125 
gender and health disparities and to pursue a career in 
the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall— 
‘‘(1) have experience in health research or pub-
lic health practice; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) have expressed an interest in the health 
professions; 
‘‘(4) demonstrate promise for becoming a leader 
in the field of women’s health; 
‘‘(5) secure admission to a health professions 
school or graduate program with an emphasis in 
gender studies; 
‘‘(6) comply with subsection (f); and 
‘‘(7) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become researchers and advance 
the research base on the intersection between gender and 
health. 
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‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
trol and Prevention shall give priority to those applicants 
that— 
‘‘(1) are from disadvantaged backgrounds; and 
‘‘(2) have identified a mentor and academic ad-
visor who will assist in the completion of their grad-
uate or professional degree and have secured a re-
search assistant position with a researcher working 
in the area of gender and health. 
‘‘(e) FELLOWSHIPS.—The Director of the Centers for 
Disease Control and Prevention may approve fellowships 
for individuals under this section for any period of edu-
cation in the student’s graduate or health profession ten-
ure, except that such a fellowship may not be provided 
to an individual for more than 3 years, and such a fellow-
ship may not exceed $18,000 per academic year (notwith-
standing any other provision of law regarding the amount 
of fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2010 through 2015. 
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‘‘SEC. 3120E. PAUL DAVID WELLSTONE INTERNATIONAL 
HEALTH FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
the Director of the Office of Minority Health, shall award 
research fellowships to college students or recent grad-
uates to advance their understanding of international 
health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall— 
‘‘(1) have educational experience in the field of 
international health; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) demonstrate promise for becoming a leader 
in the field of international health; 
‘‘(4) be a college senior or recent graduate of 
a four year higher education institution; 
‘‘(5) comply with subsection (f); and 
‘‘(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become health professionals and 
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to advance their knowledge about international issues re-
lating to healthcare access and quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those appli-
cants that— 
‘‘(1) are from a disadvantaged background; and 
‘‘(2) have identified a mentor at a health pro-
fessions school or institution, an academic advisor to 
assist in the completion of their graduate or profes-
sional degree, and an advisor from an international 
health Non-Governmental Organization, Private Vol-
unteer Organization, or other international institu-
tion or program that focuses on increasing 
healthcare access and quality for residents in devel-
oping countries. 
‘‘(e) FELLOWSHIPS.—The Secretary shall approve 
fellowships for college seniors or recent graduates, except 
that such a fellowship may not be provided to an indi-
vidual for more than 6 months, may not be awarded to 
a graduate that has not been enrolled in school for more 
than 1 year, and may not exceed $4,000 per academic year 
(notwithstanding any other provision of law regarding the 
amount of fellowship). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
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such sums as may be necessary for each of fiscal years 
2010 through 2015. 
‘‘SEC. 3120F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR 
PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, the Director of the Cen-
ters for Medicaid and Medicare, and the Administrator for 
Health Resources and Services Administration, in collabo-
ration with the Director of the Office of Minority Health, 
shall award grants to eligible entities to expose entering 
graduate students to the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall— 
‘‘(1) be a clinical, public health or health serv-
ices organization, community-based or non-profit en-
tity, or other entity determined appropriate by the 
Director of the Agency for Healthcare Research and 
Quality; 
‘‘(2) serve in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) work with students obtaining a degree in 
the health professions; and 
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
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‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
port opportunities that expose students to non-research 
based health professions, including— 
‘‘(1) public health policy; 
‘‘(2) healthcare and pharmaceutical policy; 
‘‘(3) healthcare administration and manage-
ment; 
‘‘(4) health economics; and 
‘‘(5) other professions determined appropriate 
by the Director of the Agency for Healthcare Re-
search and Quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Agency for Healthcare Re-
search and Quality shall give priority to those entities 
that— 
‘‘(1) have experience with health disparity elimi-
nation programs; 
‘‘(2) facilitate training in the fields described in 
subsection (c); and 
‘‘(3) provide counseling or other services de-
signed to assist such individuals in successfully com-
pleting their education at the post-secondary level. 
‘‘(e) STIPENDS.—The Secretary may approve the 
payment of stipends for individuals under this section for 
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any period of education in student-enhancement programs 
(other than regular courses) at health professions schools 
or entities, except that such a stipend may not be provided 
to an individual for more than 2 months, and such a sti-
pend may not exceed $100 per day (notwithstanding any 
other provision of law regarding the amount of stipends). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2010 through 2015.’’. 
SEC. 212. ADVISORY COMMITTEE ON HEALTH PROFES-
SIONS TRAINING FOR DIVERSITY. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall establish an advisory committee to be known 
as the Advisory Committee on Health Professions Train-
ing for Diversity (in this section referred to as the ‘‘Advi-
sory Committee’’). 
(b) COMPOSITION.— 
(1) IN GENERAL.—The Secretary shall deter-
mine the appropriate number of individuals to serve 
on the Advisory Committee. Such individuals shall 
not be officers or employees of the Federal Govern-
ment. 
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(2) APPOINTMENT.—Not later than 60 days 
after the date of enactment of this section, the Sec-
retary shall appoint the members of the Advisory 
Committee from among individuals who are health 
professionals. In making such appointments, the 
Secretary shall ensure a fair balance between the 
health professions, that at least 75 percent of the 
members of the Advisory Committee are health pro-
fessionals, a broad geographic representation of 
members and a balance between urban and rural 
members. Members shall be appointed based on their 
competence, interest, and knowledge of the mission 
of the profession involved. 
(3) MINORITY REPRESENTATION.—In appoint-
ing the members of the Advisory Committee under 
paragraph (2), the Secretary shall ensure the ade-
quate representation of women and minorities. 
(c) TERMS.— 
(1) IN GENERAL.—A member of the Advisory 
Committee shall be appointed for a term of 3 years, 
except that of the members first appointed— 
(A) 1⁄3 of such members shall serve for a 
term of 1 year; 
(B) 1⁄3 of such members shall serve for a 
term of 2 years; and 
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(C) 1⁄3 of such members shall serve for a 
term of 3 years. 
(2) VACANCIES.— 
(A) IN GENERAL.—A vacancy on the Advi-
sory Committee shall be filled in the manner in 
which the original appointment was made and 
shall be subject to any conditions which applied 
with respect to the original appointment. 
(B) FILLING UNEXPIRED TERM.—An indi-
vidual chosen to fill a vacancy shall be ap-
pointed for the unexpired term of the member 
replaced. 
(d) DUTIES.— 
(1) IN
GENERAL.—The Advisory Committee 
shall— 
(A) provide advice and recommendations to 
the Secretary concerning policy and program 
development and other matters of significance 
concerning activities under this part; and 
(B) not later than 2 years after the date 
of enactment of this section, and annually 
thereafter, prepare and submit to the Secretary, 
and the Committee on Health, Education, 
Labor and Pensions of the Senate, and the 
Committee on Energy and Commerce of the 
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House of Representatives, a report describing 
the activities of the Committee. 
(2) CONSULTATION WITH STUDENTS.—In car-
rying out duties under paragraph (1), the Advisory 
Committee shall consult with individuals who are at-
tending health professions schools with which this 
part is concerned. 
(e) MEETINGS AND DOCUMENTS.— 
(1) MEETINGS.—The Advisory Committee shall 
meet not less than 2 times each year. Such meetings 
shall be held jointly with other related entities estab-
lished under this title where appropriate. 
(2) DOCUMENTS.—Not later than 14 days prior 
to the convening of a meeting under paragraph (1), 
the Advisory Committee shall prepare and make 
available an agenda of the matters to be considered 
by the Advisory Committee at such meeting. At any 
such meeting, the Advisory Committee shall dis-
tribute materials with respect to the issues to be ad-
dressed at the meeting. Not later than 30 days after 
the adjourning of such a meeting, the Advisory Com-
mittee shall prepare and make available a summary 
of the meeting and any actions taken by the Com-
mittee based upon the meeting. 
(f) COMPENSATION AND EXPENSES.— 
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(1) COMPENSATION.—Each member of the Ad-
visory Committee shall be compensated at a rate 
equal to the daily equivalent of the annual rate of 
basic pay prescribed for level IV of the Executive 
Schedule under section 5315 of title 5, United 
States Code, for each day (including travel time) 
during which such member is engaged in the per-
formance of the duties of the Committee. 
(2) EXPENSES.—The members of the Advisory 
Committee shall be allowed travel expenses, includ-
ing per diem in lieu of subsistence, at rates author-
ized for employees of agencies under subchapter I of 
chapter 57 of title 5, United States Code, while 
away from their homes or regular places of business 
in the performance of services for the Committee. 
(g) FACA.—The Federal Advisory Committee Act 
shall apply to the Advisory Committee under this section 
only to the extent that the provisions of such Act do not 
conflict with the requirements of this section. 
SEC. 213. MCNAIR POSTBACCALAUREATE ACHIEVEMENT 
PROGRAM. 
Section 402E of the Higher Education Act of 1965 
(20 U.S.C. 1070a–15) is amended by striking subsection 
(g) and inserting the following: 
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‘‘(g) COLLABORATION IN HEALTH PROFESSION DI-
VERSITY TRAINING PROGRAMS.—The Secretary of Edu-
cation shall coordinate with the Secretary of Health and 
Human Services to ensure that there is collaboration be-
tween the goals of the program under this section and pro-
grams of the Health Resources and Services Administra-
tion that promote health workforce diversity. The Sec-
retary of Education shall take such measures as may be 
necessary to encourage participants in programs under 
this section to consider health profession careers. 
‘‘(h) FUNDING.—From amounts appropriated pursu-
ant to the authority of section 402A(g), the Secretary 
shall, to the extent practicable, allocate funds for projects 
authorized by this section in an amount which is not less 
than $31,000,000 for each of the fiscal years 2010 
through 2016.’’. 
TITLE III—DATA COLLECTION 
AND REPORTING 
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
(a) PURPOSE.—It is the purpose of this section to 
promote data collection, analysis, and reporting by race, 
ethnicity, and primary language among federally sup-
ported health programs. 
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(b) AMENDMENT.—Title XXXI of the Public Health 
Service Act, as amended by title II of this Act, is further 
amended by adding at the end the following: 
‘‘Subtitle 
B—Strengthening 
Data 
Collection, 
Improving 
Data 
Analysis, and Expanding Data 
Reporting 
‘‘SEC. 3131. DATA ON RACE, ETHNICITY, AND PRIMARY LAN-
GUAGE. 
‘‘(a) REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—Each health-related pro-
gram operated by or that receives funding or reim-
bursement, in whole or in part, either directly or in-
directly from the Department of Health and Human 
Services shall— 
‘‘(A) require the collection, by the agency 
or program involved, of data on the race, eth-
nicity, primary language, and sexual orientation 
of each applicant for and recipient of health-re-
lated assistance under such program— 
‘‘(i) using, at a minimum, the cat-
egories for race and ethnicity described in 
the 1997 Office of Management and Budg-
et Standards for Maintaining, Collecting, 
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and Presenting Federal Data on Race and 
Ethnicity; 
‘‘(ii) using the standards developed 
under subsection (e) for the collection of 
language data; 
‘‘(iii) collecting data for additional 
population groups if such groups can be 
aggregated into the minimum race and 
ethnicity categories; and 
‘‘(iv) where practicable, through self- 
report; 
‘‘(B) with respect to the collection of the 
data described in subparagraph (A) for appli-
cants and recipients who are minors or other-
wise legally incapacitated, require that— 
‘‘(i) such data be collected from the 
parent or legal guardian of such an appli-
cant or recipient; and 
‘‘(ii) the preferred language of the 
parent or legal guardian of such an appli-
cant or recipient be collected; 
‘‘(C) systematically analyze such data 
using the smallest appropriate units of analysis 
feasible to detect racial and ethnic disparities as 
well as disparities along lines of sexual orienta-
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tion in health and health care and when appro-
priate, for men and women separately, and re-
port the results of such analysis to the Sec-
retary, the Director of the Office for Civil 
Rights, the Committee on Health, Education, 
Labor, and Pensions and the Committee on Fi-
nance of the Senate, and the Committee on En-
ergy and Commerce and the Committee on 
Ways and Means of the House of Representa-
tives; 
‘‘(D) provide such data to the Secretary on 
at least an annual basis; and 
‘‘(E) ensure that the provision of assist-
ance to an applicant or recipient of assistance 
is not denied or otherwise adversely affected be-
cause of the failure of the applicant or recipient 
to provide race, ethnicity, primary language, 
gender, and sexual orientation data. 
‘‘(2) RULES
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed to— 
‘‘(A) permit the use of information col-
lected under this subsection in a manner that 
would adversely affect any individual providing 
any such information; and 
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‘‘(B) require health care providers to col-
lect data. 
‘‘(b) PROTECTION OF DATA.—The Secretary shall 
ensure (through the promulgation of regulations or other-
wise) that all data collected pursuant to subsection (a) is 
protected— 
‘‘(1) under the same privacy protections as the 
Secretary applies to other health data under the reg-
ulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
of 1996 (Public Law 104–191; 110 Stat. 2033) re-
lating to the privacy of individually identifiable 
health information and other protections; and 
‘‘(2) from all inappropriate internal use by any 
entity that collects, stores, or receives the data, in-
cluding use of such data in determinations of eligi-
bility (or continued eligibility) in health plans, and 
from other inappropriate uses, as defined by the 
Secretary. 
‘‘(c) NATIONAL PLAN OF THE DATA COUNCIL.—The 
Secretary shall develop and implement a national plan to 
ensure the collection of data in a culturally appropriate 
and competent manner, and to improve the collection, 
analysis, and reporting of racial, ethnic, and primary lan-
guage data at the Federal, State, territorial, Tribal, and 
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local levels, including data to be collected under subsection 
(a). The Data Council of the Department of Health and 
Human Services, in consultation with the National Com-
mittee on Vital Health Statistics, the Office of Minority 
Health, and other appropriate public and private entities, 
shall make recommendations to the Secretary concerning 
the development, implementation, and revision of the na-
tional plan. Such plan shall include recommendations on 
how to— 
‘‘(1) implement subsection (a) while minimizing 
the cost and administrative burdens of data collec-
tion and reporting; 
‘‘(2) expand awareness among Federal agencies, 
States, territories, Indian tribes, health providers, 
health plans, health insurance issuers, and the gen-
eral public that data collection, analysis, and report-
ing by race, ethnicity, and primary language is legal 
and necessary to assure equity and non-discrimina-
tion in the quality of health care services; 
‘‘(3) ensure that future patient record systems 
have data code sets for racial, ethnic, primary lan-
guage, and sexual orientation identifiers and that 
such identifiers can be retrieved from clinical 
records, including records transmitted electronically; 
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‘‘(4) improve health and health care data collec-
tion and analysis for more population groups if such 
groups can be aggregated into the minimum race 
and ethnicity categories, including exploring the fea-
sibility of enhancing collection efforts in States for 
racial and ethnic groups that comprise a significant 
proportion of the population of the State; 
‘‘(5) provide researchers with greater access to 
racial, ethnic, and primary language data, subject to 
privacy and confidentiality regulations; and 
‘‘(6) safeguard and prevent the misuse of data 
collected under subsection (a). 
‘‘(d) COMPLIANCE WITH STANDARDS.—Data col-
lected under subsection (a) shall be obtained, maintained, 
and presented (including for reporting purposes) in ac-
cordance with the 1997 Office of Management and Budget 
Standards for Maintaining, Collecting, and Presenting 
Federal Data on Race and Ethnicity (at a minimum). 
‘‘(e) LANGUAGE
COLLECTION
STANDARDS.—Not 
later than 1 year after the date of enactment of this title, 
the Deputy Assistant Secretary for Minority Health, in 
consultation with the Office for Civil Rights of the Depart-
ment of Health and Human Services, shall develop and 
disseminate Standards for the Classification of Federal 
Data on Preferred Written and Spoken Language. 
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‘‘(f) TECHNICAL ASSISTANCE FOR THE COLLECTION 
AND REPORTING OF DATA.— 
‘‘(1) IN GENERAL.—The Secretary may, either 
directly or through grant or contract, provide tech-
nical assistance to enable a health care program or 
an entity operating under such program to comply 
with the requirements of this section. 
‘‘(2) TYPES OF ASSISTANCE.—Assistance pro-
vided under this subsection may include assistance 
to— 
‘‘(A) enhance or upgrade computer tech-
nology that will facilitate racial, ethnic, and pri-
mary language data collection and analysis; 
‘‘(B) improve methods for health data col-
lection and analysis including additional popu-
lation groups beyond the Office of Management 
and Budget categories if such groups can be 
aggregated into the minimum race and ethnicity 
categories; 
‘‘(C) develop mechanisms for submitting 
collected data subject to existing privacy and 
confidentiality regulations; and 
‘‘(D) develop educational programs to in-
form health insurance issuers, health plans, 
health providers, health-related agencies, and 
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144 
the general public that data collection and re-
porting by race, ethnicity, and preferred lan-
guage are legal and essential for eliminating 
health and health care disparities. 
‘‘(g) ANALYSIS OF RACIAL AND ETHNIC DATA.—The 
Secretary, acting through the Director of the Agency for 
Healthcare Research and Quality and in coordination with 
the Administrator of the Centers for Medicare & Medicaid 
Services, shall provide technical assistance to agencies of 
the Department of Health and Human Services in meeting 
Federal standards for race, ethnicity, and primary lan-
guage data collection and analysis of racial and ethnic dis-
parities in health and health care in public programs by— 
‘‘(1) identifying appropriate quality assurance 
mechanisms to monitor for health disparities; 
‘‘(2) specifying the clinical, diagnostic, or thera-
peutic measures which should be monitored; 
‘‘(3) developing new quality measures relating 
to racial and ethnic disparities in health and health 
care; 
‘‘(4) identifying the level at which data analysis 
should be conducted; and 
‘‘(5) sharing data with external organizations 
for research and quality improvement purposes. 
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‘‘(h) REPORT.—Not later than 2 years after the date 
of enactment of this title, and biennially thereafter, the 
Secretary shall submit to the appropriate committees of 
Congress a report on the effectiveness of data collection, 
analysis, and reporting on race, ethnicity, and primary 
language under the programs and activities of the Depart-
ment of Health and Human Services and under other Fed-
eral data collection systems with which the Department 
interacts to collect relevant data on race and ethnicity. 
The report shall evaluate the progress made in the De-
partment with respect to the national plan under sub-
section (c) or subsequent revisions thereto. 
‘‘(i) DEFINITION.—In this section, the term ‘health- 
related program’ mean a program— 
‘‘(1) under the Social Security Act (42 U.S.C. 
301 et seq.) that pay for health care and services; 
and 
‘‘(2) under this Act that provide Federal finan-
cial assistance for health care, biomedical research, 
health services research, and programs designed to 
improve the public’s health. 
‘‘(j) 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 
2010 through 2015. 
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‘‘SEC. 3132. PROVISIONS RELATING TO NATIVE AMERICANS. 
‘‘(a) ESTABLISHMENT
OF
EPIDEMIOLOGY
CEN-
TERS.—The Secretary shall establish an epidemiology cen-
ter in each service area to carry out the functions de-
scribed in subsection (b). Any new center established after 
the date of the enactment of the Health Equity and Ac-
countability Act of 2009 may be operated under a grant 
authorized by subsection (d), but funding under such a 
grant shall not be divisible. 
‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 
and upon the request of Indian Tribes, Tribal Organiza-
tions, and Urban Indian Organizations, each service area 
epidemiology center established under this subsection 
shall, with respect to such service area— 
‘‘(1) collect data relating to, and monitor 
progress made toward meeting, each of the health 
status objectives of the Service, the Indian Tribes, 
Tribal Organizations, and Urban Indian Organiza-
tions in the service area; 
‘‘(2) evaluate existing delivery systems, data 
systems, and other systems that impact the improve-
ment of Indian health; 
‘‘(3) assist Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations in identifying their 
highest priority health status objectives and the 
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services needed to achieve such objectives, based on 
epidemiological data; 
‘‘(4) make recommendations for the targeting 
of services needed by the populations served; 
‘‘(5) make recommendations to improve health 
care delivery systems for Indians and Urban Indi-
ans; 
‘‘(6) provide requested technical assistance to 
Indian Tribes, Tribal Organizations, and Urban In-
dian Organizations in the development of local 
health service priorities and incidence and prevalence 
rates of disease and other illness in the community; 
and 
‘‘(7) provide disease surveillance and assist In-
dian Tribes, Tribal Organizations, and Urban Indian 
Organizations to promote public health. 
‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 
Centers for Disease Control and Prevention shall provide 
technical assistance to the centers in carrying out the re-
quirements of this subsection. 
‘‘(d) GRANTS FOR STUDIES.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to Indian Tribes, Tribal Organizations, 
Urban Indian Organizations, and eligible intertribal 
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consortia to conduct epidemiological studies of In-
dian communities. 
‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 
intertribal consortium is eligible to receive a grant 
under this subsection if— 
‘‘(A) the intertribal consortium is incor-
porated for the primary purpose of improving 
Indian health; and 
‘‘(B) the intertribal consortium is rep-
resentative of the Indian Tribes or urban In-
dian communities in which the intertribal con-
sortium is located. 
‘‘(3) APPLICATIONS.—An application for a 
grant under this subsection shall be submitted in 
such manner and at such time as the Secretary shall 
prescribe. 
‘‘(4) REQUIREMENTS.—An applicant for a 
grant under this subsection shall— 
‘‘(A) demonstrate the technical, adminis-
trative, and financial expertise necessary to 
carry out the functions described in paragraph 
(5); 
‘‘(B) consult and cooperate with providers 
of related health and social services in order to 
avoid duplication of existing services; and 
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‘‘(C) demonstrate cooperation from Indian 
tribes or Urban Indian Organizations in the 
area to be served. 
‘‘(5) USE OF FUNDS.—A grant awarded under 
paragraph (1) may be used— 
‘‘(A) to carry out the functions described 
in subsection (b); 
‘‘(B) to provide information to and consult 
with tribal leaders, urban Indian community 
leaders, and related health staff on health care 
and health service management issues; and 
‘‘(C) in collaboration with Indian Tribes, 
Tribal Organizations, and urban Indian com-
munities, to provide the Service with informa-
tion regarding ways to improve the health sta-
tus of Indians. 
‘‘(e) ACCESS
TO INFORMATION.—An epidemiology 
center operated by a grantee pursuant to a grant awarded 
under subsection (d) shall be treated as a public health 
authority for purposes of the Health Insurance Portability 
and Accountability Act of 1996 (Public Law 104–191; 110 
Stat. 2033), as such entities are defined in part 164.501 
of title 45, Code of Federal Regulations (or a successor 
regulation). The Secretary shall grant such grantees ac-
cess to and use of data, data sets, monitoring systems, 
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delivery systems, and other protected health information 
in the possession of the Secretary.’’. 
SEC. 302. COLLECTION OF RACE AND ETHNICITY DATA BY 
THE SOCIAL SECURITY ADMINISTRATION. 
Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 1150A. COLLECTION OF RACE AND ETHNICITY DATA 
BY THE SOCIAL SECURITY ADMINISTRATION. 
‘‘(a) REQUIREMENT.—The Commissioner of Social 
Security, in consultation with the Administrator of the 
Centers for Medicare & Medicaid Services, shall— 
‘‘(1) require the collection of data on the race, 
ethnicity, and primary language of all applicants for 
social security account numbers or benefits under 
title II or part A of title XVIII and all individuals 
with respect to whom the Commissioner maintains 
records of wages and self-employment income in ac-
cordance with reports received by the Commissioner 
or the Secretary of the Treasury— 
‘‘(A) using, at a minimum, the categories 
for race and ethnicity described in the 1997 Of-
fice of Management and Budget Standards for 
Maintaining, Collecting, and Presenting Federal 
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Data on Race and Ethnicity and available lan-
guage standards; and 
‘‘(B) where practicable, collecting data for 
additional population groups if such groups can 
be aggregated into the minimum race and eth-
nicity categories; 
‘‘(2) with respect to the collection of the data 
described in paragraph (1) for applicants who are 
under 18 years of age or otherwise legally incapaci-
tated, require that— 
‘‘(A) such data be collected from the par-
ent or legal guardian of such an applicant; and 
‘‘(B) the primary language of the parent 
or legal guardian of such an applicant or recipi-
ent be used; 
‘‘(3) require that such data be uniformly ana-
lyzed and reported at least annually to the Commis-
sioner of Social Security; 
‘‘(4) be responsible for storing the data re-
ported under paragraph (3); 
‘‘(5) ensure transmission to the Centers for 
Medicare & Medicaid Services and other Federal 
health agencies; 
‘‘(6) provide such data to the Secretary on at 
least an annual basis; and 
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‘‘(7) ensure that the provision of assistance to 
an applicant is not denied or otherwise adversely af-
fected because of the failure of the applicant to pro-
vide race, ethnicity, and primary language data. 
‘‘(b) PROTECTION OF DATA.—The Commissioner of 
Social Security shall ensure (through the promulgation of 
regulations or otherwise) that all data collected pursuant 
subsection (a) is protected— 
‘‘(1) under the same privacy protections as the 
Secretary applies to health data under the regula-
tions promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
of 1996 (Public Law 104–191; 110 Stat. 2033) re-
lating to the privacy of individually identifiable 
health information and other protections; and 
‘‘(2) from all inappropriate internal use by any 
entity that collects, stores, or receives the data, in-
cluding use of such data in determinations of eligi-
bility (or continued eligibility) in health plans, and 
from other inappropriate uses, as defined by the 
Secretary. 
‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit the use of information 
collected under this section in a manner that would ad-
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versely affect any individual providing any such informa-
tion. 
‘‘(d) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide technical 
assistance to enable any health entity to comply with the 
requirements of this section. 
‘‘(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 
2010 through 2015.’’. 
SEC. 303. REVISION OF HIPAA CLAIMS STANDARDS. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall revise the regulations promulgated 
under part C of title XI of the Social Security Act (42 
U.S.C. 1320d et seq.), as added by the Health Insurance 
Portability and Accountability Act of 1996 (Public Law 
104–191), relating to the collection of data on race, eth-
nicity, and primary language in a health-related trans-
action to require— 
(1) the use, at a minimum, of the categories for 
race and ethnicity described in the 1997 Office of 
Management and Budget Standards for Maintain-
ing, Collecting, and Presenting Federal Data on 
Race and Ethnicity; 
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(2) the establishment of a new data code set for 
primary language; and 
(3) the designation of the racial, ethnic, and 
primary language code sets as ‘‘required’’ for claims 
and enrollment data. 
(b) DISSEMINATION.—The Secretary of Health and 
Human Services shall disseminate the new standards de-
veloped under subsection (a) to all health entities that are 
subject to the regulations described in such subsection and 
provide technical assistance with respect to the collection 
of the data involved. 
(c) COMPLIANCE.—The Secretary of Health and 
Human Services shall require that health entities comply 
with the new standards developed under subsection (a) not 
later than 2 years after the final promulgation of such 
standards. 
SEC. 304. NATIONAL CENTER FOR HEALTH STATISTICS. 
Section 306(n) of the Public Health Service Act (42 
U.S.C. 242k(n)) is amended— 
(1) in paragraph (1), by striking ‘‘2003’’ and 
inserting ‘‘2014’’; 
(2) in paragraph (2), in the first sentence, by 
striking ‘‘2003’’ and inserting ‘‘2014’’; and 
(3) in paragraph (3), by striking ‘‘2002’’ and 
inserting ‘‘2014’’. 
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SEC. 305. GEO-ACCESS STUDY. 
The Administrator of the Substance Abuse and Men-
tal Health Services Administration shall— 
(1) conduct a study to— 
(A) determine which geographic areas of 
the United States have shortages of specialty 
mental health providers; and 
(B) assess the preparedness of speciality 
mental health providers to deliver culturally and 
linguistically appropriate services; and 
(2) submit a report to the Congress on the re-
sults of such study. 
SEC. 306. RACIAL, ETHNIC, AND LINGUISTIC DATA COL-
LECTED BY THE FEDERAL GOVERNMENT. 
(a) COLLECTION; SUBMISSION.—Not later than 90 
days after the date of the enactment of this Act, and Jan-
uary 31st of each year thereafter, each department, agen-
cy, and office of the Federal Government that has col-
lected racial, ethnic, or linguistic data during the pre-
ceding calendar year shall submit such data to the Sec-
retary of Health and Human Services. 
(b) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 
Not later than April 30, 2010, and each April 30th there-
after, the Secretary of Health and Human Services, acting 
through the Director of the National Center on Minority 
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Health and Health Disparities and the Deputy Assistant 
Secretary for Minority Health, shall— 
(1) collect and analyze the racial, ethnic, and 
linguistic data submitted under subsection (a) for 
the preceding calendar year; 
(2) make publicly available such data and the 
results of such analysis; and 
(3) submit a report to the Congress on such 
data and analysis. 
SEC. 307. HEALTH INFORMATION TECHNOLOGY GRANTS. 
(a) AUTHORITY.—The Deputy Assistant Secretary 
for Minority Health, in coordination with the Office of the 
National Coordinator for Health Information Technology, 
the Health Resources and Services Administration, the 
Substance Abuse and Mental Health Services Administra-
tion, and the National Center on Minority Health and 
Health Disparities, may award grants to appropriate enti-
ties for the purpose of ensuring appropriate and best prac-
tices to collect appropriate data and documents on the re-
duction of health disparities. 
(b) USE OF FUNDS.—A grant received under sub-
section (a) shall be used to achieve the purpose described 
in such subsection through one or more of the following: 
(1) Purchasing new, or enhancing existing, 
health information technology. 
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(2) Providing support and training to providers 
concerning such technology. 
(3) Conducting outreach and education on 
health information technology and its benefits to pa-
tients, physicians, allied health professionals, and 
advocacy groups in medically underserved commu-
nities (as defined in section 799B of the Public 
Health Service Act (42 U.S.C. 295p)). 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
$20,000,000 for each of fiscal years 2010 through 2015. 
SEC. 308. STUDY OF HEALTH INFORMATION TECHNOLOGY 
IN 
MEDICALLY 
UNDERSERVED 
COMMU-
NITIES. 
(a) STUDY.—The National Coordinator for Health 
Information Technology shall conduct a study on the de-
velopment and implementation of health information tech-
nology in medically underserved communities. The study 
shall— 
(1) identify barriers to successful implementa-
tion of health information technology in these com-
munities; 
(2) examine the impact of health information 
technology on providing quality care and reducing 
the cost of care to these communities; 
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(3) examine urban and rural community health 
systems and determine the impact that health infor-
mation technology may have on the capacity of pri-
mary health providers; and 
(4) assess the feasibility and the costs of associ-
ated with the use of health information technology 
in these communities. 
(b) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the National Coordi-
nator for Health Information Technology shall submit to 
the Congress a report on the study conducted under sub-
section (a) and shall include in such report such rec-
ommendations for legislation or administrative action as 
the Coordinator determines appropriate. 
SEC. 309. HEALTH INFORMATION TECHNOLOGY IN MEDI-
CALLY UNDERSERVED COMMUNITIES. 
The National Coordinator for Health Information 
Technology shall— 
(1) identify sources of funds that will be made 
available to promote and support the planning and 
adoption of health information technology in medi-
cally underserved communities (as defined in section 
799B of the Public Health Service Act (42 U.S.C. 
295p)), including in urban and rural areas, either 
through grants or technical assistance; 
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(2) coordinate with the funding sources to help 
such communities connect to identified funding; and 
(3) collaborate with the Agency for Healthcare 
Research and Quality, the Health Resources and 
Services Administration, and other Federal agencies 
to support technical assistance, knowledge dissemi-
nation, and resource development, to such commu-
nities seeking to plan for and adopt technology and 
establish electronic health information networks 
across providers. 
SEC. 310. DATA COLLECTION AND ANALYSIS GRANTS TO MI-
NORITY-SERVING INSTITUTIONS. 
(a) AUTHORITY.—The Secretary of Health and 
Human Services, acting through the Center on Minority 
Health and Health Disparities and the Office of Minority 
Health, may award grants to access and analyze racial and 
ethnic, and where possible, primary language data to mon-
itor and report on progress to reduce and eliminate racial 
and ethnic disparities in health and health care. 
(b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
igible entity’’ means a historically Black college or univer-
sity, an Hispanic-serving institution, a tribal college or 
university, or an Asian American and Pacific Islander- 
serving institution with an accredited public health, health 
policy, or health services research program. 
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SEC. 311. HEALTH INFORMATION TECHNOLOGY GRANTS 
FOR RURAL HEALTH CARE PROVIDERS. 
Title II of the Public Health Service Act is amended 
by adding at the end the following new part: 
‘‘PART D—HEALTH INFORMATION TECHNOLOGY 
GRANTS 
‘‘SEC. 271. GRANTS TO FACILITATE THE WIDESPREAD 
ADOPTION OF INTEROPERABLE HEALTH IN-
FORMATION TECHNOLOGY IN RURAL AREAS. 
‘‘(a) COMPETITIVE GRANTS TO ELIGIBLE ENTITIES 
IN RURAL AREAS.— 
‘‘(1) IN GENERAL.—The Secretary may award 
competitive grants to eligible entities in rural areas 
to facilitate the purchase and enhance the utilization 
of qualified health information technology systems to 
improve the quality and efficiency of health care. 
‘‘(2) ELIGIBILITY.—To be eligible to receive a 
grant under paragraph (1) an entity shall— 
‘‘(A) submit to the Secretary an applica-
tion at such time, in such manner, and con-
taining such information as the Secretary may 
require; 
‘‘(B) submit to the Secretary a strategic 
plan for the implementation of data sharing 
and interoperability measures; 
‘‘(C) be a rural health care provider; 
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‘‘(D) adopt any applicable core interoper-
ability guidelines (endorsed under other provi-
sions of law); 
‘‘(E) agree to notify patients if their indi-
vidually 
identifiable 
health 
information 
is 
wrongfully disclosed; 
‘‘(F) 
demonstrate 
significant 
financial 
need; and 
‘‘(G) provide matching funds in accordance 
with paragraph (4). 
‘‘(3) USE OF FUNDS.—Amounts received under 
a grant under this subsection shall be used to facili-
tate the purchase and enhance the utilization of 
qualified health information technology systems and 
training personnel in the use of such technology. 
‘‘(4) MATCHING REQUIREMENT.—To be eligible 
for a grant under this subsection an entity shall con-
tribute non-Federal contributions to the costs of car-
rying out the activities for which the grant is award-
ed in an amount equal to $1 for each $3 of Federal 
funds provided under the grant. 
‘‘(5) LIMIT ON GRANT AMOUNT.—In no case 
shall the payment amount under this subsection with 
respect to the purchase or enhanced utilization of 
qualified health information technology for a rural 
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health care provider, in addition to the amount of 
any loan made to the provider from a grant to a 
State under subsection (b) for such purpose, exceed 
100 percent of the provider’s costs for such purchase 
or enhanced utilization (taking into account costs for 
training, implementation, and maintenance). 
‘‘(6) PREFERENCE IN AWARDING GRANTS.—In 
awarding grants to eligible entities under this sub-
section, the Secretary shall give preference to each 
of the following types of applicants: 
‘‘(A) An entity that is located in a frontier 
or other rural underserved area as determined 
by the Secretary. 
‘‘(B) An entity that will link, to the extent 
practicable, the qualified health information 
system to a local or regional health information 
plan or plans. 
‘‘(C) A rural health care provider that is a 
nonprofit hospital or a Federally qualified 
health center. 
‘‘(D) A rural health care provider that is 
an individual practice or group practice. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.— 
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out this section, there are authorized to be ap-
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propriated $20,000,000 for fiscal year 2010, 
$30,000,000 for fiscal year 2011, and such sums as 
may be necessary, but not to exceed $30,000,000 for 
each of fiscal years 2012 through 2014. 
‘‘(2) 
AVAILABILITY.—Amounts 
appropriated 
under paragraph (1) shall remain available through 
fiscal year 2013. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) FEDERALLY
QUALIFIED
HEALTH
CEN-
TER.—The term ‘Federally qualified health center’ 
has the meaning given that term in section 
1861(aa)(4) of the Social Security Act (42 U.S.C. 
1395x(aa)(4)). 
‘‘(2) GROUP PRACTICE.—The term ‘group prac-
tice’ has the meaning given that term in section 
1877(h)(4) of the Social Security Act (42 U.S.C. 
1395nn(h)(4)). 
‘‘(3) HEALTH
CARE
PROVIDER.—The term 
‘health care provider’ means a hospital, skilled nurs-
ing facility, home health agency (as defined in sub-
section (o) of section 1861 of the Social Security 
Act, 42 U.S.C. 1395x), health care clinic, rural 
health clinic, Federally qualified health center, group 
practice, a pharmacist, a pharmacy, a laboratory, a 
physician (as defined in subsection (r) of such sec-
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tion), 
a 
practitioner 
(as 
defined 
in 
section 
1842(b)(18)(CC) 
of 
such 
Act, 
U.S.C. 
1395u(b)(18)(CC)), a health facility operated by or 
pursuant to a contract with the Indian Health Serv-
ice, and any other category of facility or clinician de-
termined appropriate by the Secretary. 
‘‘(4) HEALTH
INFORMATION; 
INDIVIDUALLY 
IDENTIFIABLE HEALTH INFORMATION.—The terms 
‘health information’ and ‘individually identifiable 
health information’ have the meanings given those 
terms in paragraphs (4) and (6), respectively, of sec-
tion 1171 of the Social Security Act (42 U.S.C. 
1320d). 
‘‘(5) LABORATORY.—The term ‘laboratory’ has 
the meaning given that term in section 353. 
‘‘(6) PHARMACIST.—The term ‘pharmacist’ has 
the meaning given that term in section 804(a)(2) of 
the Federal Food, Drug, and Cosmetic Act (21 
U.S.C. 384(a)(2)). 
‘‘(7) QUALIFIED HEALTH INFORMATION TECH-
NOLOGY.—The term ‘qualified health information 
technology’ means a system or components of health 
information technology that meet any applicable core 
interoperability guidelines (endorsed under applica-
ble provisions of law) when in use or that use inter-
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face software that allows for interoperability in ac-
cordance with such guidelines. 
‘‘(8) RURAL AREA.—The term ‘rural area’ has 
the meaning given such term for purposes of section 
1886(d)(2)(D) of the Social Security Act (42 U.S.C. 
1395ww(d)(2)(D)). 
‘‘(9) RURAL
HEALTH
CARE
PROVIDER.—The 
term ‘rural health care provider’ means a health 
care provider that is located in a rural area.’’. 
SEC. 312. SURVEY QUESTIONS ON SEXUAL ORIENTATION 
AND GENDER IDENTITY. 
The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall include in the National Health Inter-
view Survey (or any successor survey) questions to identify 
the sexual orientation and gender identity of individuals 
participating in the survey. 
SEC. 313. DISAGGREGATION OF COMPARATIVE EFFECTIVE-
NESS RESEARCH DATA. 
The Secretary of Health and Human Services may 
not make available any Federal funds for comparative ef-
fectiveness health care research, unless the recipient of the 
funds agrees to ensure that the research data will be 
disaggregated by race, ethnicity, and gender to detect and 
measure differences among subpopulations. 
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TITLE IV—ACCOUNTABILITY 
AND EVALUATION 
Subtitle A—General Provisions 
SEC. 401. FEDERAL AGENCY PLAN TO ELIMINATE DISPARI-
TIES AND IMPROVE THE HEALTH OF MINOR-
ITY POPULATIONS. 
(a) IN GENERAL.—Not later than September 1, 
2010, each Federal health agency shall develop and imple-
ment a national strategic action plan to eliminate dispari-
ties on the basis of race, ethnicity, and primary language 
and improve the health and health care of minority popu-
lations, through programs relevant to the mission of the 
agency. 
(b) PUBLICATION.—Each action plan described in 
paragraph (1) shall— 
(1) be publicly reported in draft form for public 
review and comment; 
(2) include a response to the review and com-
ment described in paragraph (1) in the final plan; 
(3) include the agency response to the 2002 In-
stitute of Medicine report, Unequal Treatment— 
Confronting Racial and Ethnic Disparities in 
Healthcare; 
(4) respond to data and analyses presented in 
the National Healthcare Disparities Report and the 
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National Healthcare Quality Report published annu-
ally by the Agency for Healthcare Research and 
Quality; 
(5) demonstrate progress in meeting the 
Healthy People 2010 objectives; and 
(6) be updated, including progress reports, for 
inclusion in an annual report to Congress. 
SEC. 402. PROHIBITION ON DISCRIMINATION IN FEDERAL 
ASSISTED HEALTH CARE SERVICES AND RE-
SEARCH PROGRAMS ON THE BASIS OF SEX, 
RACE, COLOR, NATIONAL ORIGIN, SEXUAL 
ORIENTATION, GENDER IDENTITY, OR DIS-
ABILITY STATUS. 
No person in the United States shall, on the basis 
of sex, race, color, national origin, sexual orientation, gen-
der identity, or disability status, be excluded from partici-
pation in, be denied the benefits of, or be subjected to dis-
crimination under any health care service or research pro-
gram or activity receiving Federal financial assistance. 
SEC. 403. ACCOUNTABILITY WITHIN THE DEPARTMENT OF 
HEALTH AND HUMAN SERVICES. 
Title XXXI of the Public Health Service Act, as 
amended by titles II and III of this Act, is further amend-
ed by adding at the end the following: 
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‘‘Subtitle C—Strengthening 
Accountability 
‘‘SEC. 3141. ELEVATION OF THE OFFICE OF CIVIL RIGHTS. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
within the Office for Civil Rights an Office of Health Dis-
parities, which shall be headed by a director to be ap-
pointed by the Secretary. 
‘‘(b) PURPOSE.—The Office of Health Disparities 
shall ensure that the health programs, activities, and oper-
ations of health entities which receive Federal financial as-
sistance are in compliance with title VI of the Civil Rights 
Act, which prohibits discrimination on the basis of race, 
color, or national origin. The activities of the Office shall 
include the following: 
‘‘(1) The development and implementation of 
an action plan to address racial and ethnic health 
care disparities, which shall address concerns relat-
ing to the Office for Civil Rights as released by the 
United States Commission on Civil Rights in the re-
port entitled ‘Health Care Challenge: Acknowledging 
Disparity, Confronting Discrimination, and Ensur-
ing Equity’ (September, 1999) in conjunction with 
the reports by the Institute of Medicine entitled ‘Un-
equal Treatment: Confronting Racial and Ethnic 
Disparities in Health Care’, ‘Crossing the Quality 
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Chasm: A New Health System for the 21st Cen-
tury’, and ‘In the Nation’s Compelling Interest: En-
suring Diversity in the Health Care Workforce’ and 
other related reports by the Institute of Medicine. 
This plan shall be publicly disclosed for review and 
comment and the final plan shall address any com-
ments or concerns that are received by the Office. 
‘‘(2) Investigative and enforcement actions 
against intentional discrimination and policies and 
practices that have a disparate impact on minorities. 
‘‘(3) The review of racial, ethnic, and primary 
language health data collected by Federal health 
agencies to assess health care disparities related to 
intentional discrimination and policies and practices 
that have a disparate impact on minorities. 
‘‘(4) Outreach and education activities relating 
to compliance with title VI of the Civil Rights Act. 
‘‘(5) The provision of technical assistance for 
health entities to facilitate compliance with title VI 
of the Civil Rights Act. 
‘‘(6) Coordination and oversight of activities of 
the civil rights compliance offices established under 
section 3142. 
‘‘(7) Ensuring compliance with the 1997 Office 
of Management and Budget Standards for Maintain-
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ing, Collecting, and Presenting Federal Data on 
Race, Ethnicity and the available language stand-
ards. 
‘‘(c) FUNDING AND STAFF.—The Secretary shall en-
sure the effectiveness of the Office of Health Disparities 
by ensuring that the Office is provided with— 
‘‘(1) adequate funding to enable the Office to 
carry out its duties under this section; and 
‘‘(2) staff with expertise in— 
‘‘(A) epidemiology; 
‘‘(B) statistics; 
‘‘(C) health quality assurance; 
‘‘(D) minority health and health dispari-
ties; 
‘‘(E) cultural and linguistic competency; 
and 
‘‘(F) civil rights. 
‘‘(d) REPORT.—Not later than December 31, 2010, 
and annually thereafter, the Secretary, in collaboration 
with the Director of the Office for Civil Rights and the 
Director of the Office of Minority Health, shall submit a 
report to the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives that in-
cludes— 
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‘‘(1) the number of cases filed, broken down by 
category; 
‘‘(2) the number of cases investigated and 
closed by the office; 
‘‘(3) the outcomes of cases investigated; 
‘‘(4) the staffing levels of the office including 
staff credentials; 
‘‘(5) the number of other lingering and emerg-
ing cases in which civil rights inequities can be dem-
onstrated; and 
‘‘(6) the number of cases remaining open and 
an explanation for their open status. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2010 through 2015. 
‘‘SEC. 3142. ESTABLISHMENT OF HEALTH PROGRAM OF-
FICES FOR CIVIL RIGHTS WITHIN FEDERAL 
HEALTH AND HUMAN SERVICES AGENCIES. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
civil rights compliance offices in each agency within the 
Department of Health and Human Services that admin-
isters health programs. 
‘‘(b) PURPOSE OF OFFICES.—Each office established 
under subsection (a) shall ensure that recipients of Fed-
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eral financial assistance under Federal health programs 
administer their programs, services, and activities in a 
manner that— 
‘‘(1) does not discriminate, either intentionally 
or in effect, on the basis of race, national origin, lan-
guage, ethnicity, sex, age, or disability; and 
‘‘(2) promotes the reduction and elimination of 
disparities in health and health care based on race, 
national origin, language, ethnicity, sex, age, and 
disability. 
‘‘(c) POWERS AND DUTIES.—The offices established 
in subsection (a) shall have the following powers and du-
ties: 
‘‘(1) The establishment of compliance and pro-
gram participation standards for recipients of Fed-
eral financial assistance under each program admin-
istered by an agency within the Department of 
Health and Human Services including the establish-
ment of disparity reduction standards to encompass 
disparities in health and health care related to race, 
national origin, language, ethnicity, sex, age, and 
disability. 
‘‘(2) The development and implementation of 
program-specific guidelines that interpret and apply 
Department of Health and Human Services guid-
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ance under title VI of the Civil Rights Act of 1964 
to each Federal health program administered by the 
agency. 
‘‘(3) The development of a disparity-reduction 
impact analysis methodology that shall be applied to 
every rule issued by the agency and published as 
part of the formal rulemaking process under sections 
555, 556, and 557 of title 5, United States Code. 
‘‘(4) Oversight of data collection, analysis, and 
publication requirements for all recipients of Federal 
financial assistance under each Federal health pro-
gram administered by the agency, and compliance 
with the 1997 Office of Management and Budget 
Standards for Maintaining, Collecting, and Pre-
senting Federal Data on Race and Ethnicity and the 
available language standards. 
‘‘(5) The conduct of publicly available studies 
regarding discrimination within Federal health pro-
grams administered by the agency as well as dis-
parity reduction initiatives by recipients of Federal 
financial assistance under Federal health programs. 
‘‘(6) Annual reports to the Committee on 
Health, Education, Labor, and Pensions and the 
Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce and the Committee 
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on Ways and Means of the House of Representatives 
on the progress in reducing disparities in health and 
health care through the Federal programs adminis-
tered by the agency. 
‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 
IN THE DEPARTMENT OF JUSTICE.— 
‘‘(1) DEPARTMENT
OF
HEALTH
AND
HUMAN 
SERVICES.—The Office for Civil Rights in the De-
partment of Health and Human Services shall pro-
vide standard-setting and compliance review inves-
tigation support services to the Civil Rights Compli-
ance Office for each agency. 
‘‘(2) DEPARTMENT
OF
JUSTICE.—The Office 
for Civil Rights in the Department of Justice shall 
continue to maintain the power to institute formal 
proceedings when an agency Office for Civil Rights 
determines that a recipient of Federal financial as-
sistance is not in compliance with the disparity re-
duction standards of the agency. 
‘‘(e) DEFINITION.—In this section, the term ‘Federal 
health programs’ mean programs— 
‘‘(1) under the Social Security Act (42 U.S.C. 
301 et seq.) that pay for health care and services; 
and 
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‘‘(2) under this Act that provide Federal finan-
cial assistance for health care, biomedical research, 
health services research, and programs designed to 
improve the public’s health.’’. 
SEC. 404. OFFICE OF MINORITY HEALTH. 
Section 1707 of the Public Health Service Act (42 
U.S.C. 300u–6) is amended— 
(1) by striking subsection (b) and inserting the 
following: 
‘‘(b) DUTIES.—With respect to improving the health 
of racial and ethnic minority groups, the Secretary, acting 
through the Deputy Assistant Secretary for Minority 
Health (in this section referred to as the ‘Deputy Assist-
ant Secretary’), shall carry out the following: 
‘‘(1) Establish, implement, monitor, and evalu-
ate short-range and long-range goals and objectives 
and oversee all other activities within the Public 
Health Service that relate to disease prevention, 
health promotion, service delivery, and research con-
cerning minority groups. The heads of each of the 
agencies of the Service shall consult with the Deputy 
Assistant Secretary to ensure the coordination of 
such activities. 
‘‘(2) Oversee all activities within the Depart-
ment of Health and Human Services that relate to 
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reducing or eliminating disparities in health and 
health care in racial and ethnic minority populations 
and in rural and underserved communities, including 
coordinating— 
‘‘(A) the design of programs, support for 
programs, and the evaluation of programs; 
‘‘(B) the monitoring of trends in health 
and health care; 
‘‘(C) research efforts; 
‘‘(D) the training of health providers; and 
‘‘(E) information and education programs 
and campaigns. 
‘‘(3) Enter into interagency and intra-agency 
agreements with other agencies of the Public Health 
Service. 
‘‘(4) Ensure that the Federal health agencies 
and the National Center for Health Statistics collect 
data on the health status and health care of each 
minority group, using at a minimum the categories 
specified in the 1997 OMB Standards for Maintain-
ing, Collecting, and Presenting Federal Data on 
Race and Ethnicity as required under subtitle B and 
available language standards. 
‘‘(5) Provide technical assistance to States, 
local agencies, territories, Indian tribes, and entities 
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for activities relating to the elimination of racial and 
ethnic disparities in health and health care. 
‘‘(6) Support a national minority health re-
source center to carry out the following: 
‘‘(A) Facilitate the exchange of informa-
tion regarding matters relating to health infor-
mation, health promotion and wellness, preven-
tive health services, clinical trials, health infor-
mation technology, and education in the appro-
priate use of health services. 
‘‘(B) Facilitate timely access to culturally 
and linguistically appropriate information. 
‘‘(C) Assist in the analysis of such infor-
mation. 
‘‘(D) Provide technical assistance with re-
spect to the exchange of such information (in-
cluding facilitating the development of materials 
for such technical assistance). 
‘‘(7) Carry out programs to improve access to 
health care services for individuals with limited 
English proficiency, including developing and car-
rying out programs to provide bilingual or interpre-
tive services through the development and support of 
the Robert T. Matsui Center for Cultural and Lin-
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guistic Competence in Health Care as provided for 
in section 3103. 
‘‘(8) Carry out programs to improve access to 
health care services and to improve the quality of 
health care services for individuals with low func-
tional health literacy. As used in the preceding sen-
tence, the term ‘functional health literacy’ means the 
ability to obtain, process, and understand basic 
health information and services needed to make ap-
propriate health decisions. 
‘‘(9) Advise in matters related to the develop-
ment, implementation, and evaluation of health pro-
fessions education on decreasing disparities in health 
care outcomes, with focus on cultural competency as 
a method of eliminating disparities in health and 
health care in racial and ethnic minority popu-
lations. 
‘‘(10) Assist health care professionals, commu-
nity and advocacy organizations, academic centers 
and public health departments in the design and im-
plementation of programs that will improve the qual-
ity of health outcomes by strengthening the pro-
vider-patient relationship.’’; 
(2) by redesignating subsections (f) through (h) 
as subsections (g) through (i), respectively; 
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(3) by inserting after subsection (d) the fol-
lowing: 
‘‘(f) PREPARATION OF HEALTH PROFESSIONALS TO 
PROVIDE HEALTH CARE TO MINORITY POPULATIONS.— 
The Secretary, in collaboration with the Director of the 
Bureau of Health Professions and the Deputy Assistant 
Secretary for Minority Health, shall require that health 
professional schools that receive Federal funds train fu-
ture health professionals to provide culturally and linguis-
tically appropriate health care to diverse populations.’’; 
and 
(4) by striking subsection (i) (as so redesig-
nated) and inserting the following: 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated $100,000,000 for fiscal year 2010, and 
such sums as may be necessary for each of fiscal years 
2011 through 2015.’’. 
SEC. 405. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH 
SERVICE. 
(a) ESTABLISHMENT.— 
(1) IN GENERAL.—In order to more effectively 
and efficiently carry out the responsibilities, authori-
ties, and functions of the United States to provide 
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health care services to Indians and Indian tribes, as 
are or may be hereafter provided by Federal statute 
or treaties, there is established within the Public 
Health Service of the Department of Health and 
Human Services the Indian Health Service. 
(2) 
ASSISTANT
SECRETARY
OF
INDIAN 
HEALTH.—The Service shall be administered by an 
Assistant Secretary of Indian Health, who shall be 
appointed by the President, by and with the advice 
and consent of the Senate. The Assistant Secretary 
shall report to the Secretary. Effective with respect 
to an individual appointed by the President, by and 
with the advice and consent of the Senate the term 
of service of the Assistant Secretary shall be 4 years. 
An Assistant Secretary may serve more than 1 term. 
(b) AGENCY.—The Service shall be an agency within 
the Public Health Service of the Department, and shall 
not be an office, component, or unit of any other agency 
of the Department. 
(c) FUNCTIONS AND DUTIES.—The Secretary shall 
carry out through the Assistant Secretary of the Service— 
(1) all functions which were, on the day before 
the date of enactment of the Indian Health Care 
Amendments of 1988, carried out by or under the 
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direction of the individual serving as Director of the 
Service on such day; 
(2) all functions of the Secretary relating to the 
maintenance and operation of hospital and health fa-
cilities for Indians and the planning for, and provi-
sion and utilization of, health services for Indians; 
(3) all health programs under which health care 
is provided to Indians based upon their status as In-
dians which are administered by the Secretary, in-
cluding programs under— 
(A) the Indian Health Care Improvement 
Act; 
(B) the Act of November 2, 1921 (25 
U.S.C. 13); 
(C) the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.); 
(D) the Act of August 16, 1957 (42 
U.S.C. 2005 et seq.); 
(E) the Indian Self-Determination Act (25 
U.S.C. 450f et seq.); and 
(F) title XXXI of the Public Health Serv-
ice Act, as added by this Act; and 
(4) all scholarship and loan functions carried 
out under title I of the Indian Health Care Improve-
ment Act. 
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(d) AUTHORITY.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Assistant Secretary, shall have the au-
thority— 
(A) except to the extent provided for in 
paragraph (2), to appoint and compensate em-
ployees for the Service in accordance with title 
5, United States Code; 
(B) to enter into contracts for the procure-
ment of goods and services to carry out the 
functions of the Service; and 
(C) to manage, expend, and obligate all 
funds appropriated for the Service. 
(2) PERSONNEL
ACTIONS.—Notwithstanding 
any other provision of law, the provisions of section 
12 of the Act of June 18, 1934 (48 Stat. 986; 25 
U.S.C. 472), shall apply to all personnel actions 
taken with respect to new positions created within 
the Service as a result of its establishment under 
subsection (a). 
(e) RATE OF PAY.— 
(1) POSITIONS AT LEVEL IV.—Section 5315 of 
title 5, United States Code, is amended by striking 
the following: ‘‘Assistant Secretaries of Health and 
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Human Services (6).’’ and inserting ‘‘Assistant Sec-
retaries of Health and Human Services (7).’’. 
(2) POSITIONS AT LEVEL V.—Section 5316 of 
such title is amended by striking the following: ‘‘Di-
rector, Indian Health Service, Department of Health 
and Human Services.’’. 
(f) DUTIES OF ASSISTANT SECRETARY FOR INDIAN 
HEALTH.—Section 601 of the Indian Health Care Im-
provement Act (25 U.S.C. 1661) is amended in subsection 
(a)— 
(1) by inserting ‘‘(1)’’ after ‘‘(a)’’; 
(2) in the second sentence of paragraph (1), as 
so designated, by striking ‘‘a Director,’’ and insert-
ing ‘‘the Assistant Secretary for Indian Health,’’; 
(3) by striking the third sentence of paragraph 
(1), as so designated, and all that follows through 
the end of the subsection (a) of such section and in-
serting the following: ‘‘The Assistant Secretary for 
Indian Health shall carry out the duties specified in 
paragraph (2).’’; and 
(4) by adding after paragraph (1) the following: 
‘‘(2) The Assistant Secretary for Indian Health 
shall— 
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‘‘(A) report directly to the secretary con-
cerning all policy and budget-related matters 
affecting Indian health; 
‘‘(B) collaborate with the Assistant Sec-
retary for Health concerning appropriate mat-
ters of Indian health that affect the agencies of 
the Public Health Service; 
‘‘(C) advise each Assistant Secretary of the 
Department of Health and Human Services 
concerning matters of Indian health with re-
spect to which that Assistant Secretary has au-
thority and responsibility; 
‘‘(D) advise the heads of other agencies 
and programs of the Department of Health and 
Human Services concerning matters of Indian 
health with respect to which those heads have 
authority and responsibility; and 
‘‘(E) coordinate the activities of the De-
partment of Health and Human Services con-
cerning matters of Indian health.’’. 
(g) CONTINUED SERVICE BY INCUMBENT.—The indi-
vidual serving in the position of Director of the Indian 
Health Service on the date preceding the date of enact-
ment of this Act may serve as Assistant Secretary for In-
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dian Health, at the pleasure of the President after the 
date of enactment of this Act. 
(h) CONFORMING AMENDMENTS.— 
(1) AMENDMENTS TO INDIAN HEALTH CARE IM-
PROVEMENT
ACT.—The Indian Health Care Im-
provement Act (25 U.S.C. 1601 et seq.) is amend-
ed— 
(A) in section 601— 
(i) in subsection (c), by striking ‘‘Di-
rector of the Indian Health Service’’ both 
places it appears and inserting ‘‘Assistant 
Secretary for Indian Health’’; and 
(ii) in subsection (d), by striking ‘‘Di-
rector of the Indian Health Service’’ and 
inserting ‘‘Assistant Secretary for Indian 
Health’’; and 
(B) in section 816(c)(1), by striking ‘‘Di-
rector of the Indian Health Service’’ and insert-
ing ‘‘Assistant Secretary for Indian Health’’. 
(2) AMENDMENTS TO OTHER PROVISIONS OF 
LAW.—The following provisions are each amended 
by striking ‘‘Director of the Indian Health Service’’ 
each place it appears and inserting ‘‘Assistant Sec-
retary for Indian Health’’: 
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(A) Section 203(a)(1) of the Rehabilitation 
Act of 1973 (29 U.S.C. 763(a)(1)). 
(B) Subsections (b) and (e) of section 518 
of the Federal Water Pollution Control Act (33 
U.S.C. 1377 (b) and (e)). 
(C) Section 803B(d)(1) of the Native 
American Programs Act of 1974 (42 U.S.C. 
2991b–2(d)(1)). 
(i) REFERENCES.—Reference in any other Federal 
law, Executive order, rule, regulation, or delegation of au-
thority, or any document of or relating to the Director 
of the Indian Health Service shall be deemed to refer to 
the Assistant Secretary for Indian Health. 
(j) DEFINITIONS.—For purposes of this section, the 
definitions contained in section 4 of the Indian Health 
Care Improvement Act shall apply. 
SEC. 406. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI-
NORITY HEALTH WITHIN AGENCIES OF THE 
PUBLIC HEALTH SERVICE. 
Title XVII of the Public Health Service Act (42 
U.S.C. 300u et seq.) is amended by inserting after section 
1707 the following section: 
‘‘INDIVIDUAL OFFICES OF MINORITY HEALTH WITHIN 
PUBLIC HEALTH SERVICE 
‘‘SEC. 1707A. 
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‘‘(a) IN GENERAL.—The head of each agency speci-
fied in subsection (b)(1) shall establish within the agency 
an office to be known as the Office of Minority Health. 
Each such Office shall be headed by a director, who shall 
be appointed by the head of the agency within which the 
Office is established, and who shall report directly to the 
head of the agency. The head of such agency shall carry 
out this section (as this section relates to the agency) act-
ing through such Director. 
‘‘(b) SPECIFIED AGENCIES.— 
‘‘(1) IN GENERAL.—The agencies referred to in 
subsection (a) are the following: 
‘‘(A) The Centers for Disease Control and 
Prevention. 
‘‘(B) The Health Resources and Services 
Administration. 
‘‘(C) The Substance Abuse and Mental 
Health Services Administration. 
‘‘(D) The Administration on Aging. 
‘‘(c) COMPOSITION.—The head of each specified 
agency shall ensure that the officers and employees of the 
minority health office of the agency are, collectively, expe-
rienced in carrying out community-based health programs 
for each of the various racial and ethnic minority groups 
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that are present in significant numbers in the United 
States. 
‘‘(d) DUTIES.—Each Director of a minority health of-
fice shall establish and monitor the programs of the speci-
fied agency of such office in order to carry out the fol-
lowing: 
‘‘(1) Determine the extent to which the pur-
poses of the programs are being carried out with re-
spect to racial and ethnic minority groups; 
‘‘(2) Determine the extent to which members of 
such groups are represented among the Federal offi-
cers and employees who administer the programs; 
and 
‘‘(3) Make recommendations to the head of 
such agency on carrying out the programs with re-
spect to such groups. In the case of programs that 
provide services, such recommendations shall include 
recommendations toward ensuring that— 
‘‘(A) the services are equitably delivered 
with respect to racial and ethnic minority 
groups; 
‘‘(B) the programs provide the services in 
the language and cultural context that is most 
appropriate for the individuals for whom the 
services are intended; and 
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‘‘(C) the programs utilize racial and ethnic 
minority community-based organizations to de-
liver services. 
‘‘(e) BIENNIAL REPORTS TO SECRETARY.—The head 
of each specified agency shall submit to the Secretary for 
inclusion in each biennial report describing— 
‘‘(1) the extent to which the minority health of-
fice of the agency employs individuals who are mem-
bers of racial and ethnic minority groups, including 
a specification by minority group of the number of 
such individuals employed by such office. 
‘‘(f) FUNDING.— 
‘‘(1) ALLOCATIONS.—Of the amounts appro-
priated for a specified agency for a fiscal year, the 
Secretary must designate an appropriate amount of 
funds for the purpose of carrying out activities 
under this section through the minority health office 
of the agency. In reserving an amount under the 
preceding sentence for a minority health office for a 
fiscal year, the Secretary shall reduce, by substan-
tially the same percentage, the amount that other-
wise would be available for each of the programs of 
the designated agency involved. 
‘‘(2) AVAILABILITY
OF
FUNDS
FOR
STAFF-
ING.—The purposes for which amounts made avail-
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able under paragraph may be expended by a minor-
ity health office include the costs of employing staff 
for such office.’’. 
SEC. 407. OFFICE OF MINORITY HEALTH AT THE CENTERS 
FOR MEDICARE & MEDICAID SERVICES. 
(a) IN GENERAL.—Not later than 60 days after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall establish within the Centers for 
Medicare & Medicaid Services an Office of Minority 
Health (referred to in this section as the ‘‘Office’’). 
(b) DUTIES.—The Office shall be responsible for the 
coordination and facilitation of activities of the Centers 
for Medicare & Medicaid Services to improve minority 
health and health care and to reduce racial and ethnic dis-
parities in health and health care, which shall include— 
(1) creating a strategic plan, which shall be 
made available for public review, to improve the 
health and health care of Medicare, Medicaid, and 
SCHIP beneficiaries; 
(2) promoting agency-wide policies relating to 
health care delivery and financing that could have a 
beneficial impact on the health and health care of 
minority populations; 
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(3) assisting health plans, hospitals, and other 
health entities in providing culturally and linguis-
tically appropriate health care services; 
(4) increasing awareness and outreach activities 
for minority health care consumers and providers 
about the causes and remedies for health and health 
care disparities; 
(5) developing grant programs and demonstra-
tion projects to identify, implement and evaluate in-
novative approaches to improving the health and 
health care of minority beneficiaries in the Medicare, 
Medicaid, and SCHIP programs; 
(6) considering incentive programs relating to 
reimbursement that would reward health entities for 
providing quality health care for minority popu-
lations using established benchmarks for quality of 
care; 
(7) collaborating with the compliance office to 
ensure compliance with the anti-discrimination provi-
sions under title VI of the Civil Rights Act of 1964; 
(8) identifying barriers to enrollment in public 
programs under the jurisdiction of the Centers for 
Medicare & Medicaid Services; 
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(9) monitoring and evaluating on a regular 
basis the success of minority health programs and 
initiatives; 
(10) publishing an annual report about the ac-
tivities of the Centers for Medicare & Medicaid Serv-
ices relating to minority health improvement; and 
(11) other activities determined appropriate by 
the Secretary of Health and Human Services. 
(c) STAFF.—The staff at the Office shall include— 
(1) one or more individuals with expertise in 
minority health and racial and ethnic health dispari-
ties; and 
(2) one or more individuals with expertise in 
health care financing and delivery in underserved 
communities. 
(d) COORDINATION.—In carrying out its duties under 
this section, the Office shall coordinate with— 
(1) the Office of Minority Health in the Office 
of the Secretary of Health and Human Services; 
(2) the National Centers for Minority Health 
and Health Disparities in the National Institutes of 
Health; and 
(3) the Office of Minority Health in the Centers 
for Disease Control and Prevention. 
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(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated $10,000,000 for fiscal year 2010, and 
such sums may be necessary for each of fiscal years 2011 
through 2016. 
SEC. 408. OFFICE OF MINORITY AFFAIRS AT THE FOOD AND 
DRUG ADMINISTRATION. 
Chapter IX of the Federal Food, Drug, and Cosmetic 
Act (21 U.S.C. 391 et seq.) is amended by adding at the 
end the following: 
‘‘SEC. 911. OFFICE OF MINORITY AFFAIRS. 
‘‘(a) IN GENERAL.—Not later than 60 days after the 
date of enactment of this section, the Secretary shall es-
tablish within the Office of the Commissioner of Food and 
Drugs an Office of Minority Affairs (referred to in this 
section as the ‘Office’). 
‘‘(b) DUTIES.—The Office shall be responsible for the 
coordination and facilitation of activities of the Food and 
Drug Administration to improve minority health and 
health care and to reduce racial and ethnic disparities in 
health and health care, which shall include— 
‘‘(1) promoting policies in the development and 
review of medical products that reduce racial and 
ethnic disparities in health and health care; 
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‘‘(2) encouraging appropriate data collection, 
analysis, and dissemination of racial and ethnic dif-
ferences using, at a minimum, the categories de-
scribed in the 1997 Office of Management and 
Budget standards, in response to different therapies 
in both adult and pediatric populations; 
‘‘(3) providing, in coordination with other ap-
propriate government agencies, education, training, 
and support to increase participation of minority pa-
tients and physicians in clinical trials; 
‘‘(4) collecting and analyzing data using, at a 
minimum, the categories described in the 1997 Of-
fice of Management and Budget standards, on the 
number of participants from minority racial and eth-
nic backgrounds in clinical trials used to support 
medical product approvals; 
‘‘(5) the identification of methods to reduce lan-
guage and literacy barriers; and 
‘‘(6) publishing an annual report about the ac-
tivities of the Food and Drug Administration per-
taining to minority health. 
‘‘(c) STAFF.—The staff of the Office shall include— 
‘‘(1) one or more individuals with expertise in 
the design and conduct of clinical trials of drugs, bi-
ological products, and medical devices; and 
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‘‘(2) one or more individuals with expertise in 
therapeutic classes or disease states for which med-
ical evidence suggests a difference based on race or 
ethnicity. 
‘‘(d) COORDINATION.—In carrying out its duties 
under this section, the Office shall coordinate with— 
‘‘(1) the Office of Minority Health in the Office 
of the Secretary of Health and Human Services; 
‘‘(2) the National Institute for Minority Health 
and Health Disparities in the National Institutes of 
Health; and 
‘‘(3) the Office of Minority Health in the Cen-
ters for Disease Control and Prevention. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary for 
each of the fiscal years 2010 through 2015.’’. 
SEC. 409. 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 505D the following: 
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‘‘SEC. 505E. SAFETY AND EFFECTIVENESS OF DRUGS WITH 
RESPECT TO RACIAL AND ETHNIC BACK-
GROUND. 
‘‘(a) PRE-APPROVAL STUDIES.—If there is evidence 
that there may be a disparity on the basis of racial or 
ethnic background as to the safety or effectiveness of a 
drug, then— 
‘‘(1)(A) the investigations required under sec-
tion 505(b)(1)(A) shall include adequate and well- 
controlled investigations of the disparity; or 
‘‘(B) the evidence required under section 351(a) 
of the Public Health Service Act for approval of a 
biologics license application for the drug shall in-
clude adequate and well-controlled investigations of 
the disparity; and 
‘‘(2) if the investigations confirm that there is 
a disparity, the labeling of the drug shall include ap-
propriate information about the disparity. 
‘‘(b) POST-MARKET STUDIES.— 
‘‘(1) IN GENERAL.—If there is evidence that 
there may be a disparity on the basis of racial or 
ethnic background as to the safety or effectiveness 
of a drug for which there is an approved application 
under section 505 or a license under section 351 of 
the Public Health Service Act, the Secretary may by 
order require the holder of the approved application 
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or license to conduct, by a date specified by the Sec-
retary, post-marketing studies to investigate the dis-
parity. 
‘‘(2) LABELING.—If the Secretary determines 
that the post-market studies confirm that there is a 
disparity described in paragraph (1), the labeling of 
the drug shall include appropriate information about 
the disparity. 
‘‘(3) STUDY
DESIGN.—The Secretary may 
specify all aspects of study design, including the 
number of studies and study participants, in the 
order requiring post-market studies of the drug. 
‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 
Secretary may by order modify any aspect of the 
study design as necessary after issuing an order 
under paragraph (1). 
‘‘(5) STUDY RESULTS.—The results from stud-
ies required under paragraph (1) shall be submitted 
to the Secretary as supplements to the drug applica-
tion or biological license application. 
‘‘(c) DISPARITY.—The term ‘evidence that there may 
be a disparity on the basis of racial or ethnic background 
for adult and pediatric populations as to the safety or ef-
fectiveness of a drug’ includes— 
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‘‘(1) evidence that there is a disparity on the 
basis of racial or ethnic background as to safety or 
effectiveness of a drug in the same chemical class as 
the drug; 
‘‘(2) evidence that there is a disparity on the 
basis of racial or ethnic background in the way the 
drug is metabolized; and 
‘‘(3) other evidence as the Secretary may deter-
mine. 
‘‘(d) APPLICATIONS UNDER SECTION 505(b)(2) AND 
505(j).— 
‘‘(1) IN GENERAL.—A drug for which an appli-
cation has been submitted or approved under section 
505(j) shall not be considered ineligible for approval 
under that section or misbranded under section 502 
on the basis that the labeling of the drug omits in-
formation relating to a disparity on the basis of ra-
cial or ethnic background as to the safety or effec-
tiveness of the drug, whether derived from investiga-
tions or studies required under this section or de-
rived from other sources, when the omitted informa-
tion is protected by patent or by exclusivity under 
clause (iii) or (iv) of section 505(j)(5)(B). 
‘‘(2) LABELING.—Notwithstanding clauses (iii) 
and (iv) of section 505(j)(5)(B), the Secretary may 
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require that the labeling of a drug approved under 
section 505(j) that omits information relating to a 
disparity on the basis of racial or ethnic background 
as to the safety or effectiveness of the drug include 
a statement of any appropriate contraindications, 
warnings, or precautions related to the disparity 
that the Secretary considers necessary.’’. 
(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: 
‘‘(aa) 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 505E.’’. 
(c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379h) 
is amended by adding after ‘‘are required’’ the following: 
‘‘, including supplements required under section 505E’’. 
SEC. 410. UNITED STATES COMMISSION ON CIVIL RIGHTS. 
(a) COORDINATION WITHIN DEPARTMENT OF JUS-
TICE
OF
ACTIVITIES
REGARDING
HEALTH
DISPARI-
TIES.—Section 3 of the Civil Rights Commission Act of 
1983 (42 U.S.C. 1975a) is amended— 
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(1) in paragraph (1)(B), by striking ‘‘and’’ at 
the end; 
(2) in paragraph (2), in the matter after and 
below subparagraph (D), by striking the period and 
inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(3) shall, with respect to activities carried out 
in health care and correctional facilities toward the 
goal of eliminating health disparities between the 
general population and members of racial or ethnic 
minority groups, coordinate such activities of— 
‘‘(A) the Office for Civil Rights within the 
Department of Justice; 
‘‘(B) the Office of Justice Programs within 
the Department of Justice; 
‘‘(C) the Office for Civil Rights within the 
Department of Health and Human Services; 
and 
‘‘(D) the Office of Minority Health within 
the Department of Health and Human Services 
(headed by the Deputy Assistant Secretary for 
Minority Health).’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 
1975c) is amended by striking the first sentence and in-
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serting the following: ‘‘For the purpose of carrying out 
this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2010, and such sums as may 
be necessary for each of the fiscal years 2011 through 
2015.’’. 
SEC. 411. SENSE OF CONGRESS CONCERNING FULL FUND-
ING OF ACTIVITIES TO ELIMINATE RACIAL 
AND ETHNIC HEALTH DISPARITIES. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) The health status of the American populace 
is declining and the United States currently ranks 
below most industrialized nations in health status 
measured by longevity, sickness, and mortality. 
(2) Racial and ethnic minority populations tend 
have the poorest health status and face substantial 
cultural, social, and economic barriers to obtaining 
quality health care. 
(3) Efforts to improve minority health have 
been limited by inadequate resources (funding, staff-
ing, and stewardship) and accountability. 
(b) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) funding should be doubled by fiscal year 
2010 for the National Institute for Minority Health 
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Disparities, the Office of Civil Rights in the Depart-
ment of Health and Human Services, the National 
Institute of Nursing Research, and the Office of Mi-
nority Health; 
(2) adequate funding by fiscal year 2010, and 
subsequent funding increases, should be provided for 
health professions training programs, the Racial and 
Ethnic Approaches to Community Health (REACH) 
at the Center for Disease Control and Prevention, 
the Minority HIV/AIDS Initiative, and the Excel-
lence Centers to Eliminate Ethnic/Racial Disparities 
(EXCEED) Program at the Agency for Healthcare 
Research and Quality; 
(3) current and newly created health disparity 
elimination incentives, programs, agencies, and de-
partments under this Act (and the amendments 
made by this Act) should receive adequate staffing 
and funding by fiscal year 2010; and 
(4) stewardship and accountability should be 
provided to Congress and the President for measur-
able and sustainable progress toward health dis-
parity elimination. 
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SEC. 412. GUIDELINES FOR DISEASE SCREENING FOR MI-
NORITY PATIENTS. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity, shall convene a series of meetings to develop guidelines 
for disease screening for minority patient populations 
which have a higher than average risk for many chronic 
diseases and cancers. 
(b) PARTICIPANTS.—In convening meetings under 
subsection (a), the Secretary shall ensure that meeting 
participants include representatives of— 
(1) professional societies and associations; 
(2) minority health organizations; 
(3) health care researchers and providers, in-
cluding those with expertise in minority health; 
(4) Federal health agencies, including the Of-
fice of Minority Health, the National Center on Mi-
nority Health and Health Disparities, and the Na-
tional Institutes of Health; and 
(5) other experts determined appropriate by the 
Secretary. 
(c) DISEASES.—Screening guidelines for minority 
populations shall be developed under subsection (a) for— 
(1) hypertension; 
(2) hypercholesterolemia; 
(3) diabetes; 
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(4) cardiovascular disease; 
(5) cancers, including breast, prostate, colon, 
cervical, and lung cancer; 
(6) asthma; 
(7) diabetes; 
(8) kidney diseases; 
(9) eye diseases and disorders, including glau-
coma; 
(10) HIV/AIDS and sexually transmitted dis-
eases; 
(11) uterine fibroids; 
(12) autoimmune disease; 
(13) mental health conditions; 
(14) dental health conditions and oral diseases; 
(15) environmental and related health illnesses 
and conditions; 
(16) Sickle cell disease; 
(17) violence and injury prevention and control; 
(18) genetic and related conditions; 
(19) heart disease and stroke; 
(20) tuberculosis; 
(21) chronic obstructive pulmonary disease; and 
(22) other diseases determined appropriate by 
the Secretary. 
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(d) DISSEMINATION.—Not later than 24 months 
after the date of enactment of this title, the Secretary 
shall publish and disseminate to health care provider orga-
nizations the guidelines developed under subsection (a). 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
sums as may be necessary for each of fiscal years 2010 
through 2015. 
SEC. 413. NATIONAL INSTITUTE FOR MINORITY HEALTH 
AND HEALTH DISPARITIES. 
(a) REDESIGNATION.— 
(1) IN
GENERAL.—Title IV of the Public 
Health Service Act (42 U.S.C. 281 et seq.) is 
amended— 
(A) in section 401(b)(24), by striking ‘‘Na-
tional Center on Minority Health and Health 
Disparities’’ and inserting ‘‘National Institute 
for Minority Health and Health Disparities’’; 
and 
(B) in subpart 6 of part E— 
(i) in the subpart heading, by striking 
‘‘Center’’ and inserting ‘‘Institute’’; 
(ii) in the headings of sections 485E 
and 485H, by striking ‘‘CENTER’’ and in-
serting ‘‘INSTITUTE’’; and 
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(iii) by striking (other than in section 
485E(i)(1)) the term ‘‘Center’’ each place 
it appears and inserting ‘‘Institute’’. 
(2) REFERENCES.—Any reference in any law, 
map, regulation, document, paper, or other record of 
the United States to the National Center on Minor-
ity Health and Health Disparities shall be deemed to 
be a reference to the National Institute for Minority 
Health and Health Disparities. 
(b) 
DUTIES; 
AUTHORITIES; 
FUNDING.—Section 
485E of the Public Health Service Act (42 U.S.C. 287c– 
31) is amended— 
(1) by amending subsection (e) to read as fol-
lows: 
‘‘(e) DUTIES OF THE DIRECTOR.— 
‘‘(1) INTERAGENCY COORDINATION OF MINOR-
ITY HEALTH AND HEALTH DISPARITY ACTIVITIES.— 
With respect to minority health and health dispari-
ties, the Director of the Institute shall plan, coordi-
nate, and evaluate research and other activities con-
ducted or supported by the institutes and centers of 
the National Institutes of Health. In carrying out 
the preceding sentence, the Director of the Institute 
shall evaluate the minority health and health dis-
parity activities of each of such institutes and cen-
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ters and shall provide for the periodic reevaluation 
of such activities. Such institutes and centers shall 
be responsible for providing information to the Insti-
tute, including data on clinical trials funded or con-
ducted by these institutes and centers. 
‘‘(2) CONSULTATIONS.—The Director of the In-
stitute shall carry out this subpart (including devel-
oping and revising the plan and budget required by 
subsection (f) in consultation with the heads of the 
institutes and centers of the National Institutes of 
Health, the advisory councils of such institutes and 
centers, and the advisory council established pursu-
ant to subsection (j). 
‘‘(3) COORDINATION OF ACTIVITIES.—The Di-
rector of the Institute— 
‘‘(A) shall act as the primary Federal offi-
cial with responsibility for coordinating all re-
search and activities conducted or supported by 
the National Institutes of Health on minority or 
other health disparities; 
‘‘(B) shall represent the health disparities 
research program of the National Institutes of 
Health, including the minority health and other 
health disparities research program, at all rel-
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evant executive branch task forces, committees, 
and planning activities; and 
‘‘(C) shall maintain communications with 
all relevant agencies of the Public Health Serv-
ice, including the Indian Health Service, and 
various other departments and agencies of the 
Federal Government to ensure the timely trans-
mission of information concerning advances in 
minority health disparities research and other 
health disparities research among these various 
agencies for dissemination to affected commu-
nities and health care providers.’’; 
(2) by amending subsection (f) to read as fol-
lows: 
‘‘(f) STRATEGIC PLAN.— 
‘‘(1) IN GENERAL.—Subject to the provisions of 
this section and other applicable law, the Director of 
the Institute, in consultation with the Director of 
NIH, the Directors of the other institutes and cen-
ters of the National Institutes of Health, and the 
advisory council established pursuant to subsection 
(j), shall— 
‘‘(A) annually review and revise a strategic 
plan (referred to in this section as ‘the plan’) 
and budget for the conduct and support of all 
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minority health disparity research and other 
health disparity research activities of the insti-
tutes and centers of the National Institutes of 
Health that include time-based targeted objec-
tives with measurable outcomes and assure that 
the annual review and revision of the plan uses 
an established trans-National Institutes of 
Health process subject to timely review, ap-
proval, and dissemination; 
‘‘(B) ensure that the plan and budget es-
tablish priorities among the health disparities 
research activities that such agencies are au-
thorized to carry out; 
‘‘(C) ensure that the plan and budget es-
tablish objectives regarding such activities, de-
scribe the means for achieving the objectives, 
and designate the date by which the objectives 
are expected to be achieved; 
‘‘(D) ensure that all amounts appropriated 
for such activities are expended in accordance 
with the plan and budget; 
‘‘(E) annually submit to Congress a report 
on the progress made with respect to the plan; 
and 
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‘‘(F) create and implement a plan for the 
systemic review of research activities supported 
by the National Institutes of Health that are 
within the mission of both the Institute and 
other institutes and centers of the National In-
stitutes of Health, including by establishing 
mechanisms for— 
‘‘(i) tracking minority health and 
health disparity research conducted within 
the institutes and centers assessing the ap-
propriateness of this research with regard 
to the overall goals and objectives of the 
plan; 
‘‘(ii) the early identification of appli-
cations and proposals for grants, contracts, 
and cooperative agreements supporting ex-
tramural training, research, and develop-
ment, that are submitted to the institutes 
and centers that are within the mission of 
the Institute; 
‘‘(iii) providing the Institute with the 
written descriptions and scientific peer re-
view results of such applications and pro-
posals; 
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‘‘(E) 
behavioral 
research 
and 
social 
sciences research, which may include cultural 
and linguistic research in each of the agencies. 
‘‘(3) MINORITY
HEALTH
DISPARITIES
RE-
SEARCH.—The plan and budget under paragraph (1) 
shall include a separate statement of the plan and 
budget for minority health disparities research.’’; 
(3) by amending subsection (h) to read as fol-
lows: 
‘‘(h) RESEARCH ENDOWMENTS.— 
‘‘(1) IN GENERAL.—The Director of the Insti-
tute shall carry out a program to facilitate minority 
health and health disparities research and other 
health disparities research by providing research en-
dowments at— 
‘‘(A) centers of excellence under section 
736; and 
‘‘(B) centers of excellence under section 
485F. 
‘‘(2) ELIGIBILITY.—The Director of the Insti-
tute shall provide for a research endowment under 
paragraph (1) only if the institution involved meets 
the following conditions: 
‘‘(A) The institution does not have an en-
dowment that is worth in excess of an amount 
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equal to 50 percent of the national average of 
endowment funds at institutions that conduct 
similar biomedical research or training of health 
professionals. 
‘‘(B) The application of the institution 
under paragraph (1) regarding a research en-
dowment has been recommended pursuant to 
technical and scientific peer review and has 
been approved by the advisory council estab-
lished pursuant to subsection (j). 
‘‘(C) The institution at any time was 
deemed to be eligible to receive a grant under 
section 736 and at any time received a research 
endowment under paragraph (1).’’; and 
(4) by adding at the end the following: 
‘‘(k) FUNDING.— 
‘‘(1) FULL FUNDING BUDGET.— 
‘‘(A) IN GENERAL.—With respect to a fis-
cal year, the Director of the Institute shall pre-
pare and submit directly to the President, for 
review and transmittal to Congress, a budget 
estimate for carrying out the plan for the fiscal 
year, after reasonable opportunity for comment 
(but without change) by the Secretary, the Di-
rector of the National Institutes of Health, the 
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directors of the other institutes and centers of 
the National Institutes of Health, and the advi-
sory council established pursuant to subsection 
(j). The budget estimate shall include an esti-
mate of the number and type of personnel 
needs for the Institute. 
‘‘(B) AMOUNTS NECESSARY.—The budget 
estimate submitted under subparagraph (A) 
shall estimate the amounts necessary for the in-
stitutes and centers of the National Institutes 
of Health to carry out all minority health and 
health disparities activities determined by the 
Director of the Institute to be appropriate, 
without regard to the probability that such 
amounts will be appropriated. 
‘‘(2) ALTERNATE BUDGETS.— 
‘‘(A) IN GENERAL.—With respect to a fis-
cal year, the Director of the Institute shall pre-
pare and submit to the Secretary and the Di-
rector of the National Institutes of Health the 
budget estimates described in subparagraph (B) 
for carrying out the plan for the fiscal year. 
The Secretary and such Director shall consider 
each of such estimates in making recommenda-
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tions to the President regarding a budget for 
the plan for such year. 
‘‘(B) DESCRIPTION.—With respect to the 
fiscal year involved, the budget estimates re-
ferred to in subparagraph (A) for the plan are 
as follows: 
‘‘(i) The budget estimate submitted 
under paragraph (1). 
‘‘(ii) A budget estimate developed on 
the assumption that the amounts appro-
priated will be sufficient only for— 
‘‘(I) continuing the conduct by 
the institutes and centers of the Na-
tional Institutes of Health of existing 
minority health and health disparity 
activities (if approved for continu-
ation), and continuing the support of 
such activities by the institutes and 
centers in the case of projects or pro-
grams for which the institutes or cen-
ters have made a commitment of con-
tinued support; and 
‘‘(II) carrying out activities that 
are in addition to activities specified 
in subclause (I), only for which the 
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Director determines there is the most 
substantial need. 
‘‘(iii) Such other budget estimates as 
the Director of the Institute determines to 
be appropriate.’’. 
SEC. 414. IOM REPORT ON LGBT HEALTH DISPARITIES. 
The Secretary of Health and Human Services shall 
enter into an agreement with the Institute of Medicine to 
prepare and submit to the Congress a report on— 
(1) health and health care disparities experi-
enced by the lesbian, gay, bisexual, and transgender 
communities; and 
(2) the unique health and health care chal-
lenges experienced by such communities. 
Subtitle B—Improving 
Environmental Justice 
SEC. 421. CODIFICATION OF EXECUTIVE ORDER 12898. 
(a) IN GENERAL.—The President of the United 
States is authorized and directed to execute, administer, 
and enforce as a matter of Federal law the provisions of 
Executive Order 12898, dated February 11, 1994 (‘‘Fed-
eral Actions To Address Environmental Justice In Minor-
ity Populations and Low-Income Populations’’), with such 
modifications as are provided in this section. 
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(b) DEFINITION OF ENVIRONMENTAL JUSTICE.—For 
purposes of carrying out the provisions of Executive Order 
12898, the following definitions shall apply: 
(1) The term ‘‘environmental justice’’ means 
the fair treatment and meaningful involvement of all 
people regardless of race, color, national origin, edu-
cational level, or income with respect to the develop-
ment, implementation, and enforcement of environ-
mental laws and regulations in order to ensure 
that— 
(A) minority and low-income communities 
have access to public information relating to 
human health and environmental planning, reg-
ulations, and enforcement; and 
(B) no minority or low-income population 
is forced to shoulder a disproportionate burden 
of the negative human health and environ-
mental impacts of pollution or other environ-
mental hazard. 
(2) The term ‘‘fair treatment’’ means policies 
and practices that ensure that no group of people, 
including racial, ethnic, or socioeconomic groups 
bear disproportionately high and adverse human 
health or environmental effects resulting from Fed-
eral agency programs, policies, and activities. 
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(c) JUDICIAL REVIEW AND RIGHTS OF ACTION.— 
The provisions of section 6–609 of Executive Order 12898 
shall not apply for purposes of this Act. 
SEC. 422. IMPLEMENTATION OF RECOMMENDATIONS BY 
ENVIRONMENTAL PROTECTION AGENCY. 
(a) INSPECTOR GENERAL RECOMMENDATIONS.—The 
Administrator of the Environmental Protection Agency 
shall, as promptly as practicable, carry out each of the 
following recommendations of the Inspector General of the 
agency as set forth in Report No. 2006–P–00034 entitled 
‘‘EPA needs to conduct environmental justice reviews of 
its programs, policies and activities’’: 
(1) The recommendation that the Agency’s pro-
gram and regional offices identify which programs, 
policies, and activities need environmental justice re-
views and require these offices to establish a plan to 
complete the necessary reviews. 
(2) The recommendation that the Administrator 
of the Agency ensure that these reviews determine 
whether the programs, policies, and activities may 
have a disproportionately high and adverse health or 
environmental impact on minority and low-income 
populations. 
(3) The recommendation that each program 
and regional office develop specific environmental 
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justice review guidance for conducting environmental 
justice reviews. 
(4) The recommendation that the Administrator 
designate a responsible office to compile results of 
environmental justice reviews and recommend appro-
priate actions. 
(b) GAO RECOMMENDATIONS.—In developing rules 
under laws administered by the Environmental Protection 
Agency, the Administrator of the Agency shall, as prompt-
ly as practicable, carry out each of the following rec-
ommendations of the Comptroller General of the United 
States as set forth in GAO Report numbered GAO–05– 
289 entitled ‘‘EPA Should Devote More Attention to En-
vironmental Justice when Developing Clean Air Rules’’: 
(1) The recommendation that the Administrator 
ensure that workgroups involved in developing a rule 
devote attention to environmental justice while draft-
ing and finalizing the rule. 
(2) The recommendation that the Administrator 
enhance the ability of such workgroups to identify 
potential environmental justice issues through such 
steps as providing workgroup members with guid-
ance and training to helping them identify potential 
environmental justice problems and involving envi-
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ronmental justice coordinators in the workgroups 
when appropriate. 
(3) The recommendation that the Administrator 
improve assessments of potential environmental jus-
tice impacts in economic reviews by identifying the 
data and developing the modeling techniques needed 
to assess such impacts. 
(4) The recommendation that the Administrator 
direct appropriate Agency officers and employees to 
respond fully when feasible to public comments on 
environmental justice, including improving the Agen-
cy’s explanation of the basis for its conclusions, to-
gether with supporting data. 
(c) 2004 INSPECTOR GENERAL REPORT.—The Ad-
ministrator of the Environmental Protection Agency shall, 
as promptly as practicable, carry out each of the following 
recommendations of the Inspector General of the Agency 
as set forth in the report entitled ‘‘EPA Needs to Consist-
ently Implement the Intent of the Executive Order on En-
vironmental Justice’’ (Report No. 2004–P–00007): 
(1) The recommendation that the Agency clear-
ly define the mission of the Office of Environmental 
Justice (OEJ) and provide Agency staff with an un-
derstanding of the roles and responsibilities of the 
Office. 
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(2) The recommendation that the Agency estab-
lish (through issuing guidance or a policy statement 
from the Administrator) specific time frames for the 
development of definitions, goals, and measurements 
regarding environmental justice and provide the re-
gions and program offices a standard and consistent 
definition for a minority and low-income community, 
with instructions on how the Agency will implement 
and operationalize environmental justice into the 
Agency’s daily activities. 
(3) The recommendation that the Agency en-
sure the comprehensive training program currently 
under development includes standard and consistent 
definitions of the key environmental justice concepts 
(such as ‘‘low-income’’, ‘‘minority’’, and ‘‘dispropor-
tionately impacted’’) and instructions for implemen-
tation of those concepts. 
(d) REPORT.—The Administrator shall submit an ini-
tial report to Congress within 6 months after the enact-
ment of this Act regarding the Administrator’s strategy 
for implementing the recommendations referred to in sub-
sections (a), (b), and (c). Thereafter, the Administrator 
shall provide semi-annual reports to Congress regarding 
the Administrator’s progress in implementing such rec-
ommendations and modifying the Administrator’s emer-
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gency management procedures to incorporate environ-
mental justice in the Agency’s Incident Command Struc-
ture (in accordance with the December 18, 2006, letter 
from the Deputy Administrator to the Acting Inspector 
General of the agency). 
SEC. 423. GRANT PROGRAM. 
(a) DEFINITIONS.—In this section: 
(1) DIRECTOR.—The term ‘‘Director’’ means 
the Director of the Centers for Disease Control and 
Prevention, acting in collaboration with the Adminis-
trator of the Environmental Protection Agency and 
the Director of the National Institute of Environ-
mental Health Sciences. 
(2) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a State or local community that— 
(A) bears a disproportionate burden of ex-
posure to environmental health hazards; 
(B) has established a coalition— 
(i) with not less than 1 community- 
based organization; and 
(ii) with not less than 1— 
(I) public health entity; 
(II) health care provider organi-
zation; or 
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(III) academic institution, includ-
ing any minority-serving institution 
(including an Hispanic-serving institu-
tion, a historically Black college or 
university, and a tribal college or uni-
versity); 
(C) ensures planned activities and funding 
streams are coordinated to improve community 
health; and 
(D) submits an application in accordance 
with subsection (c). 
(b) ESTABLISHMENT.—The Director shall establish a 
grant program under which eligible entities shall receive 
grants to conduct environmental health improvement ac-
tivities. 
(c) APPLICATION.—To receive a grant under this sec-
tion, an eligible entity shall submit an application to the 
Director at such time, in such manner, and accompanied 
by such information as the Director may require. 
(d) COOPERATIVE AGREEMENTS.—An eligible entity 
may use a grant under this section— 
(1) to promote environmental health; and 
(2) to address environmental health disparities. 
(e) AMOUNT OF COOPERATIVE AGREEMENT.— 
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(1) IN
GENERAL.—The Director shall award 
grants to eligible entities at the 2 different funding 
levels described in this subsection. 
(2) LEVEL 1 COOPERATIVE AGREEMENTS.— 
(A) IN
GENERAL.—An eligible entity 
awarded a grant under this paragraph shall use 
the funds to identify environmental health prob-
lems and solutions by— 
(i) 
establishing 
a 
planning 
and 
prioritizing council in accordance with sub-
paragraph (B); and 
(ii) 
conducting 
an 
environmental 
health assessment in accordance with sub-
paragraph (C). 
(B) PLANNING AND PRIORITIZING COUN-
CIL.— 
(i) IN GENERAL.—A prioritizing and 
planning council established under sub-
paragraph (A)(i) (referred to in this para-
graph as a ‘‘PPC’’) shall assist the envi-
ronmental health assessment process and 
environmental health promotion activities 
of the eligible entity. 
(ii) MEMBERSHIP.—Membership of a 
PPC shall consist of representatives from 
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various organizations within public health, 
planning, development, and environmental 
services and shall include stakeholders 
from vulnerable groups such as children, 
the elderly, disabled, and minority ethnic 
groups that are often not actively involved 
in democratic or decision-making proc-
esses. 
(iii) DUTIES.—A PPC shall— 
(I) identify key stakeholders and 
engage and coordinate potential part-
ners in the planning process; 
(II) establish a formal advisory 
group to plan for the establishment of 
services; 
(III) conduct an in-depth review 
of the nature and extent of the need 
for an environmental health assess-
ment, including a local epidemiological 
profile, an evaluation of the service 
provider capacity of the community, 
and a profile of any target popu-
lations; and 
(IV) define the components of 
care and form essential programmatic 
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linkages with related providers in the 
community. 
(C) ENVIRONMENTAL
HEALTH
ASSESS-
MENT.— 
(i) IN GENERAL.—A PPC shall carry 
out an environmental health assessment to 
identify environmental health concerns. 
(ii) 
ASSESSMENT
PROCESS.—The 
PPC shall— 
(I) define the goals of the assess-
ment; 
(II) generate the environmental 
health issue list; 
(III) analyze issues with a sys-
tems framework; 
(IV) develop appropriate commu-
nity environmental health indicators; 
(V) 
rank 
the 
environmental 
health issues; 
(VI) set priorities for action; 
(VII) develop an action plan; 
(VIII) implement the plan; and 
(IX) evaluate progress and plan-
ning for the future. 
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(D) EVALUATION.—Each eligible entity 
that receives a grant under this paragraph shall 
evaluate, report, and disseminate program find-
ings and outcomes. 
(E) TECHNICAL ASSISTANCE.—The Direc-
tor may provide such technical and other non- 
financial assistance to eligible entities as the 
Director determines to be necessary. 
(3) LEVEL 2 COOPERATIVE AGREEMENTS.— 
(A) ELIGIBILITY.— 
(i) IN GENERAL.—The Director shall 
award grants under this paragraph to eli-
gible entities that have already— 
(I) established broad-based col-
laborative partnerships; and 
(II) completed environmental as-
sessments. 
(ii) NO LEVEL 1 REQUIREMENT.—To 
be eligible to receive a grant under this 
paragraph, an eligible entity is not re-
quired to have successfully completed a 
Level 1 Cooperative Agreement (as de-
scribed in paragraph (2). 
(B) USE OF GRANT FUNDS.—An eligible 
entity awarded a grant under this paragraph 
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shall use the funds to further activities to carry 
out environmental health improvement activi-
ties, including— 
(i) addressing community environ-
mental health priorities in accordance with 
paragraph (2)(C)(ii), including— 
(I) air quality; 
(II) water quality; 
(III) solid waste; 
(IV) land use; 
(V) housing; 
(VI) food safety; 
(VII) crime; 
(VIII) injuries; and 
(IX) healthcare services; 
(ii) building partnerships between 
planning, public health, and other sectors, 
to address how the built environment im-
pacts food availability and access and 
physical activity to promote healthy behav-
iors and lifestyles and reduce overweight 
and obesity, asthma, respiratory condi-
tions, dental, oral and mental health condi-
tions, and related co-morbidities; 
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(iii) establishing programs to ad-
dress— 
(I) how environmental and social 
conditions of work and living choices 
influence physical activity and dietary 
intake; or 
(II) how those conditions influ-
ence the concerns and needs of people 
who have impaired mobility and use 
assistance devices, including wheel-
chairs and lower limb prostheses; and 
(iv) convening intervention programs 
that examine the role of the social environ-
ment in connection with the physical and 
chemical environment in— 
(I) determining access to nutri-
tional food; and 
(II) improving physical activity to 
reduce morbidity and increase quality 
of life. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
(1) $25,000,000 for fiscal year 2010; and 
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