDIES.—If there is evidence 
that there may be a disparity on the basis of racial or 
ethnic background or other demographic characteristics 
(such as age, sex, gender) as to the safety or effectiveness 
of a drug or biological product or if such product address-
es a disease that disproportionately impacts certain racial 
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or ethnic groups or other demographic characteristics 
(such as age, sex, gender), then— 
‘‘(1)(A) in the case of a drug, the investigations 
required under section 505(b)(1)(A) shall include 
adequate and well-controlled investigations of the 
disparity; or 
‘‘(B) in the case of a biological product, the evi-
dence required under section 351(a) of the Public 
Health Service Act for approval of a biologics license 
application for the biological product shall include 
adequate and well-controlled investigations of the 
disparity; and 
‘‘(2) if the investigations described in subpara-
graph (A) or (B) of paragraph (1) confirm that 
there is such a disparity, the labeling of the drug or 
biological product shall include appropriate informa-
tion about the disparity. 
‘‘(b) POSTMARKET STUDIES.— 
‘‘(1) IN GENERAL.—If there is evidence that 
there may be a disparity on the basis of racial or 
ethnic background or other demographic characteris-
tics (such as age, sex, gender) as to the safety or ef-
fectiveness of a drug for which there is an approved 
application under section 505 of this Act or of a bio-
logical product for which there is an approved li-
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(b) ENFORCEMENT.—Section 502 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend-
ed by adding at the end the following: 
‘‘(ee) If it is a drug and the holder of the approved 
application under section 505 or license under section 351 
of the Public Health Service Act for the drug has failed 
to complete the investigations or studies, or comply with 
any other requirement, of section 505G.’’. 
(c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 
required’’ the following: ‘‘, including postmarket studies 
required under section 505G’’. 
SEC. 1106. GAO AND NIH REPORTS. 
(b) 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-
tional Institutes of Health during the period be-
ginning on January 1, 2009, and ending De-
cember 31, 2019. 
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(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. 
(c) GAO REPORT.—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 
funding provided pursuant to Coronavirus Prepared-
ness and Response Supplemental Appropriations Act 
(Public Law 116–123), Families First Coronavirus 
Response Act (Public Law 116–127), Coronavirus 
Aid, Relief, and Economic Security Act (Public Law 
116–136), and Paycheck Protection Program and 
Health Care Enhancement Act (Public Law 116– 
139); 
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(2) the percentage of such organizations that 
were awarded such funding; and 
(3) the impact of such community-based organi-
zations’ efforts on reducing health disparities within 
racial and ethnic minority groups. 
(d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 
INSTITUTE ON MINORITY HEALTH AND HEALTH DIS-
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; 
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(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. 
SEC. 1107. HEALTH IMPACT ASSESSMENTS. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Health Impact Assessment is a tool to help 
planners, health officials, decision makers, 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. 
(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— 
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(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 decisionmaking 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: 
‘‘(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-
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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 
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-
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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; 
‘‘(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 
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‘‘(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 Ending Health Dispari-
ties during COVID-19 Act of 2020, the Secretary, 
acting through the Director, shall issue final guid-
ance for conducting the health impact assessments. 
In developing 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 
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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-
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. 
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‘‘(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-
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 
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‘‘(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 
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. 
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‘‘(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-
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; 
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‘‘(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-
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 
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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— 
‘‘(A) take appropriate health factors into 
consideration as early as practicable during the 
planning, review, or decisionmaking 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.— 
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‘‘(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-
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. 
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‘‘(VIII) Land use changes that 
promote 
local, 
sustainable 
food 
sources. 
‘‘(IX) Infectious disease, includ-
ing COVID–19. 
‘‘(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 
that leads to a public health emer-
gency, pandemic, or other infectious 
or biochemical agent; 
‘‘(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; 
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‘‘(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— 
‘‘(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 
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‘‘(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. 
‘‘(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 decision makers. 
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‘‘(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. 
‘‘(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. 
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‘‘(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 
‘‘(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 
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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 Ending Health Dispari-
ties During COVID–19 Act of 2020, the Secretary shall 
submit to Congress a report concerning the evaluation of 
the programs under this section, including recommenda-
tions as to how lessons learned from such programs can 
be incorporated into future guidance documents developed 
and provided by the Secretary and other Federal agencies, 
as appropriate. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary. 
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‘‘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; 
‘‘(10) ability to reduce the spread of infectious 
diseases (such as COVID–19); and 
‘‘(11) other factors, as the Secretary determines 
appropriate. 
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‘‘(b) REPRESENTATION.—In establishing the national 
working group under subsection (a): 
‘‘(1) The grantee shall ensure that the group 
has representatives of each of the following: 
‘‘(A) The Health Resources and Services 
Administration. 
‘‘(B) The Department of Health and 
Human Services Data Council. 
‘‘(C) The Office of Minority Health of the 
Department of Health and Human Services. 
‘‘(D) The Substance Abuse and Mental 
Health Services Administration. 
‘‘(E) The Bureau of Labor Statistics of 
the Department of Labor. 
‘‘(F) The National Institute on Minority 
Health and Health Disparities. 
‘‘(G) The Agency for Healthcare Research 
and Quality. 
‘‘(H) The Institute of Medicine Study 
Committee for the 2004 workforce diversity re-
port. 
‘‘(I) The Indian Health Service. 
‘‘(J) The Department of Education. 
‘‘(K) Minority-serving academic institu-
tions. 
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