I 
108TH CONGRESS 
1ST SESSION 
H. R. 918
To authorize the Health Resources and Services Administration, the National 
Cancer Institute, and the Indian Health Service to make grants for 
model programs to provide to individuals of health disparity populations 
prevention, early detection, treatment, and appropriate follow-up care 
services for cancer and chronic diseases, and to make grants regarding 
patient navigators to assist individuals of health disparity populations 
in receiving such services. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 26, 2003
Mr. MENENDEZ (for himself, Ms. PRYCE of Ohio, Mr. GREEN of Texas, Ms. 
ROS-LEHTINEN, Mr. THOMPSON of Mississippi, Mr. LINCOLN DIAZ-
BALART of Florida, Mr. RODRIGUEZ, Mrs. WILSON of New Mexico, Mrs. 
CHRISTENSEN, Mr. QUINN, Mr. SERRANO, Mr. MCCOTTER, Mr. 
PALLONE, Mr. PEARCE, Mr. UDALL of New Mexico, and Mr. MARIO 
DIAZ-BALART of Florida) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce and in addition to the 
Committee on Resources, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned 
A BILL 
To authorize the Health Resources and Services Administra-
tion, the National Cancer Institute, and the Indian 
Health Service to make grants for model programs to 
provide to individuals of health disparity populations pre-
vention, early detection, treatment, and appropriate fol-
low-up care services for cancer and chronic diseases, 
and to make grants regarding patient navigators to assist
individuals of health disparity populations in receiving 
such services.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Patient Navigator, 
Outreach, and Chronic Disease Prevention Act of 2003’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
(1) Despite notable progress in the overall 
health of the Nation, there are continuing disparities 
in the burden of illness and death experienced by Af-
rican Americans, Latinos and Hispanics, Native 
Americans, Alaska Natives, Asian and Pacific Is-
landers and the poor, compared to the United States 
population as a whole. 
(2) Many racial and ethnic minority groups suf-
fer disproportionately from cancer. Mortality and 
morbidity rates remain the most important measures 
of the overall progress against cancer. Decreasing 
rates of death from cancer reflect improvements in 
both prevention and treatment. Among all ethnic 
groups in the United States, African American 
males have the highest overall rate of mortality from 
cancer. Some specific forms of cancer affect other 
ethnic minority communities at rates up to several
times higher than the national averages (such as 
stomach and liver cancers among Asian American 
populations, colon and rectal cancer among Alaska 
natives, and cervical cancer among Hispanic and Vi-
etnamese-American women). 
(3) Regions characterized by high rates of pov-
erty also have high mortality for some forms of can-
cer. For example, in Appalachian Kentucky the inci-
dence of lung cancer among white males was 127 
per 100,000 in 1992, a rate higher than that for any 
ethnic minority group in the United States during 
the same period. 
(4) Major disparities for other chronic diseases 
exist among population groups, with a dispropor-
tionate burden of death and disability from cardio-
vascular disease in racial and ethnic minority and 
low-income populations. Compared with rates for the 
general population, coronary heart disease mortality 
was 40 percent lower for Asian Americans but 40 
percent higher for African-Americans. 
(5) Minority populations are disproportionately 
impacted by diabetes and other chronic diseases. 
Hispanics are twice as likely to have diabetes as 
non-Hispanic whites; diabetes is the fourth leading 
cause of death among Hispanic women and elderly.
African Americans are 1.7 times as likely to have di-
abetes as the general population. More than 15 per-
cent of the combined populations of Native Ameri-
cans and Alaska Natives have diabetes. 
(6) Culturally competent approaches to chronic 
disease care are needed to encourage increased par-
ticipation of racial and ethnic minorities and the 
medically underserved in chronic disease prevention, 
early detection and treatment programs. 
SEC. 3. HRSA GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; HRSA GRANTS FOR PATIENT NAVIGA-
TORS. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 
DISEASE CARE AND PREVENTION; PATIENT 
NAVIGATORS. 
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC 
DISEASE CARE AND PREVENTION.—
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, may make grants to 
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, clinics serving 
Asian Americans and Pacific Islanders and Alaskan 
Natives, and rural health clinics and qualified non-
profit entities that partner with one or more centers 
providing health care to provide navigation services,
which demonstrate the ability to perform all of the 
functions outlined in this subsection and subsections 
(b) and (c)) for the development and operation of 
model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection, 
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases; 
‘‘(B) ensure that the health services are 
provided to such individuals in a culturally com-
petent manner; 
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
‘‘(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate
follow-up care of cancer or other chronic 
disease; and 
‘‘(ii) facilitate access to appropriate 
health care services within the health care 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
‘‘(D) require training for patient naviga-
tors employed through such model programs to 
ensure the ability of navigators to perform all 
of the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
‘‘(E) ensure that consumers have direct ac-
cess 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 out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pro-
gram is serving of the services of the model program 
under the grant. Such activities shall include facili-
tating access to appropriate health care services and 
patient navigators within the health care system to 
ensure optimal patient utilization of these services. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective program evaluation, the 
grantee shall collect specific patient data recording 
services provided to each patient served by the pro-
gram and shall establish and implement procedures 
and protocols, consistent with applicable Federal and 
State laws (including 45 C.F.R. 160 and 164) to en-
sure the confidentiality of all information shared by 
a participant in the program, or their personal rep-
resentative and their health care providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually 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 difficul-
ties resolved, 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 
application 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 Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide 
for evaluations to determine which outreach ac-
tivities under paragraph (2) were most effective 
in informing the public and the specific commu-
nity that the program is serving of the model 
program services and to determine the extent to 
which such programs were effective in providing
culturally competent services to the health dis-
parity population served by the programs. 
‘‘(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
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (b), with the program under section 
417D, and to the extent practicable, with programs 
for prevention centers that are carried out by the 
Director of the Centers for Disease Control and Pre-
vention. 
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, may make grants to 
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, clinics serving 
Asian Americans and Pacific Islanders and Alaskan 
Natives, and rural health clinics and qualified non-
profit entities that partner with one or more centers
providing health care to provide navigation services, 
which demonstrate the ability to perform all of the 
functions outlined in this subsection and subsections 
(a) and (c)) for the development and operation of 
programs to pay the costs of such health centers 
in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for managing the care of individuals of 
health disparity populations for the duration of 
receiving health services from the health cen-
ters, including aid in coordinating and sched-
uling appointments and referrals, community 
outreach, assistance with transportation ar-
rangements, and assistance with insurance 
issues and other barriers to care and providing 
information about clinical trials; 
‘‘(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
‘‘(C) ensuring that patient navigators with 
direct knowledge of the communities they serve
‘‘(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 out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pa-
tient navigator 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 pro-
gram evaluation, the grantee shall collect specific pa-
tient data recording navigation services provided to 
each patient served by the program and shall estab-
lish and implement procedures and protocols, con-
sistent with applicable Federal and State laws (in-
cluding 45 C.F.R. 160 and 164) to ensure the con-
fidentiality of all information shared by a participant 
in the program, or their personal representative and 
their health care providers, group health plans, or 
health insurance insurers with the program. The pa-
tient navigator program may, consistent with appli-
cable Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually 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 difficul-
ties resolved, 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 
application 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 Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide 
for evaluations to determine the effects of the 
services of patient navigators on the individuals 
of health disparity populations for whom the
services were provided, taking into account the 
matters referred to in paragraph (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
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram 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
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 where care is provided 
free of charge, including the case of services pro-
vided through programs of the Indian Health Serv-
ice. 
‘‘(d) MODEL.—Not later than five years after the 
date of the enactment of this section, the Secretary shall 
develop 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 
subsection (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:
‘‘(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
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
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
POL-
ICY.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through 
the Office of Rural Health Policy. 
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs.’’.
SEC. 4. NCI GRANTS FOR MODEL COMMUNITY CANCER AND 
CHRONIC DISEASE CARE AND PREVENTION; 
NCI GRANTS FOR PATIENT NAVIGATORS. 
Subpart 1 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285 et seq.) is amended by adding 
at the end following section: 
‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC 
DISEASE CARE AND PREVENTION; PATIENT 
NAVIGATORS. 
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC 
DISEASE CARE AND PREVENTION.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection, 
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases; 
‘‘(B) ensure that the health services are 
provided to such individuals in a culturally com-
petent manner;
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
‘‘(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
‘‘(ii) facilitate access to appropriate 
health care services within the health care 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
‘‘(D) require training for patient naviga-
tors employed through such model programs to 
ensure the ability of navigators to perform all 
of the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance
systems and are able to aid patients in resolv-
ing access issues; and 
‘‘(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 
section, an eligible entity is a designated cancer cen-
ter of the Institute, an academic institution, Indian 
Health Service Clinics, tribal governments, urban In-
dian organizations, tribal organizations, a hospital, a 
qualified nonprofit entity that partners with one or 
more centers providing health care to provide navi-
gation services, which demonstrates the ability to 
perform all of the functions outlined in this sub-
section and subsections (b) and (c), or any other 
public or private entity determined to be appropriate 
by the Director of the Institute, that provides serv-
ices described in paragraph (1)(A) for cancer and 
chronic diseases. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective program evaluation, the 
grantee shall collect specific patient data recording 
services provided to each patient served by the pro-
gram and shall establish and implement procedures 
and protocols, consistent with applicable Federal and
State laws (including 45 C.F.R. 160 and 164) to en-
sure the confidentiality of all information shared by 
a participant in the program, or their personal rep-
resentative and their health care providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 CFR 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 difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pro-
gram is serving of the services of the model program 
under the grant. Such activities shall include facili-
tating access to appropriate health care services and 
patient navigators within the health care system to 
ensure optimal patient utilization of these services. 
‘‘(5) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section. 
‘‘(6) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Director of the 
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine which outreach activities under paragraph 
(3) were most effective in informing the public 
and the specific community that the program is 
serving of the model program services and to 
determine the extent to which such programs 
were effective in providing culturally competent 
services to the health disparity population 
served by the programs. 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Director of the Institute shall as appropriate 
disseminate to public and private entities the
findings made in evaluations under subpara-
graph (A). 
‘‘(7) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under
subsection (b), with the program under section 330I, 
and to the extent practicable, with programs for pre-
vention centers that are carried out by the Director 
of the Centers for Disease Control and Prevention. 
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of programs to pay the 
costs of such entities in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for managing the care of individuals of 
health disparity populations for the duration of 
receiving health services from the health cen-
ters, including aid in coordinating and sched-
uling appointments and referrals, community 
outreach, assistance with transportation ar-
rangements, and assistance with insurance 
issues and other barriers to care and providing 
information about clinical trials;
‘‘(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
‘‘(C) ensuring that the patient navigators 
with direct knowledge of the communities they 
serve provide services to such individuals in a 
culturally competent manner; 
‘‘(D) developing model practices for patient 
navigators, including with respect to—
‘‘(i) coordination of health services, 
including 
psychosocial 
assessment 
and 
care; 
‘‘(ii) follow-up services, including psy-
chosocial assessment and care; 
‘‘(iii) 
determining 
coverage 
under 
health insurance and health plans for all 
services; 
‘‘(iv) ensuring the initiation, continu-
ation and/or sustained access to care pre-
scribed by the patients’ health care pro-
viders; and 
‘‘(v) aiding patients with health insur-
ance coverage issues;
‘‘(E) requiring training for patient naviga-
tors to ensure the ability of navigators to per-
form all of the duties required in this sub-
section and in subsection (a), including training 
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 out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pa-
tient navigator 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 pro-
gram evaluation, the grantee shall collect specific pa-
tient data recording navigation services provided to 
each patient served by the program and shall estab-
lish and implement procedures and protocols, con-
sistent with applicable Federal and State laws (in-
cluding 45 C.F.R. 160 and 164) to ensure the con-
fidentiality of all information shared by a participant 
in the program, or their personal representative and 
their health care providers, group health plans, or 
health insurance insurers with the program. The pa-
tient navigator program may, consistent with appli-
cable Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually 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 difficul-
ties resolved, 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 Director of the In-
stitute and the application is in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section. 
‘‘(5) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Director of the 
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine the effects of the services of patient navi-
gators on the health disparity population for 
whom the services were provided, taking into 
account the matters referred to in paragraph 
(1)(C).
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Director of the Institute shall as appropriate 
disseminate to public and private entities the 
findings made in evaluations under subpara-
graph (A). 
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (a) and with the program under section 
330I. 
‘‘(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