144
to ensure that navigators are informed about 
health insurance systems and are able to aid 
patients in resolving access issues; and 
(F) ensuring that consumers have direct 
access to patient navigators during regularly 
scheduled hours of business operation. 
(2) OUTREACH SERVICES.—A condition for the 
receipt of a grant under paragraph (1) is that the 
applicant involved agree to provide ongoing outreach 
activities while receiving the grant, in a manner that 
is culturally competent for the health disparity popu-
lation served by the program, to inform the public 
and the specific community that the patient navi-
gator is serving of the services of the model program 
under the grant. 
(3) DATA COLLECTION AND REPORT.—In order 
to allow for effective patient navigator program eval-
uation, the grantee shall collect specific patient data 
recording navigation services provided to each pa-
tient served by the program and shall establish and 
implement procedures and protocols, consistent with 
applicable Federal and State laws (including 45 
C.F.R. 160 and 164) to ensure the confidentiality of 
all information shared by a participant in the pro-
gram, or their personal representative and their
145
health care providers, group health plans, or health 
insurance insurers with the program. The patient 
navigator program may, consistent with applicable 
Federal and State confidentiality laws, collect, use 
or disclose aggregate information that is not individ-
ually identifiable (as defined in 45 C.F.R. 160 and 
164). With this data, the grantee shall submit an 
annual report to the Secretary that summarizes and 
analyzes these data, provides information on needs 
for navigation services, types of access difficulties re-
solved, sources of repeated resolution and flaws in 
the system of access, including insurance barriers. 
(4) APPLICATION FOR GRANT.—A grant may be 
made under paragraph (1) only if an application for 
the grant is submitted to the Secretary and the ap-
plication is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section. 
(5) EVALUATIONS.—
(A) IN GENERAL.—The Secretary, acting 
through the Director of the Indian Health Serv-
ice, shall, directly or through grants or con-
tracts, provide for evaluations to determine the 
effects of the services of patient navigators on
146
the individuals of health disparity populations 
for whom the services were provided, taking 
into account the matters referred to in para-
graph (1)(C). 
(B) DISSEMINATION
OF
FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A). 
(6) COORDINATION WITH OTHER PROGRAMS.—
The Secretary shall coordinate the program under 
this subsection with the program under subsection 
(a) and with the program under section 417D. 
(c) REQUIREMENTS REGARDING FEES.—
(1) IN GENERAL.—A condition for the receipt 
of a grant under subsection (a)(1) or (b)(1) is that 
the program for which the grant is made have in ef-
fect—
(A) a schedule of fees or payments for the 
provision of its health care services related to 
the prevention and treatment of disease that is 
consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and 
(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or
147
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
(2) RULE OF CONSTRUCTION.—Nothing in this 
section shall be construed to require payment for 
navigation services or to require payment for health 
care services in cases, such as with the Indian 
Health Service, where care is provided free of 
charge. 
(d) MODEL.—Not later than five years after the date 
of the enactment of this section, the Secretary shall de-
velop a peer-reviewed model of systems for the services 
provided by this section. The Secretary shall update such 
model as may be necessary to ensure that the best prac-
tices are being utilized. 
(e) DURATION OF GRANT.—The period during which 
payments are made to an entity from a grant under sub-
section (a)(1) or (b)(1) may not exceed five years. The 
provision of such payments are subject to annual approval 
by the Secretary of the payments and subject to the avail-
ability of appropriations for the fiscal year involved to 
make the payments. This subsection may not be construed 
as establishing a limitation on the number of grants under 
such subsection that may be made to an entity. 
(f) DEFINITIONS.—For purposes of this section:
148
(1) The term ‘‘culturally competent’’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients. 
(2) The term ‘‘appropriate follow-up care’’ in-
cludes palliative and end-of-life care. 
(3) The term ‘‘health disparity population’’ 
means a population where there exists a significant 
disparity in the overall rate of disease incidence, 
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
(A) racial and ethnic minority groups as 
defined in section 1707; and 
(B) medically underserved groups, such as 
rural and low-income individuals and individ-
uals with low levels of literacy. 
(4)(A) The term ‘‘patient navigator’’ means an 
individual whose functions include—
(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the 
health care system to accomplish the follow-up
149
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease, including pro-
viding information about clinical trials; and 
(ii) identifying, anticipating, and helping 
patients overcome barriers within the health 
care system to ensure prompt diagnostic and 
treatment resolution of an abnormal finding of 
cancer or other chronic disease. 
(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
(g) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—
(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) (other than the 
purpose described in paragraph (2)(A)), there 
are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 
2004 through 2008. 
(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) (other than 
the purpose described in paragraph (2)(B)), 
there are authorized to be appropriated such
150
sums as may be necessary for each of the fiscal 
years 2004 through 2008. 
(C) 
BUREAU
OF
PRIMARY
HEALTH 
CARE.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through 
the Bureau of Primary Health Care. 
(2) PROGRAMS IN RURAL AREAS.—
(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) by making grants 
under such subsection for model programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2004 through 2008. 
(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) by making 
grants under such subsection for programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2004 through 2008. 
(C) OFFICE OF RURAL HEALTH POLICY.—
Amounts appropriated under subparagraph (A) 
or (B) shall be administered through the Office 
of Rural Health Policy. 
(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs
151
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs. 
TITLE IV—STRENGTHENING OUR 
HEALTH CARE WORKFORCE 
Subtitle A—Hispanic-Serving 
Health Professions Schools 
SEC. 
401. 
HISPANIC-SERVING 
HEALTH 
PROFESSIONS 
SCHOOLS. 
(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall make grants to Hispanic-serving health 
professions schools for the purpose of carrying out pro-
grams to recruit Hispanic individuals to enroll in and 
graduate from the schools, which may include providing 
scholarships and other financial assistance as appropriate. 
(b) ELIGIBILITY.—For purposes of subsection (a), an 
entity is a Hispanic-serving health professions school if the 
entity—
(1) is a school or program under section 799B 
of the Public Health Service Act (42 U.S.C. 295p); 
(2) has an enrollment of full-time equivalent 
students that is at least 9 percent Hispanic stu-
dents;
152
(3) has been effective in carrying out programs 
to recruit Hispanic individuals to enroll in and grad-
uate from the school; 
(4) has been effective in recruiting and retain-
ing Hispanic faculty members; and 
(5) has a significant number of graduates who 
are providing health services to medically under-
served populations or to individuals in health profes-
sional shortage areas. 
(c) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated $80,000,000 for each of fiscal years 
2004 through 2008. 
Subtitle B—Health Career Oppor-
tunity Program and Centers of 
Excellence 
SEC. 411. EDUCATIONAL ASSISTANCE REGARDING UNDER-
GRADUATES. 
(a) IN GENERAL.—Subpart 2 of part E of title VII 
of the Public Health Service Act (42 U.S.C. 295 et seq) 
is amended by adding at the end the following: 
‘‘SEC. 771. HEALTH CAREERS OPPORTUNITY PROGRAM. 
‘‘(a) IN GENERAL.—Subject to the provisions of this 
section, the Secretary may make grants and enter into co-
153
operative agreements and contracts for any of the fol-
lowing purposes: 
‘‘(1) Identifying and recruiting individuals 
who—
‘‘(A) are students of elementary schools, or 
students or graduates of secondary schools or of 
institutions of higher education; 
‘‘(B) are from disadvantaged backgrounds; 
and 
‘‘(C) are interested in a career in the 
health professions. 
‘‘(2) Facilitating the entry of such individuals 
into a health professions school. 
‘‘(3) Providing counseling or other services de-
signed to assist such individuals in successfully com-
pleting their education at such a school. 
‘‘(4) Providing, for a period prior to the entry 
of such individuals into the regular course of edu-
cation of such a school, preliminary education de-
signed to assist the individuals in successfully com-
pleting such regular course of education at such a 
school, or referring such individuals to institutions 
providing such preliminary education. 
‘‘(5) Paying such stipends as the Secretary may 
approve for such individuals for any period of edu-
154
cation in student-enhancement programs (other than 
regular courses) at a health professions school, ex-
cept that such a stipend may not be provided to an 
individual for more than 12 months, and such a sti-
pend may not exceed $25 per day (notwithstanding 
any other provision of law regarding the amount of 
stipends). 
‘‘(6) Carrying out programs under which such 
individuals both— 
‘‘(A) gain experience regarding a career in 
a field of primary health care through working 
at facilities of nonprofit private community-
based providers of primary health services; and 
‘‘(B) receive academic instruction to assist 
in preparing the individuals to enter health pro-
fessions schools in such fields. 
‘‘(b) RECEIPT OF AWARD.—
‘‘(1) ELIGIBLE
ENTITIES; REQUIREMENT
OF 
CONSORTIUM.—The Secretary may make an award 
under subsection (a) only if the following conditions 
are met: 
‘‘(A) The applicant for the award is a pub-
lic or nonprofit private entity, and the applicant 
has established a consortium consisting of non-
156
‘‘(i) that each of the members will 
comply with the conditions upon which the 
award is made; and 
‘‘(ii) whether and to what extent the 
award will be allocated among the mem-
bers.
‘‘(2) 
REQUIREMENT
OF
COMPETITIVE 
AWARDS.—Awards under subsection (a) shall be 
made only on a competitive basis. 
‘‘(c) FINANCIAL REQUIREMENTS.—
‘‘(1) ASSURANCES REGARDING CAPACITY.—The 
Secretary may make an award under subsection (a) 
only if the Secretary determines that, in the case of 
activities carried out under the award that prove to 
be effective toward achieving the purposes of the
activities—
‘‘(A) the members of the consortium in-
volved have or will have the financial capacity 
to continue the activities, regardless of whether 
financial assistance under subsection (a) con-
tinues to be available; and 
‘‘(B) the members of the consortium dem-
onstrate to the satisfaction of the Secretary a 
commitment to continue such activities, regard-
157
less of whether such assistance continues to be 
available. 
‘‘(2) MATCHING FUNDS.—
‘‘(A) IN GENERAL.—With respect to the 
costs of the activities to be carried out under 
subsection (a) by an applicant, the Secretary 
may make an award under such subsection only 
if the applicant agrees to make available in cash 
(directly or through donations from public or 
private entities) non-Federal contributions to-
ward such costs in an amount that, for any 
fourth or subsequent fiscal year for which the 
applicant receives such an award, is not less 
than 50 percent of such costs. 
‘‘(B) FEDERAL AMOUNTS.—Amounts pro-
vided by the Federal Government may not be 
included in determining the amount of non-Fed-
eral contributions required in subparagraph 
(A). 
‘‘(C) LIMITATION.—The Secretary may not 
require non-Federal contributions for the first 
three fiscal years for which an applicant re-
ceives a grant under subsection (a). 
‘‘(d) PREFERENCE IN MAKING AWARDS.—
‘‘(1) IN GENERAL.—
158
‘‘(A) REQUIREMENT.—In making awards 
under subsection (a), the Secretary shall, sub-
ject to paragraph (3), give preference to any
applicant that, for the purpose described in sub-
paragraph (B), has made an arrangement with 
not less than one entity from each of the fol-
lowing categories of entities: Community-based 
organizations, elementary schools, secondary 
schools, institutions of higher education, and 
health professions schools. 
‘‘(B) PURPOSE.—The purpose of arrange-
ments under subparagraph (A) is to establish a 
program for individuals identified under sub-
section (a) under which—
‘‘(i) the activities described in such 
subsection are carried out on behalf of the 
individuals; and 
‘‘(ii) health professions schools make 
a commitment to admit as students of the 
schools such individuals who participate in 
the program, subject to the individuals 
meeting reasonable academic standards for 
admission to the schools. 
‘‘(2) ADDITIONAL PREFERENCES.—Of the ap-
plicants under subsection (a) that are receiving pref-
159
erence for purposes of paragraph (1), the Secretary 
shall, subject to paragraph (3), give additional pref-
erence to applicants whose consortium under sub-
section (b) includes as members one or more health 
professions schools that have not previously received 
any award under this section (including this section 
as in effect prior to fiscal year 1997). 
‘‘(3) LIMITATION.—An applicant may not re-
ceive preference for purposes of paragraph (1) or (2) 
unless the consortium under subsection (b) includes 
not less than one health professions school that has 
demonstrated success in enrolling students from dis-
advantaged backgrounds. 
‘‘(e) OBJECTIVES UNDER AWARDS.—
‘‘(1) ESTABLISHMENT OF OBJECTIVES.—Before 
making a first award to an applicant under sub-
section (a), the Secretary shall establish objectives 
regarding the activities to be carried out under the 
award, which objectives are applicable until the next 
fiscal year for which such award is made after a 
competitive process of review. In making an award 
after such a review, the Secretary shall establish ad-
ditional objectives for the applicant. 
‘‘(2) 
PRECONDITION
FOR
SUBSEQUENT 
AWARDS.—In the case of an applicant seeking an
160
award under subsection (a) pursuant to a competi-
tive process of review, the Secretary may make the 
award only if the applicant demonstrates to the sat-
isfaction of the Secretary that the applicant has met 
the objectives that were applicable under paragraph 
(1) to the preceding awards under such subsection. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated $33,000,000 for fiscal year 2004, 
$40,000,000 for fiscal year 2005, and such sums as may 
be necessary for each subsequent fiscal year.’’. 
(b) TECHNICAL AMENDMENT.—Section 770(a) of the 
Public Health Service Act (42 U.S.C. 295e(a)) is amended 
by inserting ‘‘(other than section 771)’’ after ‘‘this sub-
part’’. 
SEC. 412. CENTERS OF EXCELLENCE. 
For the purpose of establishing and operating health 
careers centers of excellence, there are authorized to be 
appropriated $80,000,000 for fiscal year 2004 and each 
subsequent fiscal year.
161
Subtitle C—Bilingual Health 
Professionals 
SEC. 421. TRAINING OF BILINGUAL HEALTH PROFES-
SIONALS 
WITH 
RESPECT 
TO 
MINORITY 
HEALTH CONDITIONS. 
(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Health Resources and Services Ad-
ministration, shall (directly or through awards of grants 
or contracts to public or nonprofit private entities) carry 
out a program—
(1) to identify health professionals who speak 
both English and a language used by racial or ethnic 
minority groups in the United States; and 
(2) to train such health professionals with re-
spect to the treatment of health conditions known to 
disproportionately affect racial/ethnic minorities, 
such as diabetes, asthma, obesity, injuries, under-im-
munization, oral health, HIV infection, substance 
abuse, and conditions regarding mental health. 
(b) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out subsection (a), there are author-
ized to be appropriated such sums as may be necessary 
for each of the fiscal years 2004 through 2008.
162
Subtitle D—Cultural Competence 
SEC. 431. DEFINITION. 
(a) IN GENERAL.—In this Act, the term ‘‘culturally 
competent’’, with respect to the manner in which health-
related services, education, and training are provided, 
means providing the services, education, and training in 
the language and cultural context that is most appropriate 
for the individuals for whom the services, education, and 
training are intended, including as necessary the provision 
of bilingual services. 
(b) MODIFICATION.—The definition established in 
subsection (a) may be modified as needed at the discretion 
of the Secretary after providing a 30-day notice to Con-
gress. 
SEC. 432. ACTIVITIES OF OFFICE OF MINORITY HEALTH; 
CENTER FOR LINGUISTIC AND CULTURAL 
COMPETENCE IN HEALTH CARE. 
(a) EDUCATIONAL MATERIALS; TECHNICAL ASSIST-
ANCE.—
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Office of Minority Health under section 
1707 of the Public Health Service Act (42 U.S.C. 
300u–6), shall—
163
(A) provide for the development of edu-
cational materials on providing health services 
in a culturally competent manner; 
(B) provide technical assistance in carrying 
out programs that use such materials; and 
(C) provide technical assistance on other 
matters regarding the provision of health serv-
ices in a culturally competent manner. 
(2) AUTHORIZATION OF APPROPRIATIONS.—For 
the purpose of carrying out paragraph (1), there are 
authorized to be appropriated $5,000,000 for fiscal 
year 2004, and such sums as may be necessary for 
each of the fiscal years 2005 through 2008.
(b) CENTER FOR LINGUISTIC AND CULTURAL COM-
PETENCE IN HEALTH CARE.—
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Office of Minority Health under section 
1707 of the Public Health Service Act (42 U.S.C. 
300u–6), shall provide for a Center for Linguistic 
and Cultural Competence in Health Care to carry 
out programs to promote and facilitate the provision 
of health-related services, education, and training in 
a culturally competent manner. 
(2) AUTHORIZATION OF APPROPRIATIONS.—For 
the purpose of carrying out paragraph (1), there are
164
authorized to be appropriated $5,000,000 for fiscal 
year 2004, and such sums as may be necessary for 
each of the fiscal years 2005 through 2008. 
SEC. 
433. 
CULTURAL 
COMPETENCE 
DEMONSTRATION 
PROJECTS. 
(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Centers for Medicare & Medicaid 
Services, shall conduct a cultural competence demonstra-
tion project under which grants are made to two hospitals 
with a history in medicare, medicaid, and the uninsured 
to enable them to implement standards for the culturally 
competent provision of services to address the specific 
needs of any population that constitutes at least 5 percent 
of the population served by the hospital involved. 
(b) NUMBER AND TYPE.—Of the hospitals provided 
grants under this section, one shall be located in an urban 
and the other in a rural area (as defined in section 
1886(d)(2)(D) of the Social Security Act (42 U.S.C. 
1395ww(d)(2)(d)). The urban hospital shall serve a sig-
nificant limited English proficient population and be with-
in 175 miles of the border with Mexico. In selecting such 
hospitals, the Secretary shall give preference to hospitals 
that serve large immigrant populations.
165
(c) AMOUNT AND DURATION OF GRANT.—A grant 
under this section for a hospital shall be in the amount 
of $5,000,000 and shall be for a period of 5 years. 
(d) EVALUATION AND REPORT.—
(1) EVALUATION.—The Secretary shall also 
provide for a grant to an appropriate qualified entity 
in an amount not to exceed $1,000,000 to evaluate 
the demonstration projects conducted under this sec-
tion. 
(2) REPORT.—The Secretary shall submit to 
Congress a report on the projects conducted under 
this section. The Secretary shall include in such re-
port the results of the evaluation conducted under 
paragraph (1) and recommendations on whether on 
going medicare funding should be provided for im-
plementation of standards for cultural competency in 
hospitals. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated from the Federal Hos-
pital Insurance Trust Fund (under section 1817 of the 
Social Security Act (42 U.S.C. 1395i) to carry out this 
section, $11,000,000, which shall remain available until 
expended.
166
TITLE V—ADDITIONAL 
PROGRAMS 
Subtitle A—Data Regarding Race 
and Ethnicity 
SEC. 501. COLLECTION OF DATA. 
Part A of title III of the Public Health Service Act 
(42 U.S.C. 241 et seq.) is amended by inserting after sec-
tion 306 the following: 
‘‘SEC. 306A. DATA ON RACE AND ETHNICITY. 
‘‘(a) IN GENERAL.—The Secretary shall by regula-
tion provide for the following: 
‘‘(1) Health data collected under programs car-
ried out by the Secretary (whether collected directly 
or pursuant to grants, cooperative agreements, or 
contracts) shall include data on race, ethnicity, and 
spoken and written language and shall, at a min-
imum, use the categories for race and ethnicity de-
scribed in OMB Directive 15. 
‘‘(2) Data collected by the Secretary pursuant 
to title VI of the Civil Rights Act of 1964 shall in-
clude data on race and ethnicity and shall, at a min-
imum, use such categories. 
‘‘(3) Data on race and ethnicity that is collected 
under paragraph (1) or (2) shall use the procedures 
described in such Directive for collecting data from
167
an individual, and shall be maintained and presented 
(including for reporting purposes) in accordance 
with such Directive. 
‘‘(4) For health encounters that require the 
presence of a legal parent or guardian who does not 
speak English or who is limited English proficient, 
health data collected by the Secretary pursuant to 
this section shall also include data on the of the ac-
companying adult or guardian. 
‘‘(5) Such other data as the Secretary may des-
ignate (including administrative records) shall be 
collected, maintained, and presented in accordance 
with such Directive, to the extent that such data are 
collected by the Secretary and relate to health-re-
lated programs that are carried out by the Sec-
retary. 
‘‘(6) The Secretary is directed to include Puerto 
Rico in the collection of data provider under this 
section. 
‘‘(b) DEFINITION.—In this section, the term ‘OMB 
Directive 15’ means Statistical Policy Directive No. 15, 
Race and Ethnic Standards for Federal Statistics and Ad-
ministrative Reporting, as established by the Director of 
the Office of Management and Budget through the notice
168
issued October 30, 1997 (62 FR 58782). Such term in-
cludes any subsequent revisions to such Directive.’’. 
SEC. 502. DEVELOPMENT OF STANDARDS; STUDY TO MEAS-
URE PATIENT OUTCOMES UNDER MEDICARE 
AND MEDICAID PROGRAMS. 
(a) DEVELOPMENT OF STANDARDS.—Not later than 
1 year after the date of the enactment of this Act, the 
Secretary, acting through the Administrator of the Health 
Care Financing Administration, shall develop outcome 
measures to evaluate, by race and ethnicity, the perform-
ance of health care programs and projects that provide 
health care to individuals under the medicare and med-
icaid programs (under titles XVIII and XIX, respectively, 
of the Social Security Act (42 U.S.C. 1395 et seq.; 1396 
et seq.). 
(b) STUDY.—After the Secretary develops the out-
come measures under subsection (a), the Secretary shall 
conduct a study that evaluates, by race and ethnicity, the 
performance of health care programs and projects referred 
to in subsection (a). 
(c) REPORT TO CONGRESS.—Not later that 2 years 
after the date of the enactment of this Act, the Secretary
shall submit to Congress a report describing the outcome 
measures developed under subsection (a), and the results 
of the study conducted pursuant to subsection (b).
169
Subtitle B—National Assessment of 
Status of Latino Health 
SEC. 511. NATIONAL ASSESSMENT OF STATUS OF LATINO 
HEALTH. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall establish a national assessment of 
the status of Latino health to be known as the ‘‘Hispanic 
Health 
and 
Nutrition 
Examination 
Survey’’ 
or 
‘‘HHANES II’’. 
(b) GOAL.—The goal of the national assessment, in-
cluding Puerto Rice, under subsection (a) shall be to 
produce estimates of health and nutritional status for 
Mexican Americans, Puerto Ricans, Cuban Americans, 
and other Hispanic subpopulations. 
(c) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated such sums as may be nec-
essary in each of fiscal years 2004 through 2006 to carry 
out this section. 
Subtitle C—Office of Minority 
Health 
SEC. 521. REVISION AND EXTENSION OF PROGRAMS OF OF-
FICE OF MINORITY HEALTH. 
Section 1707 of the Public Health Service Act (42 
U.S.C. 300u–6) is amended by striking subsection (b) and 
all that follows and inserting the following:
170
‘‘(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 short-range and long-range goals 
and objectives and coordinate all other activities 
within the Public Health Service that relate to dis-
ease prevention, health promotion, service delivery, 
and research concerning such individuals. 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) Carry out the following types of activities 
by entering into interagency agreements with other 
agencies of the Public Health Service: 
‘‘(A) Support research, demonstrations and 
evaluations to test new and innovative models. 
‘‘(B) Increase knowledge and under-
standing of health risk factors. 
‘‘(C) Develop mechanisms that support 
better information dissemination, education, 
prevention, and service delivery to individuals 
from disadvantaged backgrounds, including in-
171
dividuals who are members of racial or ethnic 
minority groups. 
‘‘(D) Ensure that the National Center for 
Health Statistics collects data on the health 
status of each minority group. 
‘‘(E) With respect to individuals who lack 
proficiency in speaking the English language, 
enter into contracts with public and nonprofit 
private providers of primary health services for 
the purpose of increasing the access of the indi-
viduals to such services by developing and car-
rying out programs to provide bilingual or in-
terpretive services. 
‘‘(3) 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 and health promotion, preventive health 
services, and education in the appropriate use 
of health care. 
‘‘(B) Facilitate access to such information. 
‘‘(C) Assist in the analysis of issues and 
problems relating to such matters.
‘‘(D) Provide technical assistance with re-
spect to the exchange of such information (in-
172
cluding facilitating the development of materials 
for such technical assistance). 
‘‘(4) Carry out programs to improve access to 
health care services for individuals with limited pro-
ficiency in speaking the English language by facili-
tating the removal of impediments to the receipt of 
health care that result from such limitation. Activi-
ties under the preceding sentence shall include con-
ducting research and developing and evaluating 
model projects. 
‘‘(5) Not later than June 8 of each year, the 
Deputy Assistant Secretary shall submit to the Sec-
retary a report summarizing the activities of each of 
the minority health offices under section 1707A. 
‘‘(c) ADVISORY COMMITTEE.—
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an advisory committee to be known as the Advi-
sory Committee on Minority Health (in this sub-
section referred to as the ‘Committee’). The Deputy 
Assistant Secretary shall consult with the Committee 
in carrying out this section. 
‘‘(2) DUTIES.—The Committee shall provide 
advice to the Secretary, including advice on the de-
velopment of goals and specific program activities
173
under paragraphs (1) and (2) of subsection (b) for 
each racial and ethnic minority group. 
‘‘(3) CHAIRPERSON.—The Deputy Assistant 
Secretary shall serve as the chairperson of the Com-
mittee. 
‘‘(4) COMPOSITION.—
‘‘(A) IN GENERAL.—The Committee shall 
be composed of 12 voting members appointed in 
accordance with subparagraph (B), and non-
voting, ex officio members designated under 
subparagraph (C). 
‘‘(B) 
VOTING
MEMBERS.—The 
voting 
members of the Committee shall be appointed 
by the Secretary from among individuals who 
are now officers or employees of the Federal 
Government and who have expertise regarding 
issues of minority health. The racial and ethnic 
minority groups shall be equally represented 
among such members. 
‘‘(C) NONVOTING
MEMBERS.—The non-
voting, ex officio members of the Committee 
shall be the directors of each of the minority 
health office established under section 707A, 
and such additional officials of the Department
174
of Health and Human Services as the Secretary 
determines to be appropriate. 
‘‘(5) TERMS.—Each member of the Committee 
shall serve for a term of 4 years, except that the 
Secretary shall initially appoint a portion of the 
members to terms of 1 year, 2 years, and 3 years. 
‘‘(6) VACANCIES.—If a vacancy occurs on the 
Committee, a new member shall be appointed by the 
Secretary within 90 days from the date on which the 
vacancy occurs, and shall serve for the remainder of 
the term for which the predecessor of such member 
was appointed. A vacancy shall not affect the power 
of the remaining members to execute the duties of 
the Committee. 
‘‘(7) COMPENSATION.—Members of the Com-
mittee who are officers or employees of the United 
States shall serve without compensation. Members of 
the Committee who are not officers or employees of 
the United States shall receive, for each day (includ-
ing travel time) they are engaged in the performance 
of the functions of the Committee compensation in 
an amount that is not in excess of the daily equiva-
lent of the annual maximum rate of basic pay pay-
able under the General Schedule (under title 5, 
United States Code) for positions above GS-15.
175
‘‘(d) CERTAIN
REQUIREMENTS
REGARDING
DU-
TIES.—
‘‘(1) RECOMMENDATIONS
REGARDING
LAN-
GUAGE AS IMPEDIMENT TO HEALTH CARE.—The di-
rectors of the offices of minority health within the 
Department of Health and Human Services, the Di-
rector of the Office of Civil Rights, and the Director 
of the Office of Refugee Health shall seek input 
from the State minority health offices and make rec-
ommendations to the Secretary regarding activities 
under subsection (b)(4). 
‘‘(2) EQUITABLE ALLOCATION REGARDING AC-
TIVITIES.—
‘‘(A) In making awards of grants, coopera-
tive agreements, or contracts under this section 
or section 338A, 338B, 724, 736, 737, 738, or 
740, the Secretary, acting as appropriate 
through the Deputy Assistant Secretary or the 
Administrator of the Health Resources and 
Services Administration, shall ensure that such 
awards are equitably allocated with respect to 
the various racial and minority populations. 
‘‘(B) With respect to grants, cooperative 
agreements, and contracts that are available
176
under the sections specified in subparagraph 
(A), the Secretary shall—
‘‘(i) carry out activities to inform enti-
ties, as appropriate, that the entities may 
be eligible for awards of such assistance; 
‘‘(ii) provide technical assistance to 
such entities in the process of preparing 
and submitting applications for the awards 
in accordance with the policies of the Sec-
retary regarding such application; and 
‘‘(iii) inform populations, as appro-
priate, that members of the populations 
may be eligible to receive services or other-
wise participate in the activities carried out 
with such awards. 
‘‘(3) CULTURAL COMPETENCY OF SERVICES.—
The Secretary shall ensure that information and 
services provided pursuant to subsection (b) are pro-
vided in the language and cultural context that is 
most appropriate for the individuals for whom the 
information and services are intended.
‘‘(e) GRANTS
AND CONTRACTS REGARDING DU-
TIES.—
‘‘(1) IN GENERAL.—In carrying out subsection 
(b), the Deputy Assistant Secretary may make
177
awards of grants, cooperative agreements, and con-
tracts to public and nonprofit private entities. 
‘‘(2) PROCESS
FOR
MAKING
AWARDS.—The 
Deputy Assistant Secretary shall ensure that awards 
under paragraph (1) are made to the extent prac-
ticable on a competitive basis, and that an award is 
made for a proposal only if the proposal has been 
recommended for such an award through a process 
of peer review. 
‘‘(3) EVALUATION AND DISSEMINATION.—The 
Deputy Assistant Secretary, directly or through con-
tracts with public and private entities, shall provide 
for evaluations of projects carried out with awards 
made under paragraph (1) during the preceding 2 
fiscal years. The report shall be included in the re-
port required under subsection (f) for the fiscal year 
involved. 
‘‘(f) BIENNIAL REPORTS.—Not later than February 
1 of fiscal year 1998 and of each second year thereafter, 
the Deputy Assistant Secretary shall submit to the Com-
mittee on Energy and Commerce of the House of Rep-
resentatives, and to the Committee on Labor and Human 
Resources of the Senate, a report describing the activities 
carried out under this section during the preceding 2 fiscal 
years and evaluating the extent to which such activities
178
have been effective in improving the health of racial and 
ethnic minority groups. Each such report shall include the 
biennial reports submitted to the Deputy Assistant Sec-
retary under section 1707A(e) for such years by the heads 
of the minority health offices. 
‘‘(g) DEFINITION.—For purposes of this section: 
‘‘(1) RACIAL AND ETHNIC MINORITY GROUP.—
The term ‘racial and ethnic minority group’ means 
American Indians (including Alaskan Natives, Eski-
mos, and Aleuts); Asian Americans and Pacific Is-
landers; Blacks; and Hispanics/Latinos. 
‘‘(2) HISPANIC/LATINOS.—The term ‘Hispanic/
Latinos’ means individuals whose origin is Mexican, 
Puerto Rican, Cuban, Central or South American, or 
any other Spanish-speaking country. 
‘‘(h) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section, there 
are authorized to be appropriated $150,000,000 for 
each of fiscal years 2004 through 2006. 
‘‘(2) ALLOCATION OF FUNDS BY SECRETARY.—
Of the amounts appropriated under paragraph (1) 
for a fiscal year in excess of $50,000,000, the Sec-
retary shall make available not less than $3,000,000 
for carrying out subsection (b)(2)(E).’’.
179
SEC. 522. ESTABLISHMENT OF INDIVIDUAL OFFICES OF MI-
NORITY HEALTH WITHIN AGENCIES OF PUB-
LIC 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: 
‘‘SEC. 1707A. INDIVIDUAL OFFICES OF MINORITY HEALTH 
WITHIN PUBLIC HEALTH SERVICE. 
‘‘(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 Agency for Healthcare Research 
and Quality. 
‘‘(C) The Health Resources and Services 
Administration.
180
‘‘(D) The Substance Abuse and Mental 
Health Services Administration. 
‘‘(E) The Centers for Medicare & Medicaid 
Services. 
‘‘(F) The Agency for Toxic Substances and 
Disease Registry. 
‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For 
purposes of subsection (c) and the subsequent provi-
sions of this section, the term ‘minority health office’ 
includes the National Center on Minority Health 
and Health Disparities established within the Na-
tional Institutes of Health. The Director of the Na-
tional Institutes of Health shall carry out this sec-
tion (as this section relates to the agency) acting 
through the Director of such Office. 
‘‘(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 
that are present in significant numbers in the United
States. The head of such agency shall ensure that, of such 
officers and employees who are members of racial and eth-
nic minority groups, no one group is disproportionately 
represented in the overall office composition.
181
‘‘(d) DUTIES.—Each Director of a minority health of-
fice shall monitor the programs of the specified agency of 
such office in order to carry out the following: 
‘‘(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 
‘‘(C) the programs utilize racial and ethnic 
minority community-based organizations to de-
liver the services.
183
‘‘(3) SPECIFIED AGENCY.—The term ‘specified 
agency’ means—
‘‘(A) an agency specified in subsection 
(b)(1); and 
‘‘(B) the National Institutes of Health. 
‘‘(g) FUNDING.—
‘‘(1) ALLOCATIONS.—Of the amounts appro-
priated for a specified agency for a fiscal year, the 
Secretary may reserve not more than 0.5 percent for 
the purpose of carrying out activities under this sec-
tion through the minority health office of the agen-
cy. In reserving an amount under the preceding sen-
tence for a minority health office for a fiscal year, 
the Secretary shall reduce, by substantially the same 
percentage, the amount that otherwise 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-
able under paragraph (1) may be expended by a mi-
nority health office include the costs of employing 
staff for such office.’’.
184
SEC. 523. ASSISTANT SECRETARY OF HEALTH AND HUMAN 
SERVICES FOR CIVIL RIGHTS. 
(a) IN GENERAL.—Part A of title II of the Public 
Health Service Act (42 U.S.C. 202 et seq.) is amended 
by adding at the end the following: 
‘‘SEC. 229. ASSISTANT SECRETARY FOR CIVIL RIGHTS. 
‘‘(a) ESTABLISHMENT OF POSITION.—There shall be 
in the Department of Health and Human Services an As-
sistant Secretary for Civil Rights, who shall be appointed 
by the President, by and with the advice and consent of 
the Senate. 
‘‘(b) RESPONSIBILITIES.—The Assistant Secretary 
shall perform such functions relating to civil rights as the 
Secretary may assign.’’. 
(b) CONFORMING AMENDMENT.—Section 5315 of 
title 5, United States Code, is amended, in the item relat-
ing to Assistant Secretaries of Health and Human Serv-
ices, by striking ‘‘(6)’’ and inserting ‘‘(7)’’.
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