‘‘(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-
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 appropriate; 
‘‘(ii) allow public review of the docu-
ments before dissemination in order to en-
sure that the documents are understand-
able and culturally appropriate for the tar-
get populations; 
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‘‘(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. 
‘‘(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 
LEP individuals, including case studies using 
de-identified patient information, program sum-
maries, and program evaluations. 
‘‘(E) CULTURAL
AND
LINGUISTIC
COM-
PETENCE MATERIALS.—The Center shall pro-
vide information relating to culturally and lin-
guistically competent health care for minority 
populations residing in the United States to all 
health care providers and health-care-related 
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services at no cost. Such information shall in-
clude— 
‘‘(i) tenets of culturally and linguis-
tically competent care; 
‘‘(ii) cultural and linguistic com-
petence self-assessment tools; 
‘‘(iii) cultural and linguistic com-
petence training tools; 
‘‘(iv) strategic plans to increase cul-
tural and linguistic competence in different 
types of providers of health care and 
health-care-related services, including re-
gional collaborations among health care or-
ganizations; and 
‘‘(v) cultural and linguistic com-
petence information for educators, practi-
tioners, and researchers. 
‘‘(F) INFORMATION
ABOUT
PROGRESS.— 
The Center shall regularly collect and make 
publicly 
available 
information 
about 
the 
progress of entities receiving grants under sec-
tion 3404 regarding successful innovations in 
implementing the obligations under this sub-
section and provide public notice in the entities’ 
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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, LEP individuals, health 
professionals, graduate schools, and community health 
centers about— 
‘‘(1) Federal and State laws and guidelines gov-
erning access to language services; 
‘‘(2) the value of using trained interpreters and 
the risks associated with using family members, 
friends, minors, and untrained bilingual staff; 
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‘‘(3) funding sources for developing and imple-
menting language services; and 
‘‘(4) promising practices to effectively provide 
language services. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—In ad-
dition to the amounts authorized under subsection 
(e)(8)(F), there are authorized to be appropriated to carry 
out this section such sums as may be necessary for each 
of fiscal years 2015 through 2019. 
‘‘SEC. 3404. INNOVATIONS IN CULTURAL AND LINGUISTIC 
COMPETENCE GRANTS. 
‘‘(a) IN GENERAL.—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 evaluate innova-
tive, cost-effective programs to improve cultural com-
petence and language access in health care for individuals 
with limited-English proficiency. The Director of the 
Agency for Healthcare Research and Quality shall coordi-
nate with, and ensure the participation of, other agencies 
including the Health Resources and Services Administra-
tion, the Center on Minority Health and Health Dispari-
ties at the National Institutes of Health, and the Office 
of Minority Health, regarding the design and evaluation 
of the grants program. 
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‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall— 
‘‘(1) be— 
‘‘(A) a city, county, Indian tribe, State, 
territory, 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 center or clinic; 
‘‘(D) a solo or group physician practice; 
‘‘(E) an integrated health care delivery 
system; 
‘‘(F) a public hospital; 
‘‘(G) a health care group, university, or 
college; or 
‘‘(H) other entity designated by the Sec-
retary; and 
‘‘(2) prepare and submit to the Secretary an 
application, at such time, in such manner, and ac-
companied by such additional information as the 
Secretary may require. 
‘‘(c) USE OF FUNDS.—An entity shall use funds re-
ceived under a grant under this section to— 
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‘‘(1) develop, implement, and evaluate models of 
providing competent interpretation services through 
onsite interpretation, telephonic interpretation, or 
video interpretation; 
‘‘(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 organization; 
‘‘(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 service area of the organization; 
‘‘(4) develop a strategic plan to implement lan-
guage services; 
‘‘(5) develop participatory, collaborative part-
nerships with communities encompassing the LEP 
patient populations being served to gain input in de-
signing and implementing language services; 
‘‘(6) develop and implement grievance resolu-
tion processes that are culturally and linguistically 
sensitive and capable of identifying, preventing, and 
resolving complaints by LEP individuals; or 
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‘‘(7) develop short-term medical mental health 
interpretation training courses and incentives for bi-
lingual health care staff who are asked to interpret 
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 competent providers; 
‘‘(9) provide staff language training instruction, 
which shall include information on the practical limi-
tations of such instruction for non-native speakers; 
‘‘(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; 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 (42 
U.S.C. 1320d–2 note) and any applicable State pri-
vacy laws, data on the individual patient or recipi-
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ent’s race, ethnicity, and primary language are col-
lected (and periodically updated) in health records 
and integrated into the organization’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.— 
‘‘(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 and health-care-related services and the qual-
ity of health care for individuals with limited-English 
proficiency. Such evaluation shall be collected and 
disseminated through the Robert T. Matsui Center 
for Cultural and Linguistic Competence in Health 
Care established under section 3403. The Director 
of the Agency for Healthcare Research and Quality 
shall notify grantees of the availability of technical 
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assistance for the evaluation and provide such assist-
ance 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 2015 through 2019. 
‘‘SEC. 3405. 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. 
‘‘(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 do so. 
‘‘(c) USE OF FUNDS.—Research 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 LEP individuals. 
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‘‘(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 LEP individuals. 
‘‘(3) To identify optimal approaches for deliv-
ering language access. 
‘‘(4) To identify best practices for data collec-
tion, including— 
‘‘(A) the collection by providers of health 
care and health-care-related services of data on 
the race, ethnicity, and primary language of re-
cipients of such services, taking into account ex-
isting research conducted by the Government 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 Department can create or coordinate, and 
then subsidize or otherwise fund telephonic interpre-
tation providers for health care providers, taking 
into consideration, among other factors, the flexi-
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bility 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. 
‘‘(d) 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 
2015 through 2019.’’. 
SEC. 203. PILOT PROGRAM FOR IMPROVEMENT AND DE-
VELOPMENT 
OF 
STATE 
MEDICAL 
INTER-
PRETING SERVICES. 
(a) GRANTS
AUTHORIZED.—The Secretary shall 
award one grant in accordance with this section to each 
of three States to assist each such State in designing, im-
plementing, and evaluating a statewide program to provide 
onsite interpreter services under Medicaid. 
(b) GRANT PERIOD.—A grant awarded under this 
section is authorized for a period of three fiscal years be-
ginning on October 1, 2014. 
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(c) PREFERENCE.—In awarding a grant under this 
section, the Secretary shall give preference to a State— 
(1) that has a high proportion of qualified LEP 
enrollees, as determined by the Secretary; 
(2) that has a large number of qualified LEP 
enrollees, as determined by the Secretary; 
(3) that has a high growth rate of the popu-
lation of LEP individuals, as determined by the Sec-
retary; and 
(4) that has a population of qualified LEP en-
rollees that is linguistically diverse, requiring inter-
preter services in at least 200 non-English lan-
guages. 
(d) USE OF FUNDS.—A State receiving a grant under 
this section shall use the grant funds to— 
(1) ensure that all health care providers in the 
State participating in the State plan under Medicaid 
have access to onsite interpreter services, for the 
purpose of enabling effective communication between 
such providers and qualified LEP enrollees during 
the furnishing of items and services and administra-
tive interactions; 
(2) establish, expand, procure, or contract for— 
(A) a statewide health care information 
technology system that is designed to achieve 
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efficiencies and economies of scale with respect 
to onsite interpreter services provided to health 
care providers in the State participating in the 
State plan under Medicaid; and 
(B) an entity to administer such system, 
the duties of which shall include— 
(i) procuring and scheduling inter-
preter services for qualified LEP enrollees; 
(ii) procuring and scheduling inter-
preter services for LEP individuals seeking 
to enroll in the State plan under Medicaid; 
(iii) ensuring that interpreters receive 
payment for interpreter services rendered 
under the system; and 
(iv) consulting regularly with organi-
zations 
representing 
consumers, 
inter-
preters, and health care providers; and 
(3) develop mechanisms to establish, improve, 
and strengthen the competency of the medical inter-
pretation workforce that serves qualified LEP enroll-
ees in the State, including a national certification 
process that is valid, credible, and vendor-neutral. 
(e) APPLICATION.—To receive a grant under this sec-
tion, a State shall submit an application at such time and 
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containing such information as the Secretary may require, 
which shall include the following: 
(1) A description of the language access needs 
of individuals in the State enrolled in the State plan 
under Medicaid. 
(2) A description of the extent to which the 
program will— 
(A) use the grant funds for the purposes 
described in subsection (d); 
(B) meet the health care needs of rural 
populations of the State; and 
(C) collect information that accurately 
tracks the language services requested by con-
sumers as compared to the language services 
provided by health care providers in the State 
participating in the State plan under Medicaid. 
(3) A description of how the program will be 
evaluated, including a proposal for collaboration with 
organizations representing interpreters, consumers, 
and LEP individuals. 
(f) DEFINITIONS.—In this section: 
(1) QUALIFIED
LEP
ENROLLEE.—The term 
‘‘qualified LEP enrollee’’ means an individual— 
(A) who is limited-English-proficient; and 
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(B) who is enrolled in a State plan under 
Medicaid. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given the term in section 1101(a)(1) of the So-
cial Security Act (42 U.S.C. 1301(a)(1)), for pur-
poses of title XIX of such Act. 
(3) 
UNITED
STATES.—The 
term 
‘‘United 
States’’ has the meaning given the term in section 
1101(a)(2) of the Social Security Act (42 U.S.C. 
1301(a)(2)), for purposes of title XIX of such Act. 
(g) FUNDING.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated $5,000,000 
to carry out this section. 
(2) AVAILABILITY OF FUNDS.—The funds au-
thorized by paragraph (1) shall be available without 
fiscal year limitation. 
(3) INCREASED FEDERAL FINANCIAL PARTICI-
PATION.—Section 1903(a)(2)(E) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(2)(E)), as amended by 
section 205(d)(1) of this Act, is further amended by 
inserting ‘‘(or, in the case of a State receiving a 
grant under section 203 of the Health Equity and 
Accountability Act of 2014, 100 percent for each 
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quarter occurring during the grant period)’’ after 
‘‘90 percent’’. 
(h) LIMITATION.—No Federal funds under this sec-
tion may be used to provide interpreter services from a 
location outside the United States. 
SEC. 204. 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 COM-
PETENCY
TRAINING.—In determining a hos-
pital’s number of full-time equivalent residents 
for purposes of this subsection, all the time that 
is spent by an intern or resident in an approved 
medical residency training program for edu-
cation and training in cultural competency and 
linguistically appropriate service delivery shall 
be counted toward the determination of full- 
time equivalency.’’. 
(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
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1395ww(d)(5)(B)) is amended by adding at the end the 
following new clause: 
‘‘(xii) The provisions of subparagraph (L) 
of subsection (h)(4) shall apply under this sub-
paragraph 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. 205. 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.— 
(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, 
shall establish a demonstration program under 
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which the Secretary shall award grants to eligi-
ble Medicare service providers to improve com-
munication between such providers and limited- 
English-proficient Medicare beneficiaries, in-
cluding beneficiaries who live in diverse and un-
derserved 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. 
(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— 
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(i) a provider of services under part A 
of title XVIII of the Social Security Act; 
(ii) a provider of services under part 
B of such title; 
(iii) a Medicare Advantage organiza-
tion offering a Medicare Advantage plan 
under part C of such title; or 
(iv) a PDP sponsor offering a pre-
scription drug plan under part D of such 
title. 
(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 
limited-English-proficient 
individuals, 
is 
disproportionally underserved. 
(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 
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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); 
(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, 
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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, and 
economically diverse populations. 
(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.— 
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(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 limited-English- 
proficient. 
(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)— 
(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 
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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-
lation services would jeopardize the health 
of the patient. 
Subparagraph (C)(ii) shall not be construed to 
exempt emergency rooms or similar entities 
that regularly provide health care services in 
medical emergencies to limited-English-pro-
ficient patients from any applicable legal or reg-
ulatory requirements related to providing com-
petent interpreter and translation services with-
out 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 or a PDP 
sponsor offering a prescription drug plan under 
part D of such title, such entity must provide 
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at least 50 percent of the grant funds that the 
entity receives under this subsection directly to 
the entity’s network providers (including all 
health providers and pharmacists) for the pur-
pose of providing support for such providers to 
provide competent language services to Medi-
care beneficiaries who are limited-English-pro-
ficient. 
(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 limited-English- 
proficient Medicare beneficiaries in a grantee’s 
service area utilizing— 
(i) data on the numbers of limited- 
English-proficient individuals who speak 
English less than ‘‘very well’’ from the 
most recently available data from the Bu-
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reau 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 
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 lim-
ited-English-proficient 
individuals 
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). 
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(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; 
(B) ensure the linguistic competence of bi-
lingual providers; 
(C) offer and provide appropriate language 
services at no additional charge to each patient 
with limited-English proficiency for all points of 
contact 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 
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100 
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 
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.—Limited-English-pro-
ficient Medicare beneficiaries shall not have to pay 
cost-sharing or co-payments for competent language 
services 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. 
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101 
(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 
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: 
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102 
(A) An analysis of the patient outcomes 
and the costs of furnishing care to the limited- 
English-proficient Medicare beneficiaries par-
ticipating in the project as compared to such 
outcomes and costs for limited-English-pro-
ficient Medicare beneficiaries not participating, 
based on the data provided under paragraph (9) 
and any other information available to the Sec-
retary. 
(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 
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103 
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 subsection (c) of section 
1907 of this Act. 
(D) Recommendations, if any, regarding 
the extension of such project to the entire Medi-
care program, subject to the provisions of sec-
tion 1115A(c) of the Social Security Act. 
(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. 
(b) LANGUAGE 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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104 
(i) in subparagraph (B), by striking 
the ‘‘and’’ at the end; 
(ii) in subparagraph (C), by inserting 
‘‘and’’ after the comma at the end; and 
(iii) by inserting after subparagraph 
(C) the following: 
‘‘(D) language services as defined in sub-
section (iii)(1),’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Language Services and Related Terms 
‘‘(iii)(1) LANGUAGE SERVICES DEFINED.—The term 
‘language services’ has the same meaning given ‘language 
or language access services’ in section 3400 of the Public 
Health Service Act. 
‘‘(2) INTERPRETER SERVICES DEFINED.—For the 
purposes of this subsection, the term ‘interpreter services’ 
has the meaning given ‘competent interpreter services’ 
under section 3400(3) of the Public Health Service Act. 
‘‘(3) INTERPRETER DEFINED.—The term ‘inter-
preter’— 
‘‘(A) means an individual— 
‘‘(i) who faithfully, accurately, and objec-
tively transmits a spoken message from one lan-
guage into another language; and 
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105 
‘‘(ii) who knows health and health-related 
terminology in both languages; and 
‘‘(B) includes individuals who provide in-person, 
telephonic, and video interpretation. 
‘‘(4) TRANSLATION DEFINED.—The term ‘trans-
lation’ means the transmission of a written message in one 
language into a written message in another language that 
retains the intended meaning of the original message. 
‘‘(5) LIMITED-ENGLISH-PROFICIENT AND LEP DE-
FINED.—The terms ‘limited-English-proficient’ and ‘LEP’ 
have the meaning given the term ‘limited english pro-
ficient’ under section 9101(25) of the Elementary and 
Secondary Education Act of 1965, except that subpara-
graphs (A), (B), and (D) of such section not apply.’’. 
(2) COVERAGE.—Section 1832(a)(2) of such 
Act (42 U.S.C. 1395k(a)(2)) is amended— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (I); 
(B) by striking the period at the end of 
subparagraph (J) and inserting ‘‘; and’’; and 
(C) by adding at the end of subparagraph 
(J) the following: 
‘‘(K) language services (as defined in para-
graph (1) of section 1861(iii)) furnished by an 
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106 
interpreter (as defined in paragraph (3) of such 
section) or translator.’’. 
(3) PAYMENT.—Section 1833(a) of the Social 
Security Act (42 U.S.C. 1395l(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (8); 
(B) by redesignating paragraph (9) as 
paragraph (10); and 
(C) by inserting after paragraph (8) the 
following new paragraph: 
‘‘(9) in the case of language services described 
in section 1861(iii)(1), 100 percent of the reasonable 
charges for such services, as determined in consulta-
tion with the Medicare Payment Advisory Commis-
sion; and’’. 
(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 services (as such 
term is defined in section 1861(iii)(1) of such Act). 
(c) MEDICARE PARTS C AND D.— 
(1) IN GENERAL.—Medicare Advantage plans 
under part C of the Social Security Act and pre-
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scription drug plans under part D of such Act shall 
comply with title VI of the Civil Rights Act of 1964 
and section 1557 of the Patient Protection and Af-
fordable Care Act to provide effective language serv-
ices 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-
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 plan’s internal policies and proce-
dures related to recruitment and retention efforts di-
rected to workforce diversity and linguistically and 
culturally appropriate provision of services in each of 
the following contexts: 
‘‘(A) The collection of data in a manner 
that meets the requirements of title I of the 
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108 
Health Equity and Accountability Act of 2014, 
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 health plan’s lan-
guage services programs and services with re-
spect to the plan’s enrollee population, such as 
through analysis of complaints or satisfaction 
survey results. 
‘‘(D) Methods by which the plan provides 
to the Secretary information regarding the eth-
nic diversity of the plan’s enrollee population. 
‘‘(E) The periodic provision of educational 
information to plan enrollees on the plan’s lan-
guage services and programs.’’. 
(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)) is amended by— 
(A) striking ‘‘75’’ and inserting ‘‘90’’; 
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109 
(B) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language 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 (28)’’ and inserting ‘‘(28), and (29)’’. 
(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 (28), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (29) as 
paragraph (30); and 
(C) by inserting after paragraph (28) the 
following new paragraph: 
‘‘(29) language services, as such term is defined 
in section 1861(iii)(1), provided in a timely manner 
to limited-English-proficient individuals who need 
such services; and’’. 
(4) USE
OF
DEDUCTIONS
AND
COST
SHAR-
ING.—Section 1916(a)(2) of the Social Security Act 
(42 U.S.C. 1396o(2)) is amended by— 
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110 
(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 services described in section 
1905(a)(29); and’’. 
(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 (9)’’; and 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(9) LANGUAGE SERVICES.—The child health 
assistance provided to a targeted low-income child 
shall include coverage of language services, as such 
term is defined in section 1861(iii)(1), provided in a 
timely manner to limited-English-proficient individ-
uals who need such services.’’; and 
(C) in subsection (e)(2)— 
(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
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111 
(ii) by inserting ‘‘, subsection (c)(9),’’ 
after ‘‘subsection (c)(1)(C)’’. 
(6) DEFINITION
OF
CHILD
HEALTH
ASSIST-
ANCE.—Section 2110(a)(27) of the Social Security 
Act (42 U.S.C. 1397jj) is amended by striking 
‘‘translation’’ and inserting ‘‘language services as 
described in section 2103(c)(9)’’. 
(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; 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(c)) 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 ‘‘, except that expenditures 
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112 
pursuant to clause (iv) of subparagraph (D) of 
such paragraph shall not count towards this 
total’’. 
(e) FUNDING LANGUAGE SERVICES FURNISHED BY 
PROVIDERS OF HEALTH CARE AND HEALTH-CARE-RE-
LATED SERVICES THAT SERVE HIGH RATES OF UNIN-
SURED LEP INDIVIDUALS.— 
(1) PAYMENT OF COSTS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services shall make payments (on a quarterly 
basis) directly to eligible entities to support the 
provision of language services to limited- 
English-proficient individuals in an amount 
equal to an eligible entity’s eligible costs for 
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 2012 through 
2016. 
(C) RELATION TO MEDICAID DSH.—Pay-
ments under this subsection shall not offset or 
reduce payments under section 1923 of the So-
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113 
cial Security Act, nor shall payments under 
such section be considered when determining 
uncompensated costs associated with the provi-
sion of language services. 
(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 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 services for 
individual patients as a requirement for pay-
ment 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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202 
(3) 
PREEXISTING
CONDITION
INSURANCE 
PLAN.—Section 1101(d) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18001(d)) is 
amended by striking paragraph (1) and redesig-
nating paragraphs (2) and (3) as paragraphs (1) 
and (2), respectively. 
(4) BASIC
HEALTH
PROGRAM
ELIGIBILITY.— 
Section 1331(e)(1)(B) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18051(e)(1)(B)) is 
amended by striking ‘‘lawfully present in the United 
States,’’. 
(5) RESTRICTIONS ON FEDERAL PAYMENTS.— 
Section 1412 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18082) is amended by 
striking subsection (d). 
(6) REQUIREMENT TO MAINTAIN MINIMUM ES-
SENTIAL
COVERAGE.—Subsection (d) of section 
5000A of the Internal Revenue Code of 1986 is 
amended by striking paragraph (3) and by redesig-
nating paragraph (4) as paragraph (3). 
(b) CONFORMING AMENDMENT.— 
(1) Section 1411(a) of the Patient Protection 
and Affordable Care Act (42 U.S.C. 18081(a)) is 
amended by striking paragraph (1) and redesig-
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