interruption or loss of civil service status or 
privilege. 
(D) PROCUREMENT OF TEMPORARY AND 
INTERMITTENT SERVICES.—The Chairperson of 
the Commission may procure temporary and 
intermittent services under section 3109(b) of 
title 5, United States Code, at rates for individ-
uals which do not exceed the daily equivalent of 
the annual rate of basic pay prescribed for level 
V of the Executive Schedule under section 5316 
of such title. 
(g) TERMINATION.—Except with respect to activities 
in connection with the ongoing biennial report required 
under subsection (e)(2), the Commission shall terminate 
90 days after the date on which the Commission submits 
the report required under subsection (e)(3). 
(h) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
such sums as may be necessary for fiscal year 2007 and 
each subsequent fiscal year. 
SEC. 182. INSTITUTE OF MEDICINE EVALUATION AND RE-
PORT 
ON 
HEALTH 
CARE 
PERFORMANCE 
MEASURES. 
(a) EVALUATION.—
(1) IN GENERAL.—Not later than the date that 
is 2 months after the date of the enactment of this 
Act, the Secretary shall enter into an arrangement 
under which the Institute of Medicine of the Na-
tional Academy of Sciences (in this section referred 
to as the ‘‘Institute’’) shall conduct an evaluation of 
the Federal poverty line for purposes of access to 
health care services under any applicable Federal 
health care program. 
(2) POVERTY LINE DEFINED.—For purposes of 
paragraph (1), the term ‘‘poverty line’’ has the 
meaning given that term in section 673(2) of the 
Community Services Block Grant Act (42 U.S.C. 
9902(2)), including any revision required by such 
section. 
(b) REPORT.—Not later than the date that is 18 
months after the date of enactment of this Act, the Insti-
tute shall submit to the Secretary and appropriate com-
mittees of jurisdiction of the House of Representatives and 
Senate a report on the evaluation conducted under sub-
section (a)(1) describing the findings of such evaluation 
and recommendations for any adjustment of the Federal 
poverty line for appropriate access of individuals to such 
Federal health care programs.
(c) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary for purposes of conducting the evaluation and 
preparing the report required by this section. 
Subtitle H—FMAP Reimbursement 
for Native Hawaiians 
SEC. 191. 100 PERCENT FMAP FOR MEDICAL ASSISTANCE 
PROVIDED TO A NATIVE HAWAIIAN THROUGH 
A FEDERALLY-QUALIFIED HEALTH CENTER 
OR A NATIVE HAWAIIAN HEALTH CARE SYS-
TEM UNDER THE MEDICAID PROGRAM. 
(a) MEDICAID.—The third sentence of section 
1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 
is amended by inserting ‘‘, and with respect to medical 
assistance provided to a Native Hawaiian (as defined in 
section 12 of the Native Hawaiian Health Care Improve-
ment Act) through a federally-qualified health center or 
a Native Hawaiian health care system (as so defined) 
whether directly, by referral, or under contract or other 
arrangement between a federally-qualified health center or 
a Native Hawaiian health care system and another health 
care provider’’ before the period. 
(b) EFFECTIVE DATE.—The amendment made by 
this section applies to medical assistance provided on or 
after the date of enactment of this Act.
TITLE II—CULTURALLY AND LIN-
GUISTICALLY 
APPROPRIATE 
HEALTHCARE 
SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE XXIX—CULTURALLY AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTHCARE 
‘‘SEC. 2900. DEFINITIONS. 
‘‘In this title: 
‘‘(1) APPROPRIATE HEALTHCARE SERVICES.— 
The term ‘appropriate healthcare services’ includes 
services or treatments to address physical, mental, 
and behavioral disorders or syndromes. 
‘‘(2) 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. 
‘‘(3) LIMITED
ENGLISH
PROFICIENT.—The 
term ‘limited English proficient’ with respect to an 
individual means an individual who cannot speak, 
read, write, or understand the English language at 
a level that permits them to interact effectively with 
clinical or nonclinical staff at a healthcare organiza-
tion. 
‘‘(4) MINORITY.— 
‘‘(A) IN GENERAL.—The terms ‘minority’ 
and ‘minorities’ refer to individuals from a mi-
nority group. 
‘‘(B) POPULATIONS.—The term ‘minority’, 
with respect to populations, refers to racial and 
ethnic minority groups. 
‘‘(5) MINORITY
GROUP.—The term ‘minority 
group’ has the meaning given the term ‘racial and 
ethnic minority group’. 
‘‘(6) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘racial and ethnic minority group’ means 
American Indians and Alaska Natives, African 
Americans (including Caribbean Blacks and Afri-
cans), 
Asian 
Americans, 
Hispanics 
(including
Latinos), and Native Hawaiians and other Pacific 
Islanders. 
‘‘(7) STATE.—The term ‘State’ means each of 
the several states, the District of Columbia, the 
Commonwealth of Puerto Rico, the Indian tribes, 
the Virgin Islands, Guam, American Samoa, and the 
Commonwealth of the Northern Mariana Islands. 
‘‘SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVID-
UALS WITH LIMITED ENGLISH PROFICIENCY. 
‘‘(a) PURPOSE.—As provided in Executive Order 
13166, it is the purpose of this section— 
‘‘(1) to improve access to Federally conducted 
and Federally assisted programs and activities for 
individuals who are limited in their English pro-
ficiency; 
‘‘(2) to require each Federal agency to examine 
the services it provides and develop and implement 
a system by which limited English proficient individ-
uals can enjoy meaningful access to those services 
consistent with, and without substantially burdening, 
the fundamental mission of the agency; 
‘‘(3) to require each Federal agency to ensure 
that recipients of Federal financial assistance pro-
vide meaningful access to their limited English pro-
ficient applicants and beneficiaries;
‘‘(4) to ensure that recipients of Federal finan-
cial assistance take reasonable steps, consistent with 
the guidelines set forth in the Limited English Pro-
ficient Guidance of the Department of Justice (as 
issued on June 12, 2002), to ensure meaningful ac-
cess to their programs and activities by limited 
English proficient individuals; and 
‘‘(5) to ensure compliance with title VI of the 
Civil Rights Act of 1964 and that healthcare pro-
viders and organizations do not discriminate in the 
provision of services. 
‘‘(b) FEDERALLY CONDUCTED PROGRAMS AND AC-
TIVITIES.— 
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency that carries out health care-related activities 
shall prepare a plan to improve access to the feder-
ally conducted health care-related programs and ac-
tivities of the agency by limited English proficient 
individuals. 
‘‘(2) PLAN REQUIREMENT.—Each plan under 
paragraph (1) shall be consistent with the standards 
set forth in section 204 of the Healthcare Equality 
and Accountability Act, and shall include the steps 
the agency will take to ensure that limited English
proficient individuals have access to the agency’s 
health care-related programs and activities. Each 
agency shall send a copy of such plan to the Depart-
ment of Justice, which shall serve as the central re-
pository of the agencies’ plans. 
‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI-
TIES.— 
‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency providing health care-related Federal finan-
cial assistance shall ensure that the guidance for re-
cipients of Federal financial assistance developed by 
the agency to ensure compliance with title VI of the 
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 
is specifically tailored to the recipients of such as-
sistance and is consistent with the standards de-
scribed in section 204 of the Healthcare Equality 
and Accountability Act. Each agency shall send a 
copy of such guidance to the Department of Justice 
which shall serve as the central repository of the 
agencies’ plans. After approval by the Department of 
Justice, each agency shall publish its guidance docu-
ment in the Federal Register for public comment. 
‘‘(2) 
REQUIREMENTS.—The 
agency-specific 
guidance developed under paragraph (1) shall—
‘‘(A) detail how the general standards es-
tablished under section 204 of the Healthcare 
Equality and Accountability Act will be applied 
to the agency’s recipients; and 
‘‘(B) take into account the types of health 
care services provided by the recipients, the in-
dividuals served by the recipients, and other 
factors set out in such standards. 
‘‘(3) EXISTING GUIDANCES.—A Federal agency 
that has developed a guidance for purposes of title 
VI of the Civil Rights Act of 1964 that the Depart-
ment of Justice determines is consistent with the 
standards described in section 204 of the Healthcare 
Equality and Accountability Act shall examine such 
existing guidance, as well as the programs and ac-
tivities to which such guidance applies, to determine 
if modification of such guidance is necessary to com-
ply with this subsection. 
‘‘(4) CONSULTATION.—Each Federal agency 
shall consult with the Department of Justice in es-
tablishing the guidances under this subsection. 
‘‘(d) CONSULTATIONS.— 
‘‘(1) IN GENERAL.—In carrying out this sec-
tion, each Federal agency that carriers out health 
care-related activities shall ensure that stakeholders,
such as limited English proficient individuals and 
their representative organizations, recipients of Fed-
eral assistance, and other appropriate individuals or 
entities, have an adequate and comparable oppor-
tunity to provide input with respect to the actions of 
the agency. 
‘‘(2) EVALUATION.—Each Federal agency de-
scribed in paragraph (1) shall evaluate the— 
‘‘(A) particular needs of the limited 
English proficient individuals served by the 
agency, and by a recipient of assistance pro-
vided by the agency; 
‘‘(B) burdens of compliance with the agen-
cy guidance and its recipients of the require-
ments of this section; and 
‘‘(C) outcomes or effectiveness of services. 
‘‘SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTHCARE. 
‘‘Recipients of Federal financial assistance from the 
Secretary shall, to the extent reasonable and practicable 
after applying the 4-factor analysis described in title V 
of the Guidance to Federal Financial Assistance Recipi-
ents Regarding Title VI Prohibition Against National Ori-
gin Discrimination Affecting Limited-English Proficient 
Persons (June 12, 2002)— 
‘‘(1) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
provide culturally and linguistically appropriate 
healthcare to patient populations of the service area 
of the organization; 
‘‘(2) ensure that staff at all levels and across all 
disciplines of the organization receive ongoing edu-
cation and training in culturally and linguistically 
appropriate service delivery; 
‘‘(3) offer and provide language assistance serv-
ices, including bilingual staff and interpreter serv-
ices, at no cost to each patient with limited English 
proficiency at all points of contact, in a timely man-
ner during all hours of operation; 
‘‘(4) notify patients of their right to receive lan-
guage assistance services in their primary language; 
‘‘(5) ensure the competence of language assist-
ance provided to limited English proficient patients 
by interpreters and bilingual staff, and ensure that 
family, particularly minor children, and friends are 
not used to provide interpretation services— 
‘‘(A) except in case of emergency; or
‘‘(B) except on request of the patient, who 
has been informed in his or her preferred lan-
guage of the availability of free interpretation 
services; 
‘‘(6) make available easily understood patient- 
related materials, if such materials exist for non-lim-
ited English proficient patients, including informa-
tion or notices about termination of benefits and 
post signage in the languages of the commonly en-
countered groups or groups represented in the serv-
ice area of the organization; 
‘‘(7) develop and implement clear goals, poli-
cies, operational plans, and management account-
ability and oversight mechanisms to provide cul-
turally and linguistically appropriate services; 
‘‘(8) conduct initial and ongoing organizational 
assessments of culturally and linguistically appro-
priate services-related activities and integrate valid 
linguistic competence-related measures into the in-
ternal audits, performance improvement programs, 
patient satisfaction assessments, and outcomes-based 
evaluations of the organization; 
‘‘(9) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
mulgated under section 264(c) of the Health Insur-