280 
dividual eligibility determinations for the 
purpose of administering short-term, non- 
cash, in-kind emergency disaster relief to 
communities. 
(ii) APPLICABILITY OF CERTAIN SO-
CIAL SERVICES BLOCK GRANT FUNDS USE 
LIMITATIONS.—The State shall use the 
funds subject to the limitations in section 
2005 of the Social Security Act, except 
that, for purposes of this clause, section 
2005(a)(2) and 2005(a)(8) of such Act 
shall not apply. 
(iii) NO SUPPLANTATION OF CERTAIN 
STATE
FUNDS.—The State may use the 
funds to supplement, not supplant, State 
general revenue funds for social services. 
(iv) BAN ON USE FOR CERTAIN COSTS 
REIMBURSABLE BY FEMA.—The State may 
not use the funds for costs that are reim-
bursable by the Federal Emergency Man-
agement Agency, under a contract for in-
surance, or by self-insurance. 
(b) FUNDING FOR FEDERALLY RECOGNIZED INDIAN 
TRIBES AND TRIBAL ORGANIZATIONS.— 
(1) GRANTS.— 
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(A) IN GENERAL.—Within 90 days after 
the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall 
make grants to federally recognized Indian 
Tribes and Tribal organizations. 
(B) AMOUNT OF GRANT.—The amount of 
the grant for an Indian Tribe or Tribal organi-
zation shall bear the same ratio to the amount 
appropriated by paragraph (3) as the total 
amount of grants awarded to the Indian Tribe 
or Tribal organization under the Low-Income 
Home Energy Assistance Act of 1981 and the 
Community Service Block Grant for fiscal year 
2020 bears to the total amount of grants 
awarded to all Indian Tribes and Tribal organi-
zations under such Act and such Grant for the 
fiscal year. 
(2) RULES
GOVERNING
USE
OF
FUNDS.—An 
entity to which a grant is made under paragraph (1) 
shall obligate the funds not later than December 31, 
2020, and the funds shall be expended by grantees 
and subgrantees not later than December 31, 2021, 
and used in accordance with the following: 
(A) PURPOSE.— 
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(i) IN GENERAL.—The grantee shall 
use the funds only to support the provision 
of emergency services to disadvantaged 
households. 
(ii) DISADVANTAGED
DEFINED.—In 
clause (i), the term ‘‘disadvantaged’’ 
means, with respect to an entity, that the 
entity— 
(I) is an individual, or is located 
in a community, that is experiencing 
material hardship; 
(II) is a household in which there 
is a child (as defined in section 12(d) 
of the Richard B. Russell National 
School Lunch Act) or a child served 
under section 11(a)(1) of such Act, 
who, if not for the closure of the 
school attended by the child during a 
public health emergency designation 
and due to concerns about a COVID– 
19 outbreak, would receive free or re-
duced price school meals pursuant to 
such Act; 
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(III) is an individual, or is lo-
cated in a community, with barriers to 
employment; or 
(IV) is located in a community 
that, as of the date of the enactment 
of this Act, is not experiencing a 56- 
day downward trajectory of— 
(aa) influenza-like illnesses; 
(bb) COVID-like syndromic 
cases; 
(cc) documented COVID–19 
cases; or 
(dd) positive test results as 
a percentage of total COVID–19 
tests. 
(B) METHODS.— 
(i) IN GENERAL.—The grantee shall 
use the funds only for— 
(I) administering emergency serv-
ices; 
(II) providing short-term, non- 
cash, in-kind emergency disaster re-
lief; and 
(III) tribal emergency social serv-
ice operations. 
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(ii) 
ADMINISTERING
EMERGENCY 
SERVICES
DEFINED.—In clause (i), the 
term ‘‘administering emergency services’’ 
means— 
(I) providing basic economic and 
well-being necessities to ensure com-
munities are able to safely observe 
shelter-in-place and social distancing 
orders; 
(II) providing necessary supplies 
such as masks, gloves, and soap, to 
protect the public against infectious 
disease; and 
(III) connecting individuals, chil-
dren, and families to services or pay-
ments for which they may already be 
eligible. 
(C) PROHIBITIONS.— 
(i) NO INDIVIDUAL ELIGIBILITY DE-
TERMINATIONS
BY
GRANTEES
OR
SUB-
GRANTEES.—Neither the grantee nor any 
subgrantee may exercise individual eligi-
bility determinations for the purpose of ad-
ministering short-term, non-cash, in-kind 
emergency disaster relief to communities. 
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(ii) BAN ON USE FOR CERTAIN COSTS 
REIMBURSABLE
BY
FEMA.—The grantee 
may not use the funds for costs that are 
reimbursable by the Federal Emergency 
Management Agency, under a contract for 
insurance, or by self-insurance. 
(3) APPROPRIATION.—Out of any money in the 
Treasury of the United States not otherwise appro-
priated, there are appropriated to the Secretary of 
Health and Human Services $400,000,000 to carry 
out this subsection. 
SEC. 606. SUPPLEMENTAL NUTRITION ASSISTANCE PRO-
GRAM. 
(a) VALUE
OF BENEFITS.—Notwithstanding any 
other provision of law, beginning on June 1, 2020, and 
for each subsequent month through September 30, 2021, 
the value of benefits determined under section 8(a) of the 
Food and Nutrition Act of 2008 (7 U.S.C. 2017(a)), and 
consolidated block grants for Puerto Rico and American 
Samoa determined under section 19(a) of such Act (7 
U.S.C. 2028(a)), shall be calculated using 115 percent of 
the June 2019 value of the thrifty food plan (as defined 
in section 3 of such Act (7 U.S.C. 2012)) if the value of 
the benefits and block grants would be greater under that 
calculation than in the absence of this subsection. 
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(b) MINIMUM AMOUNT.— 
(1) IN GENERAL.—The minimum value of bene-
fits determined under section 8(a) of the Food and 
Nutrition Act of 2008 (7 U.S.C. 2017(a)) for a 
household of not more than 2 members shall be $30. 
(2) EFFECTIVENESS.—Paragraph (1) shall re-
main in effect until the date on which 8 percent of 
the value of the thrifty food plan for a household 
containing 1 member, rounded to the nearest whole 
dollar increment, is equal to or greater than $30. 
(c) REQUIREMENTS FOR THE SECRETARY.—In car-
rying out this section, the Secretary shall— 
(1) consider the benefit increases described in 
each of subsections (a) and (b) to be a ‘‘mass 
change’’; 
(2) require a simple process for States to notify 
households of the increase in benefits; 
(3) consider section 16(c)(3)(A) of the Food 
and Nutrition Act of 2008 (7 U.S.C. 2025(c)(3)(A)) 
to apply to any errors in the implementation of this 
section, without regard to the 120-day limit de-
scribed in that section; 
(4) disregard the additional amount of benefits 
that a household receives as a result of this section 
in determining the amount of overissuances under 
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section 13 of the Food and Nutrition Act of 2008 
(7 U.S.C. 2022); and 
(5) set the tolerance level for excluding small 
errors for the purposes of section 16(c) of the Food 
and Nutrition Act of 2008 (7 U.S.C. 2025(c)) at 
$50 through September 30, 2021. 
(d) PROVISIONS
FOR IMPACTED WORKERS.—Not-
withstanding any other provision of law, the requirements 
under subsections (d)(1)(A)(ii) and (o) of section 6 of the 
Food and Nutrition Act of 2008 (7 U.S.C. 2015) shall 
not be in effect during the period beginning on June 1, 
2020, and ending 2 years after the date of enactment of 
this Act. 
(e) ADMINISTRATIVE EXPENSES.— 
(1) IN GENERAL.—For the costs of State ad-
ministrative expenses associated with carrying out 
this section and administering the supplemental nu-
trition assistance program established under the 
Food and Nutrition Act of 2008 (7 U.S.C. 2011 et 
seq.), 
the 
Secretary 
shall 
make 
available 
$150,000,000 
for 
fiscal 
year 
2020 
and 
$150,000,000 for fiscal year 2021. 
(2) TIMING FOR FISCAL YEAR 2020.—Not later 
than 60 days after the date of the enactment of this 
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Act, the Secretary shall make available to States 
amounts for fiscal year 2020 under paragraph (1). 
(3) ALLOCATION OF FUNDS.—Funds described 
in paragraph (1) shall be made available as grants 
to State agencies for each fiscal year as follows: 
(A) 75 percent of the amounts available 
for each fiscal year shall be allocated to States 
based on the share of each State of households 
that participate in the supplemental nutrition 
assistance program as reported to the Depart-
ment of Agriculture for the most recent 12- 
month period for which data are available, ad-
justed by the Secretary (as of the date of the 
enactment of this Act) for participation in dis-
aster programs under section 5(h) of the Food 
and Nutrition Act of 2008 (7 U.S.C. 2014(h)); 
and 
(B) 25 percent of the amounts available 
for each fiscal year shall be allocated to States 
based on the increase in the number of house-
holds that participate in the supplemental nu-
trition assistance program as reported to the 
Department of Agriculture over the most recent 
12-month period for which data are available, 
adjusted by the Secretary (as of the date of the 
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enactment of this Act) for participation in dis-
aster programs under section 5(h) of the Food 
and Nutrition Act of 2008 (7 U.S.C. 2014(h)). 
(f) SNAP RULES.—No funds (including fees) made 
available under this Act or any other Act for any fiscal 
year may be used to finalize, implement, administer, en-
force, carry out, or otherwise give effect to— 
(1) the final rule entitled ‘‘Supplemental Nutri-
tion Assistance Program: Requirements for Able- 
Bodied Adults Without Dependents’’ published in 
the Federal Register on December 5, 2019 (84 Fed. 
Reg. 66782); 
(2) the proposed rule entitled ‘‘Revision of Cat-
egorical Eligibility in the Supplemental Nutrition 
Assistance Program (SNAP)’’ published in the Fed-
eral Register on July 24, 2019 (84 Fed. Reg. 
35570); or 
(3) the proposed rule entitled ‘‘Supplemental 
Nutrition Assistance Program: Standardization of 
State Heating and Cooling Standard Utility Allow-
ances’’ published in the Federal Register on October 
3, 2019 (84 Fed. Reg. 52809). 
(g) CERTAIN EXCLUSIONS FROM SNAP INCOME.— 
A Federal pandemic unemployment compensation pay-
ment made to an individual under section 2104 of the 
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CARES Act (Public Law 116–136) shall not be regarded 
as income and shall not be regarded as a resource for the 
month of receipt and the following 9 months, for the pur-
pose of determining eligibility for such individual or any 
other individual for benefits or assistance, or the amount 
of benefits or assistance, under any programs authorized 
under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 
et seq.). 
(h) PUBLIC AVAILABILITY.—Not later than 10 days 
after the date of the receipt or issuance of each document 
listed below, the Secretary shall make publicly available 
on the website of the Department of Agriculture the fol-
lowing documents: 
(1) Any State agency request to participate in 
the supplemental nutrition assistance program on-
line program under section 7(k). 
(2) Any State agency request to waive, adjust, 
or modify statutory or regulatory requirements 
under the Food and Nutrition Act of 2008 related 
to the COVID–19 outbreak. 
(3) The Secretary’s approval or denial of each 
such request under paragraphs (1) or (2). 
(i) FUNDING.—There are hereby appropriated to the 
Secretary, out of any money not otherwise appropriated, 
such sums as may be necessary to carry out this section. 
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TITLE 
VII—CULTURALLY 
AND 
LINGUISTICALLY 
COM-
PETENT CARE 
SEC. 701. ENSURING STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTH CARE. 
(a) APPLICABILITY.—This section shall apply to any 
health program or activity, any part of which is receiving 
Federal financial assistance, including credits, subsidies, 
or contracts of insurance, or any program or activity that 
is administered by an executive agency or any entity estab-
lished under title I of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18001 et seq.) (or amendments 
made thereby). 
(b) STANDARDS.—Each program or activity de-
scribed in subsection (a)— 
(1) shall implement strategies to recruit, retain, 
and promote individuals at all levels to maintain a 
diverse staff and leadership that can provide cul-
turally and linguistically appropriate health care to 
patient populations of the service area of the pro-
gram or activity; 
(2) shall educate and train governance, leader-
ship, and workforce at all levels and across all dis-
ciplines of the program or activity in culturally and 
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linguistically appropriate policies and practices on an 
ongoing basis at least yearly; 
(3) shall offer and provide language assistance, 
including trained and competent bilingual staff and 
interpreter services, to individuals with limited 
English proficiency or who have other communica-
tion needs, at no cost to the individual at all points 
of contact, and during all hours of operation, to fa-
cilitate timely access to health care services and 
health-care-related services; 
(4) shall for each language group consisting of 
individuals with limited English proficiency that con-
stitutes 5 percent or 500 individuals, whichever is 
less, of the population of persons eligible to be 
served or likely to be affected or encountered in the 
service area of the program or activity, make avail-
able at a fifth grade reading level— 
(A) easily understood patient-related mate-
rials, including print and multimedia materials, 
in the language of such language group; 
(B) information or notices about termi-
nation of benefits in such language; 
(C) signage; and 
(D) any other documents or types of docu-
ments designated by the Secretary; 
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(5) shall develop and implement clear goals, 
policies, operational plans, and management, ac-
countability, and oversight mechanisms to provide 
culturally and linguistically appropriate services and 
infuse them throughout the planning and operations 
of the program or activity; 
(6) shall conduct initial and ongoing organiza-
tional assessments of culturally and linguistically ap-
propriate services-related activities and integrate 
valid linguistic, competence-related National Stand-
ards for Culturally and Linguistically Appropriate 
Services (CLAS) measures into the internal audits, 
performance improvement programs, patient satis-
faction assessments, continuous quality improvement 
activities, and outcomes-based evaluations of the 
program or activity and develop ways to standardize 
the assessments, and such assessments must occur 
at least yearly; 
(7) shall ensure that, consistent with the pri-
vacy protections provided for under the regulations 
promulgated under section 264(c) of the Health In-
surance Portability and Accountability Act of 1996 
(42 U.S.C. 1320–2 note), data on an individual re-
quired to be collected pursuant to section 3101, in-
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cluding the individual’s alternative format pref-
erences and policy modification needs, are— 
(A) collected in health records; 
(B) integrated into the management infor-
mation systems of the program or activity; and 
(C) periodically updated; 
(8) shall maintain a current demographic, cul-
tural, and epidemiological profile of the community, 
conduct regular assessments of community health 
assets and needs, and use the results of such assess-
ments to accurately plan for and implement services 
that respond to the cultural and linguistic character-
istics of the service area of the program or activity; 
(9) shall develop participatory, collaborative 
partnerships with communities and utilize a variety 
of formal and informal mechanisms to facilitate 
community and patient involvement in designing, 
implementing, and evaluating policies and practices 
to ensure culturally and linguistically appropriate 
service-related activities; 
(10) shall ensure that conflict and grievance 
resolution processes are culturally and linguistically 
appropriate and capable of identifying, preventing, 
and resolving cross-cultural conflicts or complaints 
by patients; 
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(11) shall regularly make available to the public 
information about their progress and successful in-
novations in implementing the standards under this 
section and provide public notice in their commu-
nities about the availability of this information; and 
(12) shall, if requested, regularly make avail-
able to the head of each Federal entity from which 
Federal funds are provided, information about the 
progress and successful innovations of the program 
or activity in implementing the standards under this 
section as required by the head of such entity. 
(c) COMMENTS ACCEPTED THROUGH NOTICE AND 
COMMENT RULEMAKING.—An agency carrying out a pro-
gram described in subsection (a) shall ensure that com-
ments with respect to such program that are accepted 
through notice and comment rulemaking be accepted in 
all languages, may not require such comments to be sub-
mitted only in English, and must ensure these comments 
are considered equally as comments submitted in English 
during the agency’s review of comments submitted. 
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SEC. 702. CULTURALLY AND LINGUISTICALLY APPRO-
PRIATE 
HEALTH 
CARE 
IN 
THE 
PUBLIC 
HEALTH SERVICE ACT. 
Title XXXIV of the Public Health Service Act, as 
amended by section 104, is further amended by adding 
at the end the following: 
‘‘Subtitle 
B—CULTURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTH CARE 
‘‘SEC. 3403. DEFINITIONS. 
‘‘(a) IN GENERAL.—In this title: 
‘‘(1) BILINGUAL.—The term ‘bilingual’, with 
respect to an individual, means a person who has 
sufficient degree of proficiency in 2 languages. 
‘‘(2) CULTURAL.—The term ‘cultural’ means 
relating to integrated patterns of human behavior 
that include the language, thoughts, communica-
tions, actions, customs, beliefs, values, and institu-
tions of racial, ethnic, religious, or social groups, in-
cluding lesbian, gay, bisexual, transgender, queer, 
and questioning individuals, and individuals with 
physical and mental disabilities. 
‘‘(3) CULTURALLY
AND
LINGUISTICALLY
AP-
PROPRIATE.—The term ‘culturally and linguistically 
appropriate’ means being respectful of and respon-
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sive to the cultural and linguistic needs of all indi-
viduals. 
‘‘(4) EFFECTIVE COMMUNICATION.—The term 
‘effective communication’ means an exchange of in-
formation between the provider of health care or 
health-care-related services and the recipient of such 
services who is limited in English proficiency, or has 
a communication impairment such as a hearing, vi-
sion, speaking, or learning impairment, that enables 
access to, understanding of, and benefit from health 
care or health-care-related services, and full partici-
pation in the development of their treatment plan. 
‘‘(5) GRIEVANCE RESOLUTION PROCESS.—The 
term ‘grievance resolution process’ means all aspects 
of dispute resolution including filing complaints, 
grievance and appeal procedures, and court action. 
‘‘(6) HEALTH CARE GROUP.—The term ‘health 
care group’ means a group of physicians organized, 
at least in part, for the purposes of providing physi-
cian services under the Medicaid program under title 
XIX of the Social Security Act, the State Children’s 
Health Insurance Program under title XXI of such 
Act, or the Medicare program under title XVIII of 
such Act and may include a hospital and any other 
individual or entity furnishing services covered under 
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any such program that is affiliated with the health 
care group. 
‘‘(7) HEALTH
CARE
SERVICES.—The term 
‘health care services’ means services that address 
physical as well as mental health conditions in all 
care settings. 
‘‘(8) HEALTH-CARE-RELATED
SERVICES.—The 
term ‘health-care-related services’ means human or 
social services programs or activities that provide ac-
cess, referrals, or links to health care. 
‘‘(9) HEALTH
EDUCATOR.—The term ‘health 
educator’ includes a professional with a bacca-
laureate degree who is responsible for designing, im-
plementing, and evaluating individual and population 
health promotion and chronic disease prevention pro-
grams. 
‘‘(10) INDIAN; INDIAN TRIBE.—The terms ‘In-
dian’ and ‘Indian Tribe’ have the meanings given 
such terms in section 4 of the Indian Self-Deter-
mination and Education Assistance Act. 
‘‘(11) INDIVIDUAL
WITH
A
DISABILITY.—The 
term ‘individual with a disability’ means any indi-
vidual who has a disability as defined for the pur-
pose of section 504 of the Rehabilitation Act of 
1973. 
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‘‘(12) INDIVIDUAL
WITH
LIMITED
ENGLISH 
PROFICIENCY.—The term ‘individual with limited 
English proficiency’ means an individual whose pri-
mary language for communication is not English 
and who has a limited ability to read, write, speak, 
or understand English. 
‘‘(13) INTEGRATED
HEALTH
CARE
DELIVERY 
SYSTEM.—The term ‘integrated health care delivery 
system’ means an interdisciplinary system that 
brings together providers from the primary health, 
mental health, substance use disorder, and related 
disciplines to improve the health outcomes of an in-
dividual. Such providers may include hospitals, 
health, mental health, or substance use disorder clin-
ics and providers, home health agencies, ambulatory 
surgery centers, skilled nursing facilities, rehabilita-
tion centers, and employed, independent, or con-
tracted physicians. 
‘‘(14) INTERPRETING; INTERPRETATION.—The 
terms ‘interpreting’ and ‘interpretation’ mean the 
transmission of a spoken, written, or signed message 
from one language or format into another, faithfully, 
accurately, and objectively. 
‘‘(15) LANGUAGE ACCESS.—The term ‘language 
access’ means the provision of language services to 
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an individual with limited English proficiency or an 
individual with communication disabilities designed 
to enhance that individual’s access to, understanding 
of, or benefit from health care services or health- 
care-related services. 
‘‘(16) LANGUAGE ASSISTANCE SERVICES.—The 
term ‘language assistance services’ includes— 
‘‘(A) oral language assistance, including in-
terpretation in non-English languages provided 
in-person or remotely by a qualified interpreter 
for an individual with limited English pro-
ficiency, and the use of qualified bilingual or 
multilingual staff to communicate directly with 
individuals with limited English proficiency; 
‘‘(B) written translation, performed by a 
qualified and competent translator, of written 
content in paper or electronic form into lan-
guages other than English; and 
‘‘(C) taglines. 
‘‘(17) MINORITY.— 
‘‘(A) IN GENERAL.—The terms ‘minority’ 
and ‘minorities’ refer to individuals from a mi-
nority group. 
‘‘(B) POPULATIONS.—The term ‘minority’, 
with respect to populations, refers to racial and 
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ethnic minority groups, members of sexual and 
gender minority groups, and individuals with a 
disability. 
‘‘(18) MINORITY GROUP.—The term ‘minority 
group’ has the meaning given the term ‘racial and 
ethnic minority group’. 
‘‘(19) ONSITE
INTERPRETATION.—The term 
‘onsite interpretation’ means a method of inter-
preting or interpretation for which the interpreter is 
in the physical presence of the provider of health 
care services or health-care-related services and the 
recipient of such services who is limited in English 
proficiency or has a communication impairment such 
as an impairment in hearing, vision, or learning. 
‘‘(20) QUALIFIED
INDIVIDUAL
WITH
A
DIS-
ABILITY.—The term ‘qualified individual with a dis-
ability’ means, with respect to a health program or 
activity, an individual with a disability who, with or 
without reasonable modifications to policies, prac-
tices, or procedures, the removal of architectural, 
communication, or transportation barriers, or the 
provision of auxiliary aids and services, meets the es-
sential eligibility requirements for the receipt of aids, 
benefits, or services offered or provided by the health 
program or activity. 
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‘‘(21) QUALIFIED INTERPRETER FOR AN INDI-
VIDUAL WITH A DISABILITY.—The term ‘qualified 
interpreter for an individual with a disability’, for an 
individual with a disability— 
‘‘(A) means an interpreter who by means 
of a remote interpreting service or an on-site 
appearance; 
‘‘(i) adheres to generally accepted in-
terpreter ethics principles, including client 
confidentiality; and 
‘‘(ii) is able to interpret effectively, ac-
curately, and impartially, both receptively 
and expressively, using any necessary spe-
cialized vocabulary, terminology, and phra-
seology; and 
‘‘(B) may include sign language inter-
preters, oral transliterators (individuals who 
represent or spell in the characters of another 
alphabet), and cued language transliterators 
(individuals who represent or spell by using a 
small number of handshapes). 
‘‘(22) QUALIFIED INTERPRETER FOR AN INDI-
VIDUAL
WITH
LIMITED
ENGLISH
PROFICIENCY.— 
The term ‘qualified interpreter for an individual with 
limited English proficiency’ means an interpreter 
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who via a remote interpreting service or an on-site 
appearance— 
‘‘(A) adheres to generally accepted inter-
preter ethics principles, including client con-
fidentiality; 
‘‘(B) has demonstrated proficiency in 
speaking 
and 
understanding 
both 
spoken 
English and one or more other spoken lan-
guages; and 
‘‘(C) is able to interpret effectively, accu-
rately, and impartially, both receptively and ex-
pressly, to and from such languages and 
English, using any necessary specialized vocab-
ulary, terminology, and phraseology. 
‘‘(23) QUALIFIED
TRANSLATOR.—The term 
‘qualified translator’ means a translator who— 
‘‘(A) adheres to generally accepted trans-
lator ethics principles, including client confiden-
tiality; 
‘‘(B) has demonstrated proficiency in writ-
ing and understanding both written English 
and one or more other written non-English lan-
guages; and 
‘‘(C) is able to translate effectively, accu-
rately, and impartially to and from such lan-
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guages and English, using any necessary spe-
cialized vocabulary, terminology, and phrase-
ology. 
‘‘(24) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘racial and ethnic minority group’ means 
Indians and Alaska Natives, African Americans (in-
cluding Caribbean Blacks, Africans, and other 
Blacks), Asian Americans, Hispanics (including 
Latinos), and Native Hawaiians and other Pacific 
Islanders. 
‘‘(25) 
SEXUAL
AND
GENDER
MINORITY 
GROUP.—The term ‘sexual and gender minority 
group’ encompasses lesbian, gay, bisexual, and 
transgender populations, as well as those whose sex-
ual orientation, gender identity and expression, or 
reproductive development varies from traditional, so-
cietal, cultural, or physiological norms. 
‘‘(26) SIGHT TRANSLATION.—The term ‘sight 
translation’ means the transmission of a written 
message in one language into a spoken or signed 
message in another language, or an alternative for-
mat in English or another language. 
‘‘(27) STATE.—Notwithstanding section 2, the 
term ‘State’ means each of the several States, the 
District of Columbia, the Commonwealth of Puerto 
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Rico, the United States Virgin Islands, Guam, 
American Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
‘‘(28) 
TELEPHONIC
INTERPRETATION.—The 
term ‘telephonic interpretation’ (also known as ‘over 
the phone interpretation’ or ‘OPI’) means, with re-
spect to interpretation for an individual with limited 
English proficiency, a method of interpretation in 
which the interpreter is not in the physical presence 
of the provider of health care services or health-care- 
related services and such individual receiving such 
services, but the interpreter is connected via tele-
phone. 
‘‘(29) TRANSLATION.—The term ‘translation’ 
means the transmission of a written message in one 
language into a written or signed message in an-
other language, and includes translation into an-
other language or alternative format, such as large 
print font, Braille, audio recording, or CD. 
‘‘(30) VIDEO
REMOTE
INTERPRETING
SERV-
ICES.—The term ‘video remote interpreting services’ 
means the provision, in health care services or 
health-care-related services, through a qualified in-
terpreter for an individual with limited English pro-
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ficiency, of video remote interpreting services that 
are— 
‘‘(A) in real-time, full-motion video, and 
audio over a dedicated high-speed, wide-band-
width video connection or wireless connection 
that delivers high quality video images that do 
not produce lags, choppy, blurry, or grainy im-
ages, or irregular pauses in communication; and 
‘‘(B) in a sharply delineated image that is 
large enough to display. 
‘‘(31) VITAL DOCUMENT.—The term ‘vital doc-
ument’ includes applications for government pro-
grams that provide health care services, medical or 
financial consent forms, financial assistance docu-
ments, letters containing important information re-
garding patient instructions (such as prescriptions, 
referrals to other providers, and discharge plans) 
and participation in a program (such as a Medicaid 
managed care program), notices pertaining to the 
reduction, denial, or termination of services or bene-
fits, notices of the right to appeal such actions, and 
notices advising individuals with limited English pro-
ficiency with communication disabilities of the avail-
ability of free language services, alternative formats, 
and other outreach materials. 
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‘‘(b) REFERENCE.—In any reference in this title to 
a regulatory provision applicable to a ‘handicapped indi-
vidual’, the term ‘handicapped individual’ in such provi-
sion shall have the same meaning as the term ‘individual 
with a disability’ as defined in subsection (a). 
‘‘CHAPTER 1—RESOURCES AND INNOVA-
TION FOR CULTURALLY AND LINGUIS-
TICALLY APPROPRIATE HEALTH CARE 
‘‘SEC. 3404. ROBERT T. MATSUI CENTER FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE HEALTH 
CARE. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director of the Agency for Healthcare Re-
search and Quality, shall establish and support a center 
to be known as the ‘Robert T. Matsui Center for Cul-
turally and Linguistically Appropriate Health Care’ (re-
ferred to in this section as the ‘Center’) to carry out each 
of the following activities: 
‘‘(1) INTERPRETATION SERVICES.—The Center 
shall provide resources via the internet to identify 
and link health care providers to competent inter-
preter and translation services. 
‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 
‘‘(A) VITAL
DOCUMENTS.—The Center 
shall provide, directly or through contract, vital 
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documents from competent translation services 
for providers of health care services and health- 
care-related services at no cost to such pro-
viders. Such documents may be submitted by 
covered entities (as defined in section 92.4 of 
title 42, Code of Federal Regulations, as in ef-
fect on May 16, 2016) for translation into non- 
English languages or alternative formats at a 
fifth-grade reading level. Such translation serv-
ices shall be provided in a timely and reason-
able manner. The quality of such translation 
services shall be monitored and reported pub-
licly. 
‘‘(B) FORMS.—For each form developed or 
revised by the Secretary that will be used by in-
dividuals with limited English proficiency in 
health care or health-care-related settings, the 
Center shall translate the form, at a minimum, 
into the top 15 non-English languages in the 
United States according to the most recent data 
from the American Community Survey or its re-
placement. The translation shall be completed 
within 45 calendar days of the Secretary receiv-
ing final approval of the form from the Office 
of Management and Budget. The Center shall 
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post all translated forms on its website so that 
other entities may use the same translations. 
‘‘(3) TOLL-FREE
CUSTOMER
SERVICE
TELE-
PHONE
NUMBER.—The 
Center 
shall 
provide, 
through a toll-free number, a customer service line 
for individuals with limited English proficiency— 
‘‘(A) to obtain information about federally 
conducted or funded health programs, including 
the Medicare program under title XVIII of the 
Social Security Act, the Medicaid program 
under title XIX of such Act, and the State Chil-
dren’s Health Insurance Program under title 
XXI of such Act, marketplace coverage avail-
able pursuant to title XXVII of this Act and 
the Patient Protection and Affordable Care Act, 
and other sources of free or reduced care in-
cluding federally qualified health centers, title 
X clinics, and public health departments; 
‘‘(B) to obtain assistance with applying for 
or accessing these programs and understanding 
Federal notices written in English; and 
‘‘(C) to learn how to access language serv-
ices. 
‘‘(4) 
HEALTH
INFORMATION
CLEARING-
HOUSE.— 
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‘‘(A) IN GENERAL.—The Center shall de-
velop and maintain an information clearing-
house to facilitate the provision of language 
services by providers of health care services and 
health-care-related services to reduce medical 
errors, improve medical outcomes, improve cul-
tural competence, reduce health care costs 
caused by miscommunication with individuals 
with limited English proficiency, and reduce or 
eliminate the duplication of efforts to translate 
materials. The clearinghouse shall include the 
information described in subparagraphs (B) 
through (F) and make such information avail-
able on the internet and in print. 
‘‘(B) DOCUMENT TEMPLATES.—The Cen-
ter shall collect and evaluate for accuracy, de-
velop, and make available templates for stand-
ard documents that are necessary for patients 
and consumers to access and make educated de-
cisions about their health care, including tem-
plates for each of the following: 
‘‘(i) Administrative and legal docu-
ments, including— 
‘‘(I) intake forms; 
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‘‘(II) forms related to the Medi-
care program under title XVIII of the 
Social Security Act, the Medicaid pro-
gram under title XIX of such Act, 
and the State Children’s Health In-
surance Program under title XXI of 
such Act, including eligibility informa-
tion for such programs; 
‘‘(III) forms informing patients 
of the compliance and consent re-
quirements pursuant to the regula-
tions under section 264(c) of the 
Health Insurance Portability and Ac-
countability Act of 1996 (42 U.S.C. 
1320–2 note); and 
‘‘(IV) documents concerning in-
formed consent, advanced directives, 
and waivers of rights. 
‘‘(ii) Clinical information, such as how 
to take medications, how to prevent trans-
mission of a contagious disease, and other 
prevention and treatment instructions. 
‘‘(iii) Public health, patient education, 
and outreach materials, such as immuniza-
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tion notices, health warnings, or screening 
notices. 
‘‘(iv) Additional health or health-care- 
related materials as determined appro-
priate by the Director of the Center. 
‘‘(C) STRUCTURE
OF
FORMS.—In oper-
ating the clearinghouse, the Center shall— 
‘‘(i) ensure that the documents posted 
in English and non-English languages are 
culturally and linguistically appropriate; 
‘‘(ii) allow public review of the docu-
ments before dissemination in order to en-
sure that the documents are understand-
able and culturally and linguistically ap-
propriate for the target populations; 
‘‘(iii) allow health care providers to 
customize the documents for their use; 
‘‘(iv) facilitate access to these docu-
ments; 
‘‘(v) provide technical assistance with 
respect to the access and use of such infor-
mation; and 
‘‘(vi) carry out any other activities the 
Secretary determines to be useful to fulfill 
the purposes of the clearinghouse. 
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‘‘(D) 
LANGUAGE
ASSISTANCE
PRO-
GRAMS.—The Center shall provide for the col-
lection and dissemination of information on cur-
rent examples of language assistance programs 
and strategies to improve language services for 
individuals with limited English proficiency, in-
cluding case studies using de-identified patient 
information, program summaries, and program 
evaluations. 
‘‘(E) CULTURALLY
AND
LINGUISTICALLY 
APPROPRIATE
MATERIALS.—The Center shall 
provide information relating to culturally and 
linguistically appropriate health care for minor-
ity populations residing in the United States to 
all health care providers and health-care-related 
services at no cost. Such information shall in-
clude— 
‘‘(i) tenets of culturally and linguis-
tically appropriate care; 
‘‘(ii) culturally and linguistically ap-
propriate self-assessment tools; 
‘‘(iii) culturally and linguistically ap-
propriate training tools; 
‘‘(iv) strategic plans to increase cul-
tural and linguistic appropriateness in dif-
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ferent types of providers of health care 
services and health-care-related services, 
including regional collaborations among 
health care organizations; and 
‘‘(v) culturally and linguistically ap-
propriate information for educators, practi-
tioners, and researchers. 
‘‘(F) 
TRANSLATION
GLOSSARIES.—The 
Center shall— 
‘‘(i) develop and publish on its website 
translation glossaries that provide stand-
ardized translations of commonly used 
terms and phrases utilized in documents 
translated by the Center; and 
‘‘(ii) make these glossaries available— 
‘‘(I) free of charge; 
‘‘(II) in the 15 languages in 
which the Center translates materials; 
and 
‘‘(III) in alternative formats in 
accordance with the Americans with 
Disabilities Act of 1990 (42 U.S.C. 
12101 et seq.). 
‘‘(G) INFORMATION
ABOUT
PROGRESS.— 
The Center shall regularly collect and make 
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publicly 
available 
information 
about 
the 
progress of entities receiving grants under sec-
tion 3402 regarding successful innovations in 
implementing the obligations under this sub-
section and provide public notice in the entities’ 
communities about the availability of this infor-
mation. 
‘‘(b) DIRECTOR.—The Center shall be headed by a 
Director who shall be appointed by, and who shall report 
to, the Director of the Agency for Healthcare Research 
and Quality. 
‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di-
rector shall collaborate with the Deputy Assistant Sec-
retary for Minority Health, the Administrator of the Cen-
ters for Medicare & Medicaid Services, and the Adminis-
trator of the Health Resources and Services Administra-
tion to notify health care providers and health care organi-
zations about the availability of language access services 
by the Center. 
‘‘(d) 
EDUCATION.—The 
Secretary, 
directly 
or 
through contract, shall undertake a national education 
campaign to inform providers, individuals with limited 
English proficiency, individuals with hearing or vision im-
pairments, health professionals, graduate schools, and 
community health centers about— 
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‘‘(1) Federal and State laws and guidelines gov-
erning access to language services; 
‘‘(2) the value of using trained and competent 
interpreters and the risks associated with using fam-
ily members, friends, minors, and untrained bilin-
gual staff; 
‘‘(3) funding sources for developing and imple-
menting language services; and 
‘‘(4) promising practices to effectively provide 
language services. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2021 through 2025. 
‘‘SEC. 3405. INNOVATIONS IN CULTURALLY AND LINGUIS-
TICALLY 
APPROPRIATE 
HEALTH 
CARE 
GRANTS. 
‘‘(a) IN GENERAL.— 
‘‘(1) GRANTS.—The Secretary, acting through 
the Director of the Agency for Healthcare Research 
and Quality, shall award grants to eligible entities to 
enable such entities to design, implement, and evalu-
ate innovative, cost-effective programs to improve 
culturally and linguistically appropriate access to 
health care services for individuals with limited 
English proficiency. 
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‘‘(2) COORDINATION.—The Director of the 
Agency for Healthcare Research and Quality shall 
coordinate with, and ensure the participation of, 
other agencies including the Health Resources and 
Services Administration, the National Institute on 
Minority Health and Health Disparities at the Na-
tional Institutes of Health, and the Office of Minor-
ity Health, regarding the design and evaluation of 
the grants program. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) be— 
‘‘(A) a city, county, Indian Tribe, State, or 
subdivision thereof; 
‘‘(B) an organization described in section 
501(c)(3) of the Internal Revenue Code of 1986 
and exempt from tax under section 501(a) of 
such Code; 
‘‘(C) a community health, mental health, 
or substance use disorder center or clinic; 
‘‘(D) a solo or group physician practice; 
‘‘(E) an integrated health care delivery 
system; 
‘‘(F) a public hospital; 
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‘‘(G) a health care group, university, or 
college; or 
‘‘(H) any other entity designated by the 
Secretary; and 
‘‘(2) prepare and submit to the Secretary an 
application, at such time, in such manner, and con-
taining such additional information as the Secretary 
may reasonably require. 
‘‘(c) USE OF FUNDS.—An entity shall use funds re-
ceived through a grant under this section to— 
‘‘(1) develop, implement, and evaluate models of 
providing competent interpretation services through 
onsite interpretation, telephonic interpretation, or 
video remote interpreting services; 
‘‘(2) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
promote and provide language services to patient 
populations of the service area of the entity; 
‘‘(3) develop and maintain a needs assessment 
that identifies the current demographic, cultural, 
and epidemiological profile of the community to ac-
curately plan for and implement language services 
needed in the service area of the entity; 
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‘‘(4) develop a strategic plan to implement lan-
guage services; 
‘‘(5) develop participatory, collaborative part-
nerships with communities encompassing the patient 
populations of individuals with limited English pro-
ficiency served by the grant to gain input in design-
ing and implementing language services; 
‘‘(6) develop and implement grievance resolu-
tion processes that are culturally and linguistically 
appropriate and capable of identifying, preventing, 
and resolving complaints by individuals with limited 
English proficiency; 
‘‘(7) develop short-term medical and mental 
health interpretation training courses and incentives 
for bilingual health care staff who are asked to pro-
vide interpretation services in the workplace; 
‘‘(8) develop formal training programs, includ-
ing continued professional development and edu-
cation programs as well as supervision, for individ-
uals interested in becoming dedicated health care in-
terpreters and culturally and linguistically appro-
priate providers; 
‘‘(9) provide staff language training instruction, 
which shall include information on the practical limi-
tations of such instruction for nonnative speakers; 
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‘‘(10) develop policies that address compensa-
tion in salary for staff who receive training to be-
come either a staff interpreter or bilingual provider; 
‘‘(11) develop other language assistance services 
as determined appropriate by the Secretary; 
‘‘(12) develop, implement, and evaluate models 
of improving cultural competence, including cultural 
competence programs for community health workers; 
and 
‘‘(13) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
mulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 and 
any applicable State privacy laws, data on the indi-
vidual patient or recipient’s race, ethnicity, and pri-
mary language are collected (and periodically up-
dated) in health records and integrated into the or-
ganization’s information management systems or 
any similar system used to store and retrieve data. 
‘‘(d) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to entities that pri-
marily engage in providing direct care and that have devel-
oped partnerships with community organizations or with 
agencies with experience in improving language access. 
‘‘(e) EVALUATION.— 
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‘‘(1) BY GRANTEES.—An entity that receives a 
grant under this section shall submit to the Sec-
retary an evaluation that describes, in the manner 
and to the extent required by the Secretary, the ac-
tivities carried out with funds received under the 
grant, and how such activities improved access to 
health care services and health-care-related services 
and the quality of health care for individuals with 
limited English proficiency. Such evaluation shall be 
collected and disseminated through the Robert T. 
Matsui Center for Culturally and Linguistically Ap-
propriate Health Care established under section 
3401. The Director of the Agency for Healthcare 
Research and Quality shall notify grantees of the 
availability of technical assistance for the evaluation 
and provide such assistance upon request. 
‘‘(2) BY
SECRETARY.—The Director of the 
Agency for Healthcare Research and Quality shall 
evaluate or arrange with other individuals or organi-
zations to evaluate projects funded under this sec-
tion. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$5,000,000 for each of fiscal years 2021 through 2025. 
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‘‘SEC. 3406. RESEARCH ON CULTURAL AND LANGUAGE COM-
PETENCE. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Agency for Healthcare Research and 
Quality, shall expand research concerning language access 
in the provision of health care services. 
‘‘(b) ELIGIBILITY.—The Director of the Agency for 
Healthcare Research and Quality may conduct the re-
search described in subsection (a) or enter into contracts 
with other individuals or organizations to conduct such re-
search. 
‘‘(c) USE
OF FUNDS.—Research conducted under 
this section shall be designed to do one or more of the 
following: 
‘‘(1) To identify the barriers to mental and be-
havioral services that are faced by individuals with 
limited English proficiency. 
‘‘(2) To identify health care providers’ and 
health administrators’ attitudes, knowledge, and 
awareness of the barriers to quality health care serv-
ices that are faced by individuals with limited 
English proficiency. 
‘‘(3) To identify optimal approaches for deliv-
ering language access. 
‘‘(4) To identify best practices for data collec-
tion, including— 
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‘‘(A) the collection by providers of health 
care services and health-care-related services of 
data on the race, ethnicity, and primary lan-
guage of recipients of such services, taking into 
account existing research conducted by the Gov-
ernment or private sector; 
‘‘(B) the development and implementation 
of data collection and reporting systems; and 
‘‘(C) effective privacy safeguards for col-
lected data. 
‘‘(5) To develop a minimum data collection set 
for primary language. 
‘‘(6) To evaluate the most effective ways in 
which the Secretary can create or coordinate, and 
subsidize or otherwise fund, telephonic interpretation 
services for health care providers, taking into consid-
eration, among other factors, the flexibility necessary 
for such a system to accommodate variations in— 
‘‘(A) provider type; 
‘‘(B) languages needed and their frequency 
of use; 
‘‘(C) type of encounter; 
‘‘(D) time of encounter, including regular 
business hours and after hours; and 
‘‘(E) location of encounter. 
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‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2021 through 2025.’’. 
SEC. 703. TRAINING TOMORROW’S DOCTORS FOR CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE CARE: GRADUATE MEDICAL EDU-
CATION. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h)(4) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(L) TREATMENT
OF
CULTURALLY
AND 
LINGUISTICALLY
APPROPRIATE
TRAINING.—In 
determining a hospital’s number of full-time 
equivalent residents for purposes of this sub-
section, all the time that is spent by an intern 
or resident in an approved medical residency 
training program for education and training in 
culturally and linguistically appropriate service 
delivery, which shall include all diverse popu-
lations including people with disabilities and the 
Lesbian, gay, bisexual, transgender, queer, 
questioning, 
questioning 
and 
intersex 
(LGBTQIA) community, shall be counted to-
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325 
ward the determination of full-time equiva-
lency.’’. 
(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended— 
(1) by redesignating the clause (x) added by 
section 5505(b) of the Patient Protection and Af-
fordable Care Act as clause (xi); and 
(2) by adding at the end the following new 
clause: 
‘‘(xii) The provisions of subparagraph (L) of 
subsection (h)(4) shall apply under this subpara-
graph in the same manner as they apply under such 
subsection.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply with respect to pay-
ments made to hospitals on or after the date that is one 
year after the date of the enactment of this Act. 
SEC. 704. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID, AND 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAMS. 
(a) LANGUAGE ACCESS GRANTS
FOR MEDICARE 
PROVIDERS.— 
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(1) ESTABLISHMENT.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices, acting through the Centers for Medicare & 
Medicaid Services and in consultation with the 
Center for Medicare and Medicaid Innovation 
(as referred to in section 1115A of the Social 
Security Act (42 U.S.C. 1315a)), shall establish 
a demonstration program under which the Sec-
retary shall award grants to eligible Medicare 
service providers to improve communication be-
tween such providers and Medicare beneficiaries 
who are limited English proficient, including 
beneficiaries who live in diverse and under-
served communities. 
(B) 
APPLICATION
OF
INNOVATION 
RULES.—The demonstration project under sub-
paragraph (A) shall be conducted in a manner 
that is consistent with the applicable provisions 
of subsections (b), (c), and (d) of section 1115A 
of the Social Security Act (42 U.S.C. 1315a). 
(C) NUMBER OF GRANTS.—To the extent 
practicable, the Secretary shall award not less 
than 24 grants under this subsection. 
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(D) GRANT PERIOD.—Except as provided 
under paragraph (2)(D), each grant awarded 
under this subsection shall be for a 3-year pe-
riod. 
(2) ELIGIBILITY REQUIREMENTS.—To be eligi-
ble for a grant under this subsection, an entity must 
meet the following requirements: 
(A) MEDICARE
PROVIDER.—The entity 
must be— 
(i) a provider of services under part A 
of title XVIII of the Social Security Act 
(42 U.S.C. 1395c et seq.); 
(ii) a provider of services under part 
B of such title (42 U.S.C. 1395j et seq.); 
(iii) a Medicare Advantage organiza-
tion offering a Medicare Advantage plan 
under part C of such title (42 U.S.C. 
1395w–21 et seq.); or 
(iv) a PDP sponsor offering a pre-
scription drug plan under part D of such 
title (42 U.S.C. 1395w–101 et seq.). 
(B) UNDERSERVED
COMMUNITIES.—The 
entity must serve a community that, with re-
spect to necessary language services for improv-
ing access and utilization of health care among 
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English learners, is disproportionally under-
served. 
(C) APPLICATION.—The entity must pre-
pare and submit to the Secretary an applica-
tion, at such time, in such manner, and accom-
panied by such additional information as the 
Secretary may require. 
(D) REPORTING.—In the case of a grantee 
that received a grant under this subsection in 
a previous year, such grantee is only eligible for 
continued payments under a grant under this 
subsection if the grantee met the reporting re-
quirements under paragraph (9) for such year. 
If a grantee fails to meet the requirement of 
such paragraph for the first year of a grant, the 
Secretary may terminate the grant and solicit 
applications from new grantees to participate in 
the demonstration program. 
(3) DISTRIBUTION.—To the extent feasible, the 
Secretary shall award— 
(A) at least 6 grants to providers of serv-
ices described in paragraph (2)(A)(i); 
(B) at least 6 grants to service providers 
described in paragraph (2)(A)(ii); 
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(C) at least 6 grants to organizations de-
scribed in paragraph (2)(A)(iii); and 
(D) at least 6 grants to sponsors described 
in paragraph (2)(A)(iv). 
(4) CONSIDERATIONS IN AWARDING GRANTS.— 
(A) VARIATION IN GRANTEES.—In award-
ing grants under this subsection, the Secretary 
shall select grantees to ensure the following: 
(i) The grantees provide many dif-
ferent types of language services. 
(ii) The grantees serve Medicare bene-
ficiaries who speak different languages, 
and who, as a population, have differing 
needs for language services. 
(iii) The grantees serve Medicare 
beneficiaries in both urban and rural set-
tings. 
(iv) The grantees serve Medicare 
beneficiaries in at least two geographic re-
gions, as defined by the Secretary. 
(v) The grantees serve Medicare bene-
ficiaries in at least two large metropolitan 
statistical areas with racial, ethnic, sexual, 
gender, disability, and economically diverse 
populations. 
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(B) PRIORITY
FOR
PARTNERSHIPS
WITH 
COMMUNITY ORGANIZATIONS AND AGENCIES.— 
In awarding grants under this subsection, the 
Secretary shall give priority to eligible entities 
that have a partnership with— 
(i) a community organization; or 
(ii) a consortia of community organi-
zations, State agencies, and local agencies, 
that has experience in providing language serv-
ices. 
(5) USE OF FUNDS FOR COMPETENT LANGUAGE 
SERVICES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (E), a grantee may only use grant funds 
received under this subsection to pay for the 
provision of competent language services to 
Medicare beneficiaries who are English learn-
ers. 
(B) COMPETENT LANGUAGE SERVICES DE-
FINED.—For purposes of this subsection, the 
term ‘‘competent language services’’ means— 
(i) interpreter and translation services 
that— 
(I) subject to the exceptions 
under subparagraph (C)— 
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(aa) if the grantee operates 
in a State that has statewide 
health care interpreter standards, 
meet the State standards cur-
rently in effect; or 
(bb) if the grantee operates 
in a State that does not have 
statewide health care interpreter 
standards, utilizes competent in-
terpreters who follow the Na-
tional Council on Interpreting in 
Health Care’s Code of Ethics and 
Standards of Practice and com-
ply with the requirements of sec-
tion 1557 of the Patient Protec-
tion and Affordable Care Act (42 
U.S.C. 18116) as published in 
the Federal Register on May 18, 
2016; and 
(II) that, in the case of inter-
preter 
services, 
are 
provided 
through— 
(aa) onsite interpretation; 
(bb) telephonic interpreta-
tion; or 
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(cc) 
video 
interpretation; 
and 
(ii) the direct provision of health care 
or health-care-related services by a com-
petent bilingual health care provider. 
(C) EXCEPTIONS.—The requirements of 
subparagraph (B)(i)(I) do not apply, with re-
spect to interpreter and translation services and 
a grantee— 
(i) in the case of a Medicare bene-
ficiary who is an English learner if— 
(I) such beneficiary has been in-
formed, in the beneficiary’s primary 
language, of the availability of free in-
terpreter and translation services and 
the beneficiary instead requests that a 
family member, friend, or other per-
son provide such services; and 
(II) the grantee documents such 
request in the beneficiary’s medical 
record; or 
(ii) in the case of a medical emergency 
where the delay directly associated with ob-
taining a competent interpreter or trans-
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lation services would jeopardize the health 
of the patient. 
Clause (ii) shall not be construed to exempt 
emergency rooms or similar entities that regu-
larly provide health care services in medical 
emergencies to patients who are English learn-
ers from any applicable legal or regulatory re-
quirements related to providing competent in-
terpreter and translation services without undue 
delay. 
(D) MEDICARE
ADVANTAGE
ORGANIZA-
TIONS AND PDP SPONSORS.—If a grantee is a 
Medicare Advantage organization offering a 
Medicare Advantage plan under part C of title 
XVIII of the Social Security Act (42 U.S.C. 
1395w–21 et seq.) or a PDP sponsor offering 
a prescription drug plan under part D of such 
title (42 U.S.C. 1395w–101 et seq.), such entity 
must provide at least 50 percent of the grant 
funds that the entity receives under this sub-
section directly to the entity’s network providers 
(including all health providers and pharmacists) 
for the purpose of providing support for such 
providers to provide competent language serv-
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ices to Medicare beneficiaries who are English 
learners. 
(E) ADMINISTRATIVE
AND
REPORTING 
COSTS.—A grantee may use up to 10 percent of 
the grant funds to pay for administrative costs 
associated with the provision of competent lan-
guage services and for reporting required under 
paragraph (9). 
(6) DETERMINATION
OF
AMOUNT
OF
GRANT 
PAYMENTS.— 
(A) IN GENERAL.—Payments to grantees 
under this subsection shall be calculated based 
on the estimated numbers of Medicare bene-
ficiaries who are English learners in a grantee’s 
service area utilizing— 
(i) data on the numbers of English 
learners who speak English less than ‘‘very 
well’’ from the most recently available data 
from the Bureau of the Census or other 
State-based study the Secretary determines 
likely to yield accurate data regarding the 
number of such individuals in such service 
area; or 
(ii) data provided by the grantee, if 
the grantee routinely collects data on the 
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primary language of the Medicare bene-
ficiaries that the grantee serves and the 
Secretary determines that the data is accu-
rate and shows a greater number of 
English learners than would be estimated 
using the data under clause (i). 
(B) DISCRETION OF SECRETARY.—Subject 
to subparagraph (C), the amount of payment 
made to a grantee under this subsection may be 
modified annually at the discretion of the Sec-
retary, based on changes in the data under sub-
paragraph (A) with respect to the service area 
of a grantee for the year. 
(C) 
LIMITATION
ON
AMOUNT.—The 
amount of a grant made under this subsection 
to a grantee may not exceed $500,000 for the 
period under paragraph (1)(D). 
(7) ASSURANCES.—Grantees under this sub-
section shall, as a condition of receiving a grant 
under this subsection— 
(A) ensure that clinical and support staff 
receive appropriate ongoing education and 
training in linguistically appropriate service de-
livery; 
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(B) ensure the linguistic competence of bi-
lingual providers; 
(C) offer and provide appropriate language 
services at no additional charge to each patient 
who is an English learner for all points of con-
tact between the patient and the grantee, in a 
timely manner during all hours of operation; 
(D) notify Medicare beneficiaries of their 
right to receive language services in their pri-
mary language; 
(E) post signage in the primary languages 
commonly used by the patient population in the 
service area of the organization; and 
(F) ensure that— 
(i) primary language data are col-
lected for recipients of language services 
and such data are consistent with stand-
ards developed under title XXXIV of the 
Public Health Service Act, as added by 
section 202 of this Act, to the extent such 
standards are available upon the initiation 
of the demonstration program; and 
(ii) consistent with the privacy protec-
tions provided under the regulations pro-
mulgated pursuant to section 264(c) of the 
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Health Insurance Portability and Account-
ability Act of 1996 (42 U.S.C. 1320d–2 
note), if the recipient of language services 
is a minor or is incapacitated, primary lan-
guage data are collected on the parent or 
legal guardian of such recipient. 
(8) NO COST SHARING.—Medicare beneficiaries 
who are English learners shall not have to pay cost 
sharing or co-payments for competent language serv-
ices provided under this demonstration program. 
(9) REPORTING
REQUIREMENTS
FOR
GRANT-
EES.—Not later than the end of each calendar year, 
a grantee that receives funds under this subsection 
in such year shall submit to the Secretary a report 
that includes the following information: 
(A) The number of Medicare beneficiaries 
to whom competent language services are pro-
vided. 
(B) The primary languages of those Medi-
care beneficiaries. 
(C) The types of language services pro-
vided to such beneficiaries. 
(D) Whether such language services were 
provided by employees of the grantee or 
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338 
through a contract with external contractors or 
agencies. 
(E) The types of interpretation services 
provided to such beneficiaries, and the approxi-
mate length of time such service is provided to 
such beneficiaries. 
(F) The costs of providing competent lan-
guage services. 
(G) An account of the training or accredi-
tation of bilingual staff, interpreters, and trans-
lators providing services funded by the grant 
under this subsection. 
(10) EVALUATION
AND
REPORT
TO
CON-
GRESS.—Not later than 1 year after the completion 
of a 3-year grant under this subsection, the Sec-
retary shall conduct an evaluation of the demonstra-
tion program under this subsection and shall submit 
to the Congress a report that includes the following: 
(A) An analysis of the patient outcomes 
and the costs of furnishing care to the Medicare 
beneficiaries who are English learners partici-
pating in the project as compared to such out-
comes and costs for such Medicare beneficiaries 
not participating, based on the data provided 
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339 
under paragraph (9) and any other information 
available to the Secretary. 
(B) The effect of delivering language serv-
ices on— 
(i) Medicare beneficiary access to care 
and utilization of services; 
(ii) the efficiency and cost effective-
ness of health care delivery; 
(iii) patient satisfaction; 
(iv) health outcomes; and 
(v) the provision of culturally appro-
priate services provided to such bene-
ficiaries. 
(C) The extent to which bilingual staff, in-
terpreters, and translators providing services 
under such demonstration were trained or ac-
credited and the nature of accreditation or 
training needed by type of provider, service, or 
other category as determined by the Secretary 
to ensure the provision of high-quality interpre-
tation, translation, or other language services to 
Medicare beneficiaries if such services are ex-
panded pursuant to section 1115A(c) of the So-
cial Security Act (42 U.S.C. 1315a(c)). 
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340 
(D) Recommendations, if any, regarding 
the extension of such project to the entire Medi-
care Program, subject to the provisions of such 
section 1115A(c). 
(11) APPROPRIATIONS.—There is appropriated 
to carry out this subsection, in equal parts from the 
Federal Hospital Insurance Trust Fund under sec-
tion 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical In-
surance Trust Fund under section 1841 of such Act 
(42 U.S.C. 1395t), $16,000,000 for each fiscal year 
of the demonstration program. 
(12) ENGLISH
LEARNER
DEFINED.—In this 
subsection, the term ‘‘English learner’’ has the 
meaning given such term in section 8101(20) of the 
Elementary and Secondary Education Act of 1965, 
except that subparagraphs (A), (B), and (D) of such 
section shall not apply. 
(b) LANGUAGE ASSISTANCE SERVICES UNDER THE 
MEDICARE PROGRAM.— 
(1) INCLUSION
AS
RURAL
HEALTH
CLINIC 
SERVICES.—Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended— 
(A) in subsection (aa)(1)— 
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341 
(i) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(ii) by adding ‘‘and’’ at the end of 
subparagraph (C); and 
(iii) by inserting after subparagraph 
(C) the following new subparagraph: 
‘‘(D) language assistance services as defined in 
subsection (jjj)(1),’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Language Assistance Services and Related Terms 
‘‘(kkk)(1) The term ‘language assistance services’ 
means ‘language access’ or ‘language assistance services’ 
(as those terms are defined in section 3400 of the Public 
Health Service Act) furnished by a ‘qualified interpreter 
for an individual with limited English proficiency’ or a 
‘qualified translator’ (as those terms are defined in such 
section 3400) to an ‘individual with limited English pro-
ficiency’ (as defined in such section 3400) or an ‘English 
learner’ (as defined in paragraph (2)). 
‘‘(2) The term ‘English learner’ has the meaning 
given that term in section 8101(20) of the Elementary and 
Secondary Education Act of 1965, except that subpara-
graphs (A), (B), and (D) of such section shall not apply.’’. 
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343 
(4) WAIVER
OF
BUDGET
NEUTRALITY.—For 
the 3-year period beginning on the date of enact-
ment of this section, the budget neutrality provision 
of section 1848(c)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 
apply with respect to language assistance services 
(as defined in section 1861(kkk)(1) of such Act). 
(c) MEDICARE PARTS C AND D.— 
(1) IN GENERAL.—Medicare Advantage plans 
under part C of title XVIII of the Social Security 
Act (42 U.S.C. 1395w–21 et seq.) and prescription 
drug plans under part D of such title (42 U.S.C. 
1395q–101) shall comply with title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 
section 1557 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18116) to provide effective 
language services to enrollees of such plans. 
(2) MEDICARE
ADVANTAGE
PLANS
AND
PRE-
SCRIPTION
DRUG
PLANS
REPORTING
REQUIRE-
MENT.—Section 1857(e) of the Social Security Act 
(42 U.S.C. 1395w–27(e)) is amended by adding at 
the end the following new paragraph: 
‘‘(5) REPORTING REQUIREMENTS RELATING TO 
EFFECTIVE LANGUAGE SERVICES.—A contract under 
this part shall require a Medicare Advantage organi-
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344 
zation (and, through application of section 1860D– 
12(b)(3)(D), a contract under section 1860D–12 
shall require a PDP sponsor) to annually submit 
(for each year of the contract) a report that contains 
information on the internal policies and procedures 
of the organization (or sponsor) related to recruit-
ment and retention efforts directed to workforce di-
versity and linguistically and culturally appropriate 
provision of services in each of the following con-
texts: 
‘‘(A) The collection of data in a manner 
that meets the requirements of title I of the 
Ending Health Disparities During COVID–19 
Act of 2020, regarding the enrollee population. 
‘‘(B) Education of staff and contractors 
who have routine contact with enrollees regard-
ing the various needs of the diverse enrollee 
population. 
‘‘(C) Evaluation of the language services 
programs and services offered by the organiza-
tion (or sponsor) with respect to the enrollee 
population, such as through analysis of com-
plaints or satisfaction survey results. 
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‘‘(D) Methods by which the plan provides 
to the Secretary information regarding the eth-
nic diversity of the enrollee population. 
‘‘(E) The periodic provision of educational 
information to plan enrollees on the language 
services and programs offered by the organiza-
tion (or sponsor).’’. 
(d) IMPROVING LANGUAGE SERVICES IN MEDICAID 
AND CHIP.— 
(1) 
PAYMENTS
TO
STATES.—Section 
1903(a)(2)(E) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(E)), as amended by section 203(g)(3), 
is further amended by— 
(A) striking ‘‘75’’ and inserting ‘‘95’’; 
(B) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language assistance 
services’’; and 
(C) striking ‘‘children of families’’ and in-
serting ‘‘individuals’’. 
(2) STATE
PLAN
REQUIREMENTS.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended by striking 
‘‘and (29)’’ and inserting ‘‘(29), and (30)’’. 
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346 
(3) DEFINITION
OF
MEDICAL
ASSISTANCE.— 
Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended by— 
(A) in paragraph (29), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (30) as 
paragraph (31); and 
(C) by inserting after paragraph (29) the 
following new paragraph: 
‘‘(30) language assistance services, as such 
term is defined in section 1861(kkk)(1), provided in 
a timely manner to individuals with limited English 
proficiency as defined in section 3400 of the Public 
Health Service Act; and’’. 
(4) USE
OF
DEDUCTIONS
AND
COST
SHAR-
ING.—Section 1916(a)(2) of the Social Security Act 
(42 U.S.C. 1396o(a)(2)) is amended by— 
(A) by striking ‘‘or’’ at the end of subpara-
graph (D); 
(B) by striking ‘‘; and’’ at the end of sub-
paragraph (E) and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) language assistance services described 
in section 1905(a)(29); and’’. 
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347 
(5) CHIP COVERAGE REQUIREMENTS.—Section 
2103 of the Social Security Act (42 U.S.C. 1397cc) 
is amended— 
(A) in subsection (a), in the matter before 
paragraph (1), by striking ‘‘and (7)’’ and in-
serting ‘‘(7), and (10)’’; and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(10) LANGUAGE ASSISTANCE SERVICES.—The 
child health assistance provided to a targeted low-in-
come child shall include coverage of language assist-
ance services, as such term is defined in section 
1861(jjj)(1), provided in a timely manner to individ-
uals with limited English proficiency (as defined in 
section 3400 of the Public Health Service Act).’’; 
and 
(C) in subsection (e)(2)— 
(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
(ii) 
by 
inserting 
‘‘or 
subsection 
(c)(10)’’ after ‘‘subsection (c)(1)(D)’’. 
(6) DEFINITION
OF
CHILD
HEALTH
ASSIST-
ANCE.—Section 2110(a)(27) of the Social Security 
Act (42 U.S.C. 1397jj(a)(27)) is amended by strik-
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348 
ing ‘‘translation’’ and inserting ‘‘language assistance 
services as described in section 2103(c)(10)’’. 
(7) STATE
DATA
COLLECTION.—Pursuant to 
the reporting requirement described in section 
2107(b)(1) of the Social Security Act (42 U.S.C. 
1397gg(b)(1)), the Secretary of Health and Human 
Services shall require that States collect data on— 
(A) the primary language of individuals re-
ceiving child health assistance under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.); and 
(B) in the case of such individuals who are 
minors or incapacitated, the primary language 
of the individual’s parent or guardian. 
(8) CHIP PAYMENTS
TO
STATES.—Section 
2105 of the Social Security Act (42 U.S.C. 1397ee) 
is amended— 
(A) in subsection (a)(1), by striking ‘‘75’’ 
and inserting ‘‘90’’; and 
(B) in subsection (c)(2)(A), by inserting 
before the period at the end the following: ‘‘, 
except that expenditures pursuant to clause (iv) 
of subparagraph (D) of such paragraph shall 
not count towards this total’’. 
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349 
(e) FUNDING
LANGUAGE
ASSISTANCE
SERVICES 
FURNISHED
BY PROVIDERS
OF HEALTH CARE
AND 
HEALTH-CARE-RELATED SERVICES THAT SERVE HIGH 
RATES OF UNINSURED LEP INDIVIDUALS.— 
(1) PAYMENT OF COSTS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services (referred to in this subsection as the 
‘‘Secretary’’) shall make payments (on a quar-
terly basis) directly to eligible entities to sup-
port the provision of language assistance serv-
ices to English learners in an amount equal to 
an eligible entity’s eligible costs for providing 
such services for the quarter. 
(B) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there are 
appropriated to the Secretary of Health and 
Human Services such sums as may be nec-
essary for each of fiscal years 2021 through 
2025. 
(C) RELATION TO MEDICAID DSH.—Pay-
ments under this subsection shall not offset or 
reduce payments under section 1923 of the So-
cial Security Act (42 U.S.C. 1396r–4), nor 
shall payments under such section be consid-
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350 
ered when determining uncompensated costs as-
sociated with the provision of language assist-
ance services for the purposes of this section. 
(2) 
METHODOLOGY
FOR
PAYMENT
OF 
CLAIMS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a methodology to determine the average 
per person cost of language assistance services. 
(B) 
DIFFERENT
ENTITIES.—In 
estab-
lishing such methodology, the Secretary may es-
tablish different methodologies for different 
types of eligible entities. 
(C) NO
INDIVIDUAL
CLAIMS.—The Sec-
retary may not require eligible entities to sub-
mit individual claims for language assistance 
services for individual patients as a requirement 
for payment under this subsection. 
(3) DATA COLLECTION INSTRUMENT.—For pur-
poses of this subsection, the Secretary shall create a 
standard data collection instrument that is con-
sistent with any existing reporting requirements by 
the Secretary or relevant accrediting organizations 
regarding the number of individuals to whom lan-
guage access are provided. 
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351 
(4) GUIDELINES.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary shall establish and distribute guidelines con-
cerning the implementation of this subsection. 
(5) REPORTING REQUIREMENTS.— 
(A) REPORT TO SECRETARY.—Entities re-
ceiving payment under this subsection shall pro-
vide the Secretary with a quarterly report on 
how the entity used such funds. Such report 
shall contain aggregate (and may not contain 
individualized) data collected using the instru-
ment under paragraph (3) and shall otherwise 
be in a form and manner determined by the 
Secretary. 
(B) REPORT
TO
CONGRESS.—Not later 
than 2 years after the date of enactment of this 
Act, and every 2 years thereafter, the Secretary 
shall submit a report to Congress concerning 
the implementation of this subsection. 
(6) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE COSTS.—The term ‘‘eligible 
costs’’ means, with respect to an eligible entity 
that provides language assistance services to 
English learners, the product of— 
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352 
(i) the average per person cost of lan-
guage assistance services, determined ac-
cording to the methodology devised under 
paragraph (2); and 
(ii) the number of English learners 
who are provided language assistance serv-
ices by the entity and for whom no reim-
bursement is available for such services 
under the amendments made by sub-
sections (a), (b), (c), or (d) or by private 
health insurance. 
(B) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means an entity that— 
(i) is a Medicaid provider that is— 
(I) a physician; 
(II) a hospital with a low-income 
utilization rate (as defined in section 
1923(b)(3) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(3))) of greater 
than 25 percent; or 
(III) a Federally qualified health 
center 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
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353 
(ii) not later than 6 months after the 
date of the enactment of this Act, provides 
language assistance services to not less 
than 8 percent of the entity’s total number 
of patients; and 
(iii) prepares and submits an applica-
tion to the Secretary, at such time, in such 
manner, and accompanied by such infor-
mation as the Secretary may require, to 
ascertain the entity’s eligibility for funding 
under this subsection. 
(C) 
ENGLISH
LEARNER.—The 
term 
‘‘English learner’’ has the meaning given such 
term in section 8101(20) of the Elementary 
and Secondary Education Act of 1965 (20 
U.S.C. 7801(20)), except that subparagraphs 
(A), (B), and (D) of such section shall not 
apply. 
(D) LANGUAGE ASSISTANCE SERVICES.— 
The term ‘‘language assistance services’’ has 
the meaning given such term in section 
1861(kkk)(1) of the Social Security Act, as 
added by subsection (b). 
(f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 
SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 
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354 
OTHER LAWS.—Nothing in this section shall be construed 
to limit otherwise existing obligations of recipients of Fed-
eral financial assistance under title VI of the Civil Rights 
Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 
the Affordable Care Act, or other laws that protect the 
civil rights of individuals. 
(g) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided and subject to paragraph (2), the amendments 
made by this section shall take effect on January 1, 
2021. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) which the Secretary of 
Health and Human Services determines requires 
State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirement imposed by the amendments 
made by this section, the State plan shall not be re-
garded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet 
this additional requirement before the first day of 
the first calendar quarter beginning after the close 
of the first regular session of the State legislature 
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355 
that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a 
separate regular session of the State legislature. 
SEC. 705. REQUIREMENTS FOR HEALTH PROGRAMS OR AC-
TIVITIES RECEIVING FEDERAL FUNDS. 
(a) COVERED ENTITY; COVERED PROGRAM OR AC-
TIVITY.—In this section— 
(1) the term ‘‘covered entity’’ has the meaning 
given such term in section 92.4 of title 42, Code of 
Federal Regulations, as in effect on May 16, 2016; 
and 
(2) the term ‘‘covered program or activity’’ has 
the meaning given such term in section 92.4 of title 
42, Code of Federal Regulations, as in effect on May 
16, 2016. 
(b) REQUIREMENTS.—A covered entity, in order to 
ensure the right of individuals with limited English pro-
ficiency to receive access to high-quality health care 
through the covered program or activity, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in cul-
turally and linguistically appropriate service delivery; 
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(2) offer and provide appropriate language as-
sistance services at no additional charge to each pa-
tient that is an individual with limited English pro-
ficiency at all points of contact, in a timely manner 
during all hours of operation; 
(3) notify patients of their right to receive lan-
guage services in their primary language; and 
(4) utilize only qualified interpreters for an in-
dividual with limited English proficiency or qualified 
translators, except as provided in subsection (c). 
(c) EXEMPTIONS.—The requirements of subsection 
(b)(4) shall not apply as follows: 
(1) When a patient requests the use of family, 
friends, or other persons untrained in interpretation 
or translation if each of the following conditions are 
met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
(B) The covered entity informs the patient 
in the primary language of the patient that he 
or she has the option of having the entity pro-
vide to the patient an interpreter and trans-
lation services without charge. 
(C) The covered entity informs the patient 
that the entity may not require an individual 
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with a limited English proficiency to use a fam-
ily member or friend as an interpreter. 
(D) The covered entity evaluates whether 
the person the patient wishes to use as an in-
terpreter is competent. If the covered entity has 
reason to believe that such person is not com-
petent as an interpreter, the entity provides its 
own interpreter to protect the covered entity 
from liability if the patient’s interpreter is later 
found not competent. 
(E) If the covered entity has reason to be-
lieve that there is a conflict of interest between 
the interpreter and patient, the covered entity 
may not use the patient’s interpreter. 
(F) The covered entity has the patient sign 
a waiver, witnessed by at least 1 individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
(E) and is translated into the patient’s primary 
language. 
(2) When a medical emergency exists and the 
delay directly associated with obtaining competent 
interpreter or translation services would jeopardize 
the health of the patient, but only until a competent 
interpreter or translation service is available. 
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(d) RULE
OF CONSTRUCTION.—Subsection (c)(2) 
shall not be construed to mean that emergency rooms or 
similar entities that regularly provide health care services 
in medical emergencies are exempt from legal or regu-
latory requirements related to competent interpreter serv-
ices. 
SEC. 706. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTH CARE SERVICES. 
(a) REPORT.—Not later than 1 year after the date 
of enactment of this Act and annually thereafter, the Sec-
retary of Health and Human Services shall enter into a 
contract with the National Academy of Medicine for the 
preparation and publication of a report that describes 
Federal efforts to ensure that all individuals with limited 
English proficiency have meaningful access to health care 
services and health-care-related services that are culturally 
and linguistically appropriate. Such report shall include— 
(1) a description and evaluation of the activities 
carried out under this Act; 
(2) a description and analysis of best practices, 
model programs, guidelines, and other effective 
strategies for providing access to culturally and lin-
guistically appropriate health care services; 
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(3) recommendations on the development and 
implementation of policies and practices by providers 
of health care services and health-care-related serv-
ices for individuals with limited English proficiency, 
including people with cognitive, hearing, vision, or 
print impairments; 
(4) recommend guidelines or standards for 
health literacy and plain language, informed consent, 
discharge instructions, and written communications, 
and for improvement of health care access; 
(5) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(6) a description of the costs associated with or 
savings related to the provision of language services. 
(b) 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 
2021 through 2025. 
SEC. 707. HEALTH PROFESSIONS COMPETENCIES TO AD-
DRESS RACIAL AND ETHNIC MENTAL HEALTH 
DISPARITIES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Assistant Secretary 
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mitted to the Secretary as a supplement to the drug 
application or biologics license application. 
‘‘(c) APPLICATIONS UNDER SECTION 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 or other demographic 
characteristics (such as age, sex, gender) as to the 
safety or effectiveness of the drug as to the safety 
or effectiveness of the drug, whether derived from 
investigations or studies required under this section 
or derived from other sources, when the omitted in-
formation is protected by patent or by exclusivity 
under section 505(j)(5)(F). 
‘‘(2) LABELING.—Notwithstanding paragraph 
(1), the Secretary may require that the labeling of 
a drug approved under section 505(j) that omits in-
formation relating to a disparity on the basis of ra-
cial or ethnic background (such as age, sex, gender) 
as to the safety or effectiveness of the drug include 
a statement of any appropriate contraindications, 
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warnings, or precautions related to the disparity 
that the Secretary considers necessary. 
‘‘(d) DEFINITION.—The term ‘evidence that there 
may be a disparity on the basis of racial or ethnic back-
ground or other demographic characteristics (such as age, 
sex, gender) as to the safety or effectiveness’, with respect 
to a drug or biological product, includes— 
‘‘(1) evidence that there is a disparity on the 
basis of racial or ethnic background or other demo-
graphic characteristics (such as age, sex, gender) as 
to safety or effectiveness of a drug or biological 
product in the same chemical class as the drug or 
biological product; 
‘‘(2) evidence that there is a disparity on the 
basis of racial or ethnic background or other demo-
graphic characteristics (such as age, sex, gender) in 
the way the drug or biological product is metabo-
lized; 
‘‘(3) other evidence as the Secretary may deter-
mine appropriate; and 
‘‘(4) if such product addresses a disease/condi-
tion that evidence shows disproportionately impacts 
certain racial or ethnic groups or other demographic 
characteristics (such as age, sex, gender).’’. 
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‘‘(G) 
health 
professional 
associations, 
which may include underrepresented minority 
health professional associations; and 
‘‘(H) institutions, including national and 
regional community-based organizations with 
demonstrated commitment to a diversified 
workforce— 
‘‘(i) located in communities with pre-
dominantly underrepresented minority pop-
ulations; 
‘‘(ii) with whom partnerships have 
been formed for the purpose of increasing 
workforce diversity; and 
‘‘(iii) in which at least 20 percent of 
the enrolled participants are underrep-
resented minorities; and 
‘‘(2) 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 a 
grant under subsection (a) shall be used to expand existing 
workforce diversity programs, implement new workforce 
diversity programs, or evaluate existing or new workforce 
diversity programs, including with respect to mental 
health care professions. Such programs shall enhance di-
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