I 
111TH CONGRESS 
1ST SESSION H. R. 3090 
To improve the health of minority individuals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 26, 2009 
Mrs. CHRISTENSEN (for herself, Mr. DAVIS of Illinois, Ms. BORDALLO, Ms. 
ROYBAL-ALLARD, Mr. CLYBURN, Mr. RANGEL, Ms. LEE of California, 
Mr. HONDA, Mr. CUMMINGS, Ms. JACKSON-LEE of Texas, Ms. CLARKE, 
Mr. WATT, Mr. CLAY, Mr. THOMPSON of Mississippi, Mr. MEEK of Flor-
ida, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. AL GREEN of Texas, 
Mr. JOHNSON of Georgia, Mr. CLEAVER, Mr. ELLISON, Ms. WATSON, 
Mr. JACKSON of Illinois, Mr. CARSON of Indiana, Mr. TOWNS, Ms. 
FUDGE, Ms. KILPATRICK of Michigan, Ms. RICHARDSON, Ms. BALDWIN, 
Mr. FATTAH, Mr. BISHOP of Georgia, Mr. SCOTT of Georgia, Mr. PAYNE, 
Mr. MEEKS of New York, Mr. GRIJALVA, Mr. SCOTT of Virginia, Mr. 
DAVIS of Alabama, Mr. GRAYSON, Ms. EDWARDS of Maryland, Ms. 
MOORE of Wisconsin, Ms. CORRINE BROWN of Florida, Ms. WATERS, Ms. 
HIRONO, Ms. DEGETTE, Mr. FALEOMAVAEGA, Ms. MATSUI, Mr. LEWIS 
of Georgia, Mr. GONZALEZ, Mr. SABLAN, Mr. PIERLUISI, Mr. REYES, 
Mr. ORTIZ, Ms. VELA´ZQUEZ, Mr. LUJA´N, Mr. HASTINGS of Florida, and 
Mr. CUELLAR) introduced the following bill; which was referred to the 
Committee on Energy and Commerce, and in addition to the Committees 
on Ways and Means, Education and Labor, the Judiciary, Natural Re-
sources, Armed Services, Veterans’ Affairs, and Agriculture, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To improve the health of minority individuals, and for other 
purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Accountability Act of 2009’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—CULTURALLY AND LINGUISTICALLY APPROPRIATE 
HEALTH CARE 
Sec. 101. Amendment to the Public Health Service Act. 
Sec. 102. Federal reimbursement for culturally and linguistically appropriate 
services under the Medicare, Medicaid and the State Children’s 
Health Insurance Program. 
Sec. 103. Increasing understanding of and improving health literacy. 
Sec. 104. Assurances for receiving Federal funds. 
Sec. 105. Report on Federal efforts to provide culturally and linguistically ap-
propriate health care services. 
Sec. 106. English for speakers of other languages. 
Sec. 107. Definition. 
Sec. 108. Treatment of the Medicare part B program under title VI of the Civil 
Rights Act of 1964. 
Sec. 109. Implementation. 
TITLE II—HEALTH WORKFORCE DIVERSITY 
Sec. 201. Amendment to the Public Health Service Act. 
Sec. 202. Health Careers Opportunity Program. 
Sec. 203. Program of excellence in health professions education for underrep-
resented minorities. 
Sec. 204. Hispanic-Serving Health Professions Schools. 
Sec. 205. Health professions student loan fund; authorizations of appropria-
tions regarding students from disadvantaged backgrounds. 
Sec. 206. National Health Service Corps; recruitment and fellowships for indi-
viduals from disadvantaged backgrounds. 
Sec. 207. Loan repayment program of Centers for Disease Control and Preven-
tion. 
Sec. 208. Cooperative agreements for online degree programs at schools of pub-
lic health and schools of allied health. 
Sec. 209. Mid-care health professions scholarship program. 
Sec. 210. National report on the preparedness of health professionals to care 
for diverse populations. 
Sec. 211. Scholarship and fellowship programs. 
Sec. 212. Advisory Committee on Health Professions Training for Diversity. 
Sec. 213. McNair Postbaccalaureate Achievement Program. 
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TITLE III—DATA COLLECTION AND REPORTING 
Sec. 301. Amendment to the Public Health Service Act. 
Sec. 302. Collection of race and ethnicity data by the Social Security Adminis-
tration. 
Sec. 303. Revision of HIPAA claims standards. 
Sec. 304. National Center for Health Statistics. 
Sec. 305. Geo-access study. 
Sec. 306. Racial, ethnic, and linguistic data collected by the Federal Govern-
ment. 
Sec. 307. Health information technology grants. 
Sec. 308. Study of health information technology in medically underserved com-
munities. 
Sec. 309. Health information technology in medically underserved communities. 
Sec. 310. Data collection and analysis grants to minority-serving institutions. 
Sec. 311. Health information technology grants for rural health care providers. 
Sec. 312. Survey questions on sexual orientation and gender identity. 
Sec. 313. Disaggregation of comparative effectiveness research data. 
TITLE IV—ACCOUNTABILITY AND EVALUATION 
Subtitle A—General Provisions 
Sec. 401. Federal agency plan to eliminate disparities and improve the health 
of minority populations. 
Sec. 402. Prohibition on discrimination in Federal assisted health care services 
and research programs on the basis of sex, race, color, national 
origin, sexual orientation, gender identity, or disability status. 
Sec. 403. Accountability within the Department of Health and Human Services. 
Sec. 404. Office of Minority Health. 
Sec. 405. Establishment of the Indian Health Service as an agency of the Pub-
lic Health Service. 
Sec. 406. Establishment of individual offices of minority health within agencies 
of the Public Health Service. 
Sec. 407. Office of Minority Health at the Centers for Medicare & Medicaid 
Services. 
Sec. 408. Office of Minority Affairs at the Food and Drug Administration. 
Sec. 409. Safety and effectiveness of drugs with respect to racial and ethnic 
background. 
Sec. 410. United States Commission on Civil Rights. 
Sec. 411. Sense of Congress concerning full funding of activities to eliminate 
racial and ethnic health disparities. 
Sec. 412. Guidelines for disease screening for minority patients. 
Sec. 413. National Institute for Minority Health and Health Disparities. 
Sec. 414. IOM report on LGBT health disparities. 
Subtitle B—Improving Environmental Justice 
Sec. 421. Codification of Executive Order 12898. 
Sec. 422. Implementation of recommendations by Environmental Protection 
Agency. 
Sec. 423. Grant program. 
Sec. 424. Additional research on the relationship between the built environment 
and the health of community residents. 
TITLE V—IMPROVEMENT OF HEALTH CARE SERVICES 
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Subtitle A—Health Empowerment Zones 
Sec. 501. Short title. 
Sec. 502. Findings. 
Sec. 503. Designation of health empowerment zones. 
Sec. 504. Assistance to those seeking designation. 
Sec. 505. Benefits of designation. 
Sec. 506. Definition. 
Sec. 507. Authorization of appropriations. 
Subtitle B—Other Improvements of Health Care Services 
CHAPTER 1—IN GENERAL 
Sec. 511. Amendment to the Public Health Service Act. 
Sec. 512. Medicaid payment for certain aliens. 
Sec. 513. Medicaid payment parity for the territories. 
Sec. 514. Extension of Medicare secondary payer. 
Sec. 515. Border health grants. 
Sec. 516. Cancer prevention and treatment demonstration for ethnic and racial 
minorities. 
Sec. 517. Grants to promote positive health behaviors in women and children. 
Sec. 518. Exception for citizens of freely associated States. 
Sec. 519. Medicare graduate medical education. 
Sec. 520. HIV/AIDS reduction in racial and ethnic minority communities. 
Sec. 521. Grants for racial and ethnic approaches to community health. 
Sec. 522. Critical access hospital improvements. 
Sec. 523. Coverage of marriage and family therapist services and mental health 
counselor services under part B of the Medicare program. 
Sec. 524. Establishment of rural community hospital (RCH) program. 
Sec. 525. Medicare remote monitoring pilot projects. 
Sec. 526. Rural health quality advisory commission and demonstration projects. 
Sec. 527. Rural health care services. 
Sec. 528. Community health center collaborative access expansion. 
Sec. 529. Facilitating the provision of telehealth services across State lines. 
Sec. 530. Removing barriers to health care and nutrition assistance health cov-
erage for children, pregnant women, and lawfully residing indi-
viduals. 
Sec. 531. Removing Medicare barrier to health care. 
CHAPTER 2—LUNG CANCER MORTALITY REDUCTION 
Sec. 541. Short title. 
Sec. 542. Findings. 
Sec. 543. Sense of Congress concerning investment in lung cancer research. 
Sec. 544. Lung Cancer Mortality Reduction Program. 
Sec. 545. Department of defense and the department of veterans affairs. 
Sec. 546. Lung cancer advisory board. 
Sec. 547. Authorization of appropriations. 
TITLE VI—ELIMINATING DISPARITIES IN DIABETES PREVENTION 
ACCESS AND CARE ACT 
Subtitle A—NATIONAL INSTITUTES OF HEALTH 
Sec. 611. Research, treatment, and education. 
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Subtitle B—CENTERS FOR DISEASE CONTROL AND PREVENTION 
Sec. 621. Research, education, and other activities. 
Subtitle C—HEALTH RESOURCES AND SERVICES ADMINISTRATION 
Sec. 631. Research, education, and other activities. 
Subtitle D—ADDITIONAL PROGRAMS 
Sec. 641. Research, education, and other activities. 
TITLE I—CULTURALLY AND LIN-
GUISTICALLY 
APPROPRIATE 
HEALTH CARE 
SEC. 101. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) FINDINGS.—Congress finds the following: 
(1) Effective communication is essential to 
meaningful access to quality physical and mental 
health care. 
(2) Research establishes that the lack of lan-
guage services creates barriers to and diminishes the 
quality of health care and health status for limited 
English proficient individuals. 
(3) The number of limited English speaking 
residents in the United States who speak English 
less than very well and, therefore, cannot effectively 
communicate with health and social service providers 
continues to increase significantly. 
(4) The responsibility to fund language services 
in the provision of health care and health care-re-
lated services to limited English proficient individ-
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uals is a societal one that cannot fairly be visited 
solely upon the health care, public health or social 
services community. 
(5) Linguistic diversity in the health care and 
health care-related services workforce is important 
for providing all patients the environment most con-
ducive to positive health outcomes. 
(6) All members of the health care and health 
care-related services community should continue to 
educate their staff and constituents about limited 
English proficient issues and help them identify re-
sources to improve access to quality care for limited 
English proficient individuals. 
(7) Access to English as a Second Language in-
struction is an important mechanism for ensuring 
effective communication and eliminating the lan-
guage barriers that impede access to health care. 
(8) Competent languages services in health care 
settings should be available as a matter of course. 
(b) AMENDMENT.—The Public Health Service Act 
(42 U.S.C. 201 et seq.) is amended by adding at the end 
the following: 
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‘‘TITLE XXXI—CULTURALLY AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTH CARE 
‘‘SEC. 3100. DEFINITIONS. 
‘‘In this title: 
‘‘(1) BILINGUAL.—The term ‘bilingual’ with re-
spect to an individual means a person who has suffi-
cient degree of proficiency in two languages. 
‘‘(2) COMPETENT
INTERPRETER
SERVICES.— 
The term ‘competent interpreter services’ means a 
trans-language rendition of a spoken message in 
which the interpreter comprehends the source lan-
guage and can speak comprehensively in the target 
language to convey the meaning intended in the 
source language. The interpreter knows health and 
health-related terminology and provides accurate in-
terpretations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source message. 
‘‘(3) COMPETENT
TRANSLATION
SERVICES.— 
The term ‘competent translation services’ means a 
trans-language rendition of a written document in 
which the translator comprehends the source lan-
guage and can write comprehensively in the target 
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language to convey the meaning intended in the 
source language. The translator knows health and 
health-related terminology and provides accurate 
translations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source document. 
‘‘(4) EFFECTIVE COMMUNICATION.—The term 
‘effective communication’ means an exchange of in-
formation between the provider of health care or 
health care-related services and the limited English 
proficient recipient of such services that enables lim-
ited English proficient individuals to access, under-
stand, and benefit from health care or health care- 
related services. 
‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 
term ‘grievance resolution process’ means all aspects 
of dispute resolution including filing complaints, 
grievance and appeal procedures and court action. 
‘‘(6) HEALTH CARE GROUP.—The term ‘health 
care group’ means a group of physicians organized, 
at least in part, for the purposes of providing physi-
cians’ services under the Medicaid, SCHIP, or Medi-
care programs and may include a hospital and any 
other individual or entity furnishing services covered 
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under the Medicaid, SCHIP or Medicare programs 
that is affiliated with the health care group. 
‘‘(7) HEALTH
CARE
SERVICES.—The term 
‘health care services’ means services that address 
physical as well as mental health conditions in all 
care settings. 
‘‘(8) HEALTH CARE-RELATED SERVICES.—The 
term ‘health care-related services’ means human or 
social services programs or activities that provide ac-
cess, referrals or links to health care. 
‘‘(9) INDIAN TRIBE.—The term ‘Indian tribe’ 
means any Indian tribe, band, nation, or other orga-
nized group or community, including any Alaska Na-
tive village or group or regional or village corpora-
tion as defined in or established pursuant to the 
Alaska Native Claims Settlement Act (85 Stat. 688) 
(43 U.S.C. 1601 et seq.), which is recognized as eli-
gible for the special programs and services provided 
by the United States to Indians because of their sta-
tus as Indians. 
‘‘(10) INTEGRATED
HEALTH
CARE
DELIVERY 
SYSTEM.—The term ‘integrated health care delivery 
system’ means a system comprised of more than one 
type of health care provider for the purposes of pro-
viding a. The providers may include hospitals, clin-
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ics, home health agencies, ambulatory surgery cen-
ters, skilled nursing facilities, rehabilitation facilities 
and clinics, and employed, independent or contracted 
physicians. 
‘‘(11) 
INTERPRETING/INTERPRETATION.—The 
terms ‘interpreting’ and ‘interpretation’ mean the 
transmission of a spoken message from one language 
into another, faithfully, accurately, and objectively. 
‘‘(12) LANGUAGE ACCESS.—The term ‘language 
access’ means the provision of language services to 
an LEP individual designed to enhance that individ-
ual’s access to, understanding of or benefit from 
health care or health care-related services. 
‘‘(13) LANGUAGE
SERVICES.—The term ‘lan-
guage services’ means provision of healthcare serv-
ices directly in a non-English language, interpreta-
tion, translation and non-English signage. 
‘‘(14) LEP.—The term ‘LEP’ means limited 
English proficient. 
‘‘(15) LEP RELATED
DATA
COLLECTION
AC-
TIVITIES.—The term ‘LEP related data collection 
activities’ includes identifying, collecting, storing, 
tracking, and analyzing primary language data, and 
information on the methods used to meet the lan-
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