I 
113TH CONGRESS 
2D SESSION 
H. R. 5507 
To provide for a study by the Institute of Medicine on health disparities, 
to direct the Secretary of Health and Human Services to develop guide-
lines on reducing health disparities, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 17, 2014 
Mr. PASCRELL introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To provide for a study by the Institute of Medicine on 
health disparities, to direct the Secretary of Health and 
Human Services to develop guidelines on reducing health 
disparities, and for other purposes. 
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 ‘‘Reducing Disparities 
Using Care Models and Education Act of 2014’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
(1) The infant death rate among African-Amer-
icans is more than double that of Whites. 
(2) The death rate for all cancers is 30 percent 
higher for African-Americans than for Whites; for 
prostate cancer, it is more than double that for 
Whites. 
(3) Black women have a higher death rate from 
breast cancer despite having a mammography 
screening rate that is nearly the same as the rate for 
White women. 
(4) Diabetes incidence is highest among Native 
Americans, at 15.9 percent, followed by 13.2 percent 
for African-Americans, 12.8 percent for Hispanics, 
9.0 percent for Asians, and 7.6 percent for Whites. 
(5) New cases of hepatitis and tuberculosis are 
higher in Asians and Pacific Islanders living in the 
United States than in Whites. 
(6) Individuals in same-sex couples were more 
likely than individuals in different-sex couples to re-
port a delay in getting necessary prescriptions. 
(7) Infants born to Black women are 1.5 to 3 
times more likely to die than those born to women 
of other races or ethnicities, and American Indian 
and Alaska Native infants die from sudden infant 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
death syndrome (SIDS) at nearly 2.5 times the rate 
of White infants. 
(8) Low-income children have higher rates of 
mortality (even with the same condition), have high-
er rates of disability, and are more likely to have 
multiple conditions. 
(9) White children are half as likely as Black 
and Latino children not to be in excellent or very 
good health. 
(10) As of 2012, 38.9 percent of United States 
adults were obese, with the highest rate among Afri-
can-Americans at 47.9 percent, followed by His-
panics at 42.5 percent, Whites at 32.6 percent, and 
Asians at 10.8 percent. 
(11) The risk of stroke is twice as high for Af-
rican-Americans as for Whites, and African-Ameri-
cans are more likely to die of stroke. Other ethnic 
minorities also have higher risk than Whites. Over-
all, strokes are most prevalent in the Southeast 
United States, and less so in the Northeast. 
(12) African-Americans accounted for 44 per-
cent of all those infected with HIV, despite being 
only 12 percent of the United States population. 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
(13) Black men who have sex with men (MSM) 
ages 13 to 24 had the most new infections among 
youth. 
(14) One study found that among heterosexuals 
living in the same urban community, those below the 
poverty line were twice as likely to contract human 
immunodeficiency virus (HIV). 
(15) Persons with less than a high school di-
ploma (6.7 percent) and high school graduates (4.0 
percent) were more likely to report major depression 
than those with at least some college education (2.5 
percent). 
(16) Only about 10 percent of physicians prac-
tice in rural America despite the fact that nearly 
one-fourth of the population lives in these areas. 
(17) Rural residents are less likely to have em-
ployer-provided health care coverage or prescription 
drug coverage, and the rural poor are less likely to 
be covered by Medicaid benefits than their urban 
counterparts. 
(18) Twenty percent of nonmetropolitan coun-
ties lack mental health services versus 5 percent of 
metropolitan counties. 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
(19) Fifteen percent of persons with disabilities 
report not seeing a doctor due to cost in comparison 
to 6 percent of the general population. 
SEC. 3. INSTITUTE OF MEDICINE STUDY. 
(a) IN GENERAL.—Not later than 60 days after the 
date of the enactment of this Act, the Secretary shall enter 
into an arrangement with the Institute of Medicine under 
which the Institute agrees to study— 
(1) the extent of health disparities in the type 
and quality of preventive interventions, health serv-
ices, and outcomes in the United States; 
(2) the factors that may contribute to inequities 
in such disparities; 
(3) existing programs and policies intended to 
reduce such disparities; 
(4) best practices and successful strategies in 
programs that aim to reduce such disparities; 
(5) priorities for successful intervention pro-
grams targeting such disparities; and 
(6) potential opportunities for expanding or 
replicating such programs. 
(b) REPORT.—The arrangement under subsection (a) 
shall provide for submission by the Institute of Medicine 
to the Secretary and Congress, not later than 20 months 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
after the date of enactment of this Act, of a report on 
the results of the study. 
SEC. 4. GUIDELINES FOR DEVELOPMENT AND IMPLEMEN-
TATION OF HEALTH DISPARITIES REDUC-
TION PROGRAMS AND ACTIVITIES. 
(a) GUIDELINES.—Not later than 90 days after the 
submission of the report described in section 3(b), and 
taking such report into consideration, the Secretary shall 
develop guidelines for entities to develop and implement 
programs and activities to reduce health disparities. 
(b) USE BY HHS.—The Secretary shall, where ap-
propriate, incorporate the use of the guidelines developed 
under subsection (a) into the programs and activities of 
the Department of Health and Human Services. 
(c) GRANTS FOR DISPARITIES REDUCTION ACTIVI-
TIES.— 
(1) IN GENERAL.—The Secretary may award 
grants to entities for the development and implemen-
tation of programs and activities to reduce health 
disparities in accordance with the guidelines de-
scribed in subparagraph (a). 
(2) APPLICATIONS.—To seek a grant under this 
subsection, an entity shall submit an application to 
the Secretary at such time, in such manner, and 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
containing such information as the Secretary may 
require. 
(3) MINIMUM CONTENTS.—The Secretary shall 
require that an application for a grant under this 
subsection contains at a minimum— 
(A) a description of the population and 
public health concern the program will target 
and an outreach plan to ensure that the most 
in need populations will benefit; 
(B) a description of the strategies the enti-
ty will use— 
(i) to develop and implement its pro-
grams and activities in accordance with the 
guidelines developed under subsection (a); 
and 
(ii) to make the interventions sustain-
able; and 
(C) an agreement by the entities to peri-
odically provide data with respect to— 
(i) the population served; 
(ii) improvements in reducing health 
disparities; and 
(iii) effectiveness of the interventions 
used. 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
(d) APPROPRIATIONS.—To carry out this section, 
there are authorized to be appropriated $5,000,000 for fis-
cal year 2016 and such sums as may be necessary for each 
of fiscal years 2017 through 2020. 
SEC. 5. TESTING ALTERNATIVE PAYMENT AND DELIVERY 
MODELS TO REDUCE HEALTH DISPARITIES. 
(a) IN GENERAL.—The Secretary acting through the 
Centers for Medicare and Medicaid Innovation under sec-
tion 1115A of the Social Security Act (42 U.S.C. 1315a) 
shall provide for the testing of a payment and service de-
livery model that includes incentives for reducing health 
disparities consistent with the cost and quality criteria 
otherwise applicable to the testing of models under such 
section. 
(b) DOCUMENTATION REQUIREMENT
FOR MODEL 
TESTING.—In carrying out subsection (a), the Secretary 
shall require that an application to conduct such testing 
of such a model include at least— 
(1) documentation of at least one health dis-
parity targeted for reduction; 
(2) a root-cause analysis of the health disparity 
targeted for reduction; 
(3) identification and selection of performance 
targets for such reduction; 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS
(4) a proposal to make payments in some way 
contingent on a reduction in health disparities; and 
(5) a reliable method for monitoring progress in 
achieving such a reduction. 
SEC. 6. DEFINITIONS. 
In this Act: 
(1) The term ‘‘health disparity’’ means signifi-
cant disparity in the overall rate of disease inci-
dence, prevalence, morbidity, mortality, or survival 
rates in a population as compared to the health sta-
tus of the general population. 
(2) The term ‘‘intervention’’ means an activity 
taken by an entity on behalf of individuals or popu-
lations to reduce health disparities. 
(3) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
Æ 
VerDate Sep 11 2014 
04:11 Sep 23, 2014
Jkt 039200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6301
E:\BILLS\H5507.IH
H5507
SSpencer on DSK4SPTVN1PROD with BILLS