103 
percentage of grant funds as compared to overall en-
tity funding. 
(c) PUBLIC AVAILABILITY.—The report under sub-
section (a) shall be made available for public review and 
comment. 
SEC. 402. FEDERAL AGENCY PLAN TO ELIMINATE DISPARI-
TIES AND IMPROVE THE HEALTH OF MINOR-
ITY POPULATIONS. 
(a) IN GENERAL.—Not later than September 1, 
2007, 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 healthcare 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; 
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(4) demonstrate progress in meeting the 
Healthy People 2010 objectives; and 
(5) be updated, including progress reports, for 
inclusion in an annual report to Congress. 
SEC. 403. ACCOUNTABILITY WITHIN THE DEPARTMENT OF 
HEALTH AND HUMAN SERVICES. 
Title XXIX 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: 
‘‘Subtitle C—Strengthening 
Accountability 
‘‘SEC. 2941. 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 
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healthcare disparities, which shall address concerns 
relating to the Office for Civil Rights as released by 
the United States Commission on Civil Rights in the 
report entitled ‘Health Care Challenge: Acknowl-
edging Disparity, Confronting Discrimination, and 
Ensuring Equity’ (September, 1999). This plan shall 
be publicly disclosed for review and comment and 
the final plan shall address any comments or con-
cerns 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 healthcare 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 2942. 
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‘‘(7) Ensuring compliance with the 1997 Office 
of Management and Budget Standards for Maintain-
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; and 
‘‘(E) civil rights. 
‘‘(d) REPORT.—Not later than December 31, 2007, 
and annually thereafter, the Secretary, in collaboration 
with the Director of the Office for Civil Rights, shall sub-
mit 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 includes— 
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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; and 
‘‘(4) the staffing levels of the office including 
staff credentials. 
‘‘(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 
2007 through 2012. 
‘‘SEC. 2942. 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-
eral financial assistance under Federal health programs 
administer their programs, services, and activities in a 
manner that— 
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‘‘(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 healthcare 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 healthcare 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-
ance under title VI of the Civil Rights Act of 1964 
to each Federal health program administered by the 
agency. 
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‘‘(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 
on Ways and Means of the House of Representatives 
on the progress in reducing disparities in health and 
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healthcare 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 healthcare and services; 
and 
‘‘(2) under this Act that provide Federal finan-
cial assistance for healthcare, biomedical research, 
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health services research, and programs designed to 
improve the public’s health.’’. 
SEC. 404. OFFICE OF MINORITY HEALTH DISPARITY ELIMI-
NATION. 
Section 1707 of the Public Health Service Act (42 
U.S.C. 300u–6) is amended— 
(1) by striking the section heading and insert-
ing 
the 
following: 
‘‘OFFICE
OF
MINORITY 
HEALTH DISPARITY ELIMINATION’’; 
(2) by striking ‘‘Office of Minority Health’’ 
each place such term appears and inserting ‘‘Office 
of Minority Health Disparity Elimination’’; 
(3) 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 Disparity Elimination (in this section referred to 
as the ‘Deputy Assistant 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-
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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 
reducing or eliminating disparities in health and 
healthcare in racial and ethnic minority populations, 
including coordinating— 
‘‘(A) the design of programs, support for 
programs, and the evaluation of programs; 
‘‘(B) the monitoring of trends in health 
and healthcare; 
‘‘(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 healthcare of each mi-
nority group, using at a minimum the categories 
specified in the 1997 OMB Standards for Maintain-
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113 
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 
for activities relating to the elimination of racial and 
ethnic disparities in health and healthcare. 
‘‘(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, 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 
healthcare services for individuals with limited 
English proficiency, including developing and car-
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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-
guistic Competence in Healthcare as provided for in 
section 2903. 
‘‘(8) Carry out programs to improve access to 
healthcare services and to improve the quality of 
healthcare 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 
healthcare outcomes, with focus on cultural com-
petency as a method of eliminating disparities in 
health and healthcare in racial and ethnic minority 
populations. 
‘‘(10) Assist healthcare 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-
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115 
ity of health outcomes by strengthening the pro-
vider-patient relationship.’’. 
(4) by redesignating subsections (c) through (f) 
and subsections (g) and (h) as subsections (d) 
through (g) and subsections (j) and (k), respectively; 
(5) by inserting after subsection (b), the fol-
lowing: 
‘‘(c) NATIONAL PLAN TO ELIMINATE RACIAL AND 
ETHNIC HEALTH AND HEALTHCARE DISPARITIES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Deputy Assistant Secretary, shall— 
‘‘(A) not later than 1 year after the date 
of enactment of the Healthcare Equality and 
Accountability Act, establish and implement a 
comprehensive plan to achieve the goal of 
Healthy People 2010 to eliminate health dis-
parities in the United States; 
‘‘(B) establish the plan referred to in sub-
paragraph (A) in consultation with— 
‘‘(i) the Director of the Centers for 
Disease Control and Prevention; 
‘‘(ii) the Director of the National In-
stitutes of Health; 
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‘‘(iii) the Director of the National 
Center on Minority Health and Health 
Disparities; 
‘‘(iv) the Director of the Agency for 
Healthcare Research and Quality; 
‘‘(v) the Administrator of the Health 
Resources and Services Administration; 
‘‘(vi) the Administrator of the Centers 
for Medicare and Medicaid Services; 
‘‘(vii) the Director of the Office for 
Civil Rights; 
‘‘(viii) the Administrator of the Sub-
stance Abuse and Mental Health Services 
Administration; 
‘‘(ix) the Commissioner of Food and 
Drugs; and 
‘‘(x) the heads of other appropriate 
public and private entities; 
‘‘(C) ensure that the plan includes measur-
able objectives, describes the means for achiev-
ing such objectives, and designates a date by 
which such objectives are expected to be 
achieved; 
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‘‘(D) ensure that all amounts appropriated 
for such activities are expended in accordance 
with the plan; 
‘‘(E) review the plan on at least an annual 
basis and revise the plan as appropriate; 
‘‘(F) ensure that the plan will serve as a 
binding statement of policy with respect to the 
agencies’ activities related to disparities in 
health and healthcare; and 
‘‘(G) not later than March 1 of each year, 
submit the plan (or any revisions to the plan), 
to the Committee on Health, Education, Labor, 
and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Rep-
resentatives. 
‘‘(2) COMPONENTS OF THE PLAN.—The Deputy 
Assistant Secretary shall ensure that the comprehen-
sive plan established under paragraph (1) address-
es— 
‘‘(A) the recommendations of the 2002 In-
stitute of Medicine report (Unequal Treatment) 
with respect to racial and ethnic disparities in 
healthcare; 
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118 
‘‘(B) health and disease prevention edu-
cation for racial, ethnic, and primary language 
health disparity populations; 
‘‘(C) research to identify sources of health 
and healthcare disparities in minority groups; 
‘‘(D) the implementation and assessment 
of promising intervention strategies; 
‘‘(E) data collection and the monitoring of 
the healthcare and health status of health dis-
parity populations; 
‘‘(F) care of individuals who lack pro-
ficiency with the English language; 
‘‘(G) care of individuals with low func-
tional health literacy; 
‘‘(H) the training, recruitment, and reten-
tion of minority health professionals; 
‘‘(I) programs to expand and facilitate ac-
cess to healthcare services, including the use of 
telemedicine, National Health Service Scholars, 
community health workers, and case managers; 
‘‘(J) public and health provider awareness 
of racial and ethnic disparities in healthcare; 
‘‘(K) methods to evaluate and measure 
progress toward the goal of eliminating dispari-
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ties in health and healthcare in racial and eth-
nic minority populations; 
‘‘(L) the promotion of interagency and 
intra-agency coordination and collaboration and 
public-private and community partnerships; and 
‘‘(M) the preparedness of health profes-
sionals to care for racially, ethnically, and lin-
guistically diverse populations and low func-
tional health literacy populations including eval-
uations.’’; 
(6) in subsection (d) (as so redesignated)— 
(A) in paragraph (1), by inserting ‘‘and 
Racial, Ethnic, and Primary Language Health 
Disparities 
Elimination’’ 
after 
‘‘Minority 
Health’’; and 
(B) in paragraph (2)— 
(i) by striking ‘‘Deputy Assistant’’; 
and 
(ii) by striking ‘‘(10) of subsection 
(b)’’ and inserting ‘‘(9) of subsection (c)’’; 
(7) in subsection (e)(1) (as so redesignated)— 
(A) in subparagraph (A), by striking ‘‘sub-
section 
(b)(9)’’ 
and 
inserting 
‘‘subsection 
(b)(7)’’; and 
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(B) in subparagraph (B), by striking ‘‘sub-
section (b)(10)’’ and inserting ‘‘subsection 
(b)(8)’’; 
(8) in subsection (f)(3) (as so redesignated), by 
striking ‘‘subsection (f)’’ and inserting ‘‘subsection 
(g)’’; 
(9) in subsection (g)(1) (as so redesignated)— 
(A) by striking ‘‘1999 and each second’’ 
and inserting ‘‘2006 and each’’; 
(B) by striking ‘‘Labor and Human Re-
sources’’ and inserting ‘‘Health, Education, 
Labor, and Pensions’’; 
(C) by striking ‘‘2 fiscal years’’ and insert-
ing ‘‘fiscal year’’; and 
(D) by inserting after ‘‘improving the 
health of racial and ethnic minority groups’’ the 
following: ‘‘reducing and eliminating disparities 
in health and healthcare in racial and ethnic 
minority populations, in accordance with the 
national plan specified under subsection (c) and 
the goals of Healthy People 2010’’; 
(10) by inserting after subsection (g) (as so re-
designated) the following: 
‘‘(h) FEDERAL PARTNERSHIP WITH ACCREDITATION 
ENTITIES.— 
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‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of the Healthcare Equality 
and Accountability Act, the Secretary, in collabora-
tion with the Director of the Agency for Healthcare 
Research and Quality, the Administrator of the Cen-
ters for Medicare and Medicaid Services, the Direc-
tor of the Office for Minority Health, and the heads 
of appropriate State agencies, shall convene a work-
ing group with members of accreditation organiza-
tions and other quality standard setting organiza-
tions to develop guidelines to evaluate and report on 
the health and healthcare of minority populations 
served by health centers, health plans, hospitals, and 
other federally funded health entities. 
‘‘(2) REPORT.—Not later than 6 months after 
the convening of the working group under paragraph 
(1), the working group shall submit a report to the 
Secretary at such time, in such manner, and con-
taining such information as the Secretary may re-
quire, including guidelines and recommendations on 
how each accreditation body will work with con-
stituent members to ensure the adoption of such 
guidelines. 
‘‘(3) DEMONSTRATION
PROJECTS.—The Sec-
retary, acting through the Administrator of the Cen-
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ters for Medicare and Medicaid Services, shall award 
grants for the establishment of demonstration 
projects to assess the impact of providing financial 
incentives for the reporting and analysis of the qual-
ity of minority healthcare by hospitals, health plans, 
health centers, and other healthcare entities. 
‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.— 
There are authorized to be appropriated to carry out 
this subsection, such sums as may be necessary for 
each of fiscal years 2007 through 2012. 
‘‘(i) PREPARATION OF HEALTH PROFESSIONALS TO 
PROVIDE HEALTHCARE TO MINORITY POPULATIONS.— 
The Secretary, in collaboration with the Director of the 
Bureau of Health Professions and the Deputy Assistant 
Secretary for Minority Health Disparity Elimination, shall 
require that health professional schools that receive Fed-
eral funds train future health professionals to provide cul-
turally and linguistically appropriate healthcare to diverse 
populations.’’; and 
(11) by striking subsection (k) (as so redesig-
nated) and inserting the following: 
‘‘(k) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section (other than subsection 
(h)), there is authorized to be appropriated $100,000,000 
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for fiscal year 2006, and such sums as may be necessary 
for each of fiscal years 2007 through 2012.’’. 
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 
healthcare 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. 
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(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 
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 healthcare 
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.); 
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(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 XXIX of the Public Health Serv-
ice Act; and 
(4) all scholarship and loan functions carried 
out under title I of the Indian Health Care Improve-
ment Act. 
(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 
VerDate Aug 31 2005 
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bajohnson on PROD1PC77 with BILLS