‘‘(e) EVALUATION.— 
‘‘(1) An entity that receives a grant under this 
section shall submit to the Secretary an evaluation 
that describes, in the manner and to the extent re-
quired by the Secretary, the activities carried out 
with funds received under the grant, and how such 
activities improved access to health and health care- 
related services and the quality of health care for in-
dividuals with limited English proficiency. Such eval-
uation shall be collected and disseminated through 
the Robert T. Matsui Center for Cultural and Lin-
guistic Competence in Health Care established under 
section 3103. The Director of the Agency for 
Healthcare Research and Quality shall notify grant-
ees of the availability of technical assistance for the 
evaluation and provide such assistance upon request. 
‘‘(2) The Director of the Agency for Healthcare 
Research and Quality shall evaluate or arrange with 
other individuals or organizations to evaluate 
projects funded under this section. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$5,000,000 for each of fiscal years 2010 through 2014. 
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‘‘SEC. 3105. 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. 
‘‘(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-
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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-
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, 
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such sums as may be necessary for each of fiscal years 
2010 through 2014.’’. 
SEC. 102. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID AND 
THE STATE CHILDREN’S HEALTH INSURANCE 
PROGRAM. 
(a) MEDICARE.—Title XVIII of the Social Security 
Act is amended by adding at the end the following new 
section: 
‘‘MEDICARE SUPPORT FOR LANGUAGE SERVICES 
‘‘SEC. 1899. 
‘‘(a) ENSURING APPROPRIATE PAYMENT FOR THE 
FURNISHING
OF LINGUISTICALLY APPROPRIATE LAN-
GUAGE SERVICES TO ALL MEDICARE BENEFICIARIES.— 
‘‘(b) TEMPORARY COST-BASED PAYMENTS FOR LAN-
GUAGE SERVICES TO HOSPITALS.— 
‘‘(1) IN
GENERAL.—Not later than 90 days 
after enactment of this section, the Secretary shall 
initiate quarterly payments to all hospitals that are 
certified as Medicare providers (including short-term 
acute inpatient hospitals, long-term care hospitals, 
inpatient rehabilitation facilities, children’s, cancer, 
psychiatric, and critical access hospitals) to pay for 
the costs of providing language services to limited 
English proficient Medicare beneficiaries. These pay-
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ments shall cover the provision of language services 
by hospitals in inpatient and outpatient settings. 
These payments shall continue until the Secretary 
develops and implements reimbursement standards 
for language services pursuant to the process set 
forth in subsection (b). 
‘‘(2) DETERMINATION
OF
TEMPORARY
PAY-
MENTS.—Payments under paragraph (1) shall be 
calculated based on the estimated numbers of LEP 
Medicare beneficiaries in a hospital’s service area 
utilizing— 
‘‘(A) data on the numbers of LEP individ-
uals (defined for purposes of this paragraph as 
individuals who speak English less than ‘very 
well’) from the most recently available data 
from the Bureau of the Census; or 
‘‘(B) the hospital’s own data if— 
‘‘(i) the hospital routinely collects 
data on patients’ primary language or need 
for an interpreter in both in- and out-pa-
tient settings; 
‘‘(ii) the data collection system used 
by the hospital is, as determined by the 
Secretary, likely to yield accurate data re-
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garding the number of LEP individuals 
served by the hospital, and, 
‘‘(iii) the hospital’s data documents 
greater numbers of LEP individuals than 
does the data described in clause (i). 
‘‘(C) DISTRIBUTION
OF
FUNDS.—On a 
quarterly 
basis, 
the 
Secretary 
shall 
pay 
amounts directly to eligible hospitals to pay for 
the costs of providing language services to LEP 
Medicare beneficiaries. 
‘‘(D) METHODOLOGIES.—In establishing a 
methodology for temporary payments, the Sec-
retary may establish one or more payment 
methodologies for inpatient and outpatient set-
tings. 
‘‘(3) REPORTING
REQUIREMENTS.—Hospitals 
receiving payment under paragraph (1) shall provide 
the Secretary with two reports on— 
‘‘(A) the number of Medicare beneficiaries 
to whom language services are provided; 
‘‘(B) the languages of those Medicare 
beneficiaries; 
‘‘(C) the types of language services pro-
vided (such as provision of services directly in 
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non-English language by a health care provider 
or use of an interpreter); 
‘‘(D) type of interpretation (such as in-per-
son, telephonic, or video interpretation); 
‘‘(E) the methods of providing language 
services (staff, contract with external inde-
pendent contractors, or agencies); 
‘‘(F) the length of time for each interpre-
tation encounter; and 
‘‘(G) the costs of providing language serv-
ices (whether actual or estimated, as deter-
mined by the Secretary). 
‘‘(4) NO
COST-SHARING.—There shall be no 
cost-sharing for language services provided as tem-
porary payments to hospitals. 
‘‘(5) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
this subsection such sums as may be necessary for 
each of fiscal years 2010 through 2014. 
‘‘(c) DEVELOPMENT
OF PAYMENT AMOUNTS
FOR 
LANGUAGE SERVICES.— 
‘‘(1) IN GENERAL.—Not later than 6 months 
after enactment of this section, the Secretary shall 
convene a Working Group to advise the Secretary on 
the development of payment amounts that are based 
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on hospital-reported costs for language services pro-
vided to LEP Medicare beneficiaries. Reimburse-
ment shall apply to all Medicare-covered services 
furnished by certified providers to eligible bene-
ficiaries, whether covered under parts A and B or 
under the Medicare Advantage program under 
part C. 
‘‘(2) VARIATIONS.—The Secretary, in consulta-
tion with the Working Group, may establish vari-
ations within the reimbursement system based upon 
available delivery methods and costs for providing 
language services including such factors as— 
‘‘(A) the type of language services provided 
(such as provision of services directly in a non- 
English language by a health care provider or 
use of an interpreter); 
‘‘(B) type of interpretation services pro-
vided (such as in-person, telephonic, or video in-
terpretation); 
‘‘(C) the methods and costs of providing 
language services (including the costs of pro-
viding language services with internal staff or 
through contract with external independent con-
tractors or agencies); 
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‘‘(D) providing services for languages not 
frequently encountered in the United States; 
and 
‘‘(E) providing services in rural areas. 
‘‘(3) NO
COST-SHARING.—There shall be no 
cost-sharing for language services provided as pay-
ments to hospitals under this subsection. 
‘‘(4) LIMITATIONS.— 
‘‘(A) IN GENERAL.—Reimbursement shall 
only be provided to hospitals under this sub-
section that report their costs of providing lan-
guage services, including information on the 
factors described in paragraph (1) that are uti-
lized in establishing the reimbursement rates 
and any other information specified by the Sec-
retary. 
‘‘(B) USE
OF
INTERPRETER
OR
TRANS-
LATION SERVICES.— 
‘‘(i) IN
GENERAL.—Reimbursement 
shall be provided under this subsection 
only to hospitals that utilize interpreter or 
translation services. 
‘‘(ii) INTERPRETER
SERVICES
DE-
FINED.—In this paragraph the term ‘inter-
preter services’ means services designed to 
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provide a competent trans-language ren-
dition of a spoken message in which an in-
terpreter comprehends the source language 
and can speak comprehensively in the tar-
get language to convey the meaning in-
tended in the source language. Such inter-
preter shall know health and health-related 
terminology and provide accurate interpre-
tations by choosing equivalent expressions 
that convey the best matching and mean-
ing to the source language and captures, to 
the greatest possible extent, all nuances in-
tended in the source message. 
‘‘(iii) 
INTERPRETER
DEFINED.—In 
this paragraph, the he term ‘interpreter’ 
means an individual who transmits a spo-
ken message from one language into an-
other, faithfully, accurately, and objec-
tively. Such term includes an individual 
who provide in-person, telephonic, and 
video interpretation and also includes an 
individual who is employed or contracted 
by those who provide benefits under sec-
tion 1832. 
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‘‘(iv) TRANSLATION.—In this para-
graph, the term ‘translation’ means the 
competent transmission of a written mes-
sage in one language into a written mes-
sage in another language. 
‘‘(v) 
EXEMPTIONS.—The 
require-
ments of clauses (i) and (ii) shall not 
apply— 
‘‘(I) when a individual (who has 
been informed in the individual’s pri-
mary language of the availability of 
free interpreter and translation serv-
ices) requests the use of family, 
friends or other persons untrained in 
interpretation or translation; and 
‘‘(II) when a medical emergency 
exists and the delay directly associ-
ated with obtaining a competent inter-
preter or translation services would 
jeopardize the health of the individual. 
Nothing in this clause shall exempt emer-
gency rooms or similar entities that regu-
larly provide health care services in med-
ical emergencies from having in place sys-
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tems to provide competent interpreter and 
translation services without undue delay. 
‘‘(5) WORKING GROUP.—The Secretary shall es-
tablish a Working Group (in this subsection referred 
to as the ‘Working Group’) to develop the payment 
amounts under this paragraph. Such Working Group 
include representatives from the American Hospital 
Association, National Association of Public Hos-
pitals and Health Systems, Association of Language 
Companies, the National Council of Interpreting in 
Health Care, organizations that advocate on behalf 
of limited English proficient individuals, and other 
individuals or entities determined appropriate by the 
Secretary, including those who have specific exper-
tise in either developing cost-based reimbursement 
or provision of language services, that will be useful. 
‘‘(6) PUBLICATION.— 
‘‘(A) PROPOSED REIMBURSEMENT STAND-
ARDS.—Not later than 18 months after the 
date of enactment of this section, the Secretary 
shall, contingent upon consultation with and ap-
proval of the Working Group— 
‘‘(i) prepare and make available to the 
public through the Internet, the Federal 
Register, and other appropriate public 
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and technical assistance after the reim-
bursement standards becomes effective. 
‘‘(iii) PHASE-OUT.—When the final 
reimbursement standards go into effect, 
the temporary adjustments described in 
subsection (a) shall be phased out over a 
one-year period as hospitals implement the 
new reimbursement rates. Final reimburse-
ment rates shall not be constrained at the 
level of total temporary adjustments. Re-
imbursement shall be set at the level of the 
costs of language services at eligible hos-
pitals. 
‘‘(d) OTHER MEDICARE PAYMENT SYSTEMS.— 
‘‘(1) PAYMENT SYSTEMS.— 
‘‘(A) IN
GENERAL.—Not later than two 
years after enactment of this Act, and using the 
guidelines described in subsection (b), the Sec-
retary shall make recommendations to include 
payments or adjustments for language services 
provided to limited English proficient Medicare 
beneficiaries for all of the remaining payment 
systems under this title, except the physician 
fee schedule under such 1848, including psy-
chiatric hospitals, skilled nursing facilities, 
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home health agencies, rehabilitation facilities, 
and long-term care hospitals, as well as the 
TEFRA per discharge limit for children’s and 
cancer hospitals excluded from the inpatient 
hospital prospective payment system under sec-
tion 1886(d), the ambulance fee schedule, and 
payments to critical access hospitals. Program 
costs for language services in critical access 
hospitals shall be considered allowable costs 
under this title and shall be calculated in the 
same manner as other Medicare costs on the 
cost report. These costs should be incorporated 
into interim payments. 
‘‘(B) IMPLEMENTATION.—The Secretary 
shall implement these payments within three 
years. 
‘‘(C) NO COST-SHARING.—There shall be 
no cost-sharing for such language services. 
‘‘(2) MEDICARE
REIMBURSEMENT
FOR
LAN-
GUAGE SERVICES PROVIDED IN SUPPORT OF PHYSI-
CIAN OFFICE SERVICES.— 
‘‘(A) STUDY.—The Medicare Payment Ad-
visory Commission shall conduct a study that 
examines ways that Medicare can pay for lan-
guage services (including foreign language and 
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sign language) provided in support of physician 
office services and other services paid for 
through the physician fee schedule under sec-
tion 1848. The report on such study shall in-
clude the following: 
‘‘(i) Recommendations and effective 
methods for adopting a payment method-
ology for on-site interpreters, pursuant to 
which such interpreters and agencies could 
directly bill Medicare for language services 
provided in support of benefits paid for 
under section 1832 for a limited English 
proficient Medicare patient. For purposes 
of this subparagraph, the term ‘on-site in-
terpreters’ include interpreters who work 
as independent contractors, for agencies 
that provide on-site interpretation, and 
who are employed by those who provide 
benefits provided under section 1832. 
‘‘(ii) Recommendations and effective 
methods for Medicare contracting directly 
with agencies that provide off-site interpre-
tation, including telephonic and video in-
terpretation, pursuant to which such con-
tractors could directly bill Medicare for the 
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services provided in support of benefits 
provided under section 1832 for a limited 
English proficient Medicare patient. 
‘‘(iii) Recommendations for modifying 
the existing Medicare resource-based rel-
ative value scale (RBRVS) by adding new 
procedure codes in the Health Care Com-
mon Procedure Coding System. 
‘‘(B) REPORT.—Not later than 1 year 
after the date of the enactment of this section, 
the Commission shall submit to Congress and 
the Centers for Medicare & Medicaid Services a 
report on the study conducted under subpara-
graph (A), together with recommendations re-
garding the appropriateness of directly reim-
bursing interpreters versus physicians for lan-
guage services provided in support of benefits 
provided under section 1832. 
‘‘(C) IMPLEMENTATION.— 
‘‘(i) IN GENERAL.—Not later than 1 
year after the submission of the report des-
ignated in subparagraph (B), the Secretary 
shall publish, after consultation with and 
the approval of the Medicare Payment Ad-
visory Commission, final reimbursement 
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standards for language services provided in 
support of benefits provided under section 
1832. These standards shall be published 
in the Federal Register and on the Inter-
net and shall go into effect within six 
months of the date of such publication. 
The final standards must ensure that— 
‘‘(I) for the first three years of 
implementation, the payments for lan-
guage services do not diminish other 
fees provided in support of benefits 
provided under section 1832; and 
‘‘(II) enrollees do not have to pay 
any co-pays or cost-sharing for lan-
guage services provided in support of 
benefits provided under section 1832. 
‘‘(ii) TRAINING.—Between such date 
of publication and the effective date, the 
Secretary shall provide training and tech-
nical assistance to providers covered by the 
physician fee schedule under section 1848 
on the final reimbursement standards. As 
necessary, the Secretary shall continue to 
provide training and technical assistance 
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after the reimbursement standards be-
comes effective.’’. 
(b) CONFORMING AMENDMENTS.— 
(1) TECHNICAL AMENDMENTS.— 
(A) Section 1861 of the Social Security 
Act (42 U.S.C. 1395x) is amended by adding at 
the end the following new subsection: 
‘‘Language Services; Interpreter Services; Interpreter; 
Translation; LEP 
‘‘(hhh)(1) The term ‘language services’ means the 
provision of healthcare services to limited English pro-
ficient enrollees directly in a non-English language, or 
through the provision of interpreter services, translation 
and non-English signage. 
‘‘(2) For the purposes of this subsection, the term 
‘interpreter services’ means services designed to provide 
a competent trans-language rendition of a spoken message 
in which an interpreter comprehends the source language 
and can speak comprehensively in the target language to 
convey the meaning intended in the source language and 
interpreter knows health and health-related terminology 
and provides accurate interpretations by choosing equiva-
lent expressions that convey the best matching and mean-
ing to the source language and captures, to the greatest 
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possible extent, all nuances intended in the source mes-
sage. 
‘‘(3) The term ‘interpreter’ means an individual who 
transmits a spoken message from one language into an-
other, faithfully, accurately, and objectively. Such term in-
cludes individuals who provide in-person, telephonic, and 
video interpretation and such term ‘interpreter’ individ-
uals who are employed or contracted by those who provide 
benefits provided under section 1832. 
‘‘(4) The term ‘translation’ means the competent 
transmission of a written message in one language into 
a written message in another language. 
‘‘(5) The terms ‘limited English proficient’ and 
‘LEP’, with respect to an individual, means an individual 
who speaks a primary language other than English.’’. 
(B) Subsection (aa)(1)(B) of such section 
is amended by inserting ‘‘, language services as 
defined in subsection (hhh),’’ after ‘‘clinical so-
cial worker (as defined in subsection (hh)(1)),’’. 
(C) Section 1833(a) of the Social Security 
Act (42 U.S.C. 1395l) is amended— 
(i) by redesignating paragraph (9) as 
paragraph (10); and 
(ii) by inserting after paragraph (8) 
the following new paragraph: 
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‘‘(9) in the case of language services described 
in section 1861(hhh), 100 percent of the reasonable 
charges for such services.’’. 
(D) Section 1832(a)(2) of such Act (42 
U.S.C. 1395k(a)(2)) is amended— 
(i) by striking ‘‘and’’ at the end of 
subparagraph (I); 
(ii) by striking the period at the end 
of subparagraph (K) and inserting ‘‘and’’; 
and 
(iii) by adding at the end of subpara-
graph (K) the following: 
‘‘(L) language services (as defined in sec-
tion 1861(hhh) furnished by a interpreter or 
translator, whether contracted or employed by 
the entity providing benefits under this sec-
tion.’’ 
(E) WAIVER OF BUDGET NEUTRALITY.— 
For the first 3 years after the effective date 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 to language services. 
(F) EFFECTIVE
DATE.—These amend-
ments made by this subsection are effective 
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upon publication of the final reimbursement 
standards described in section 1899(b) of the 
Social Security Act, as added by subsection (a). 
(2) MEDICARE PART C AND PART D.—The Sec-
retary of Health and Human Services shall ensure 
Medicare Advantage plans participating in Medicare 
part C and prescription drug plans participating in 
Medicare part D effectively provide language serv-
ices to their enrollees. The Secretary shall require 
annual reporting for such plans that includes infor-
mation on internal policies and procedures related to 
cultural appropriateness in each of the following 
contexts: 
(A) Collection of data regarding the en-
rollee population. 
(B) Education of plan staff and contrac-
tors who have routine contact with enrollees re-
garding the diverse needs of the enrollee popu-
lation. 
(C) Recruitment and retention efforts that 
encourage workforce diversity. 
(D) Evaluation of the health plan’s lan-
guage services programs and services with re-
spect to the plan’s enrollee population, using 
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processes such as an analysis of complaints and 
satisfaction survey results. 
(E) Methods by which the plan provides in-
formation regarding the ethnic diversity of the 
plan’s enrollee population. 
(F) The periodic provision of educational 
information to plan enrollee on the plan’s lan-
guage services and programs. Plans may use 
existing means of communications. 
(c) IMPROVING LANGUAGE SERVICES IN MEDICAID 
AND SCHIP.— 
(1) Section 1903(a)(2)(E) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended 
by— 
(A) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language services’’; 
and 
(B) striking ‘‘children of families’’ and in-
serting ‘‘individuals’’. 
(2) Section 1902(a)(10)(A) of the Social Secu-
rity Act (42 U.S.C. 1396a(a)(10)(A)) is amended by 
striking ‘‘and (21)’’ and inserting ‘‘(21), and (28)’’. 
(3) Section 1905(a) of the Social Security Act 
(42 U.S.C. 1396d(a)) is amended by— 
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(A) in paragraph (27), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (28) as 
paragraph (29); and 
(C) by inserting after paragraph (27) the 
following new paragraph: 
‘‘(27) language services (including the provision 
of health care services directly in a non-English lan-
guage, interpretation, translation, and non-English 
signage), provided in a timely manner to limited 
English proficient individuals who need language 
services in connection with administrative and cov-
ered services; and’’. 
(4) Section 1916(a)(2) of the Social Security 
Act (42 U.S.C. 1396o(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 services described in section 
1905(a)(27); and’’. 
(5) Section 2103 of the Social Security Act (42 
U.S.C. 1397cc) is amended— 
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(A) in subsection (a), in the matter before 
paragraph (1), by striking ‘‘(7)’’ and inserting 
‘‘, (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 (including 
the provision of health care services directly in a 
non-English language, interpretation, translation 
and non-English signage) provided in a timely man-
ner to limited English proficient individuals who 
need them, in connection with administrative and 
covered services.’’; and 
(C) in subsection (e)(2)— 
(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
(ii) by inserting ‘‘or subsection (c)(9)’’ 
after ‘‘subsection (c)(1)(C)’’. 
(6) 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)(7)’’. 
(7) Pursuant to the reporting requirement de-
scribed in section 2107(b)(1) of the Social Security 
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Act (42 U.S.C. 1397gg(b)(1)), the Secretary of 
Health and Human Services shall ensure that States 
collect data on the— 
(A) primary language of those assisted; 
and 
(B) for individuals who are minors or inca-
pacitated, the primary language of the individ-
ual’s parent or guardian. 
(8) Section 2105(c)(2)(A) of the Social Security 
Act (42 U.S.C. 1397ee(c)) is amended by inserting 
before the period ‘‘, except that expenditures pursu-
ant to section 2105(a)(1)(D)(iv) shall not count to-
wards this total’’. 
(d) 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 
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entity’s eligible costs for such services for the 
quarter. 
(B) LIMITATION.—If the amount of funds 
appropriated under subparagraph (C) to carry 
out this subsection for a fiscal year is insuffi-
cient to ensure that each eligible entity can re-
ceive full payment under subparagraph (A), the 
Secretary shall reduce in a pro rata manner the 
amount of such payment to each such entity. 
(C) 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 2010 through 
2014. 
(D) LANGUAGE
SERVICES.—In this sub-
section, the term ‘‘language services’’ has the 
meaning given such term in section 3100 of the 
Public Health Service Act. 
(2) ELIGIBLE COSTS DEFINED.— 
(A) IN GENERAL.—In this subsection, the 
term ‘‘eligible costs’’ means, with respect to an 
eligible entity that provides language services to 
LEP individuals, the product of— 
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(i) the average per person cost of lan-
guage services, determined according to 
the methodology devised under subpara-
graph (B), and 
(ii) the number of limited English 
proficient individuals who are provided lan-
guage services by the entity and for whom 
no reimbursement is available for such 
services under the amendments made by 
subsections (a), (b), or (c) or by private 
health insurance. 
(B) METHODOLOGY.—The Secretary shall 
devise a methodology to determine the average 
per person cost of language services. In estab-
lishing a payment methodology, the Secretary 
may establish different methodologies for dif-
ferent types of eligible entities. The Secretary 
shall not require eligible entities to provide indi-
vidual claims for language services for each in-
dividual patient to be provided payment under 
this subsection. 
(3) ELIGIBLE
ENTITY.—In order to receive 
grants under this paragraph, an entity must— 
(A) be— 
(i) an individual provider; 
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(ii) a hospital with a low income utili-
zation 
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 cen-
ter (as defined in section 1905(l)(2)(B) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(l)(2)(B))); 
(B) provide language services to at least 8 
percent of the entity’s total number of patients; 
and 
(C) prepare and submit an application to 
the Secretary, at such time, in such manner, 
and accompanied by such information as the 
Secretary may require to ascertain the entities’ 
eligibility for funding under this subsection. 
(4) RELATION TO MEDICAID DSH.—Payments 
under this subsection shall not offset or reduce pay-
ments under section 1923 of the Social Security Act, 
nor shall payments under such section be considered 
when determining uncompensated costs associated 
with the provision of language services. 
(5) REPORTING REQUIREMENTS.—Entities re-
ceiving payment under this subsection shall provide 
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the Secretary with a quarterly report on such pay-
ments. Such report shall contain aggregate (and not 
individualized) data and shall otherwise be in a form 
and manner determined by the Secretary. 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. 
(6) GUIDANCE.— 
(A) ESTABLISHMENT.—Not later than 6 
months after the date of enactment of this Act, 
the Secretary of Health and Human Services 
shall establish guidelines concerning the imple-
mentation of this subsection. 
(B) REPORT.—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 implementa-
tion of such guidelines. 
(e) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2009. 
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SEC. 103. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity and the Administrator of the Health Resources and 
Services Administration, in consultation with the National 
Center on Minority Health and Health Disparities and the 
Office of Minority Health, shall award grants to eligible 
entities to improve health care for patient populations that 
have low functional health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—Grants awarded under subsection (a) 
through the Agency for Healthcare Research and 
Quality shall be used— 
(A) to define and increase the under-
standing of health literacy; 
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(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
(D) for any other activity determined ap-
propriate by the Director of the Agency. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—Grants awarded under subsection (a) 
through the Health Resources and Services Adminis-
tration shall be used to conduct demonstration 
projects for interventions for patients with low 
health literacy that may include— 
(A) the development of new disease man-
agement programs for patients with low health 
literacy; 
(B) the tailoring of existing disease man-
agement programs addressing mental, physical, 
oral, and behavioral health conditions for pa-
tients with low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
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(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; and 
(F) other activities determined appropriate 
by the Administrator of the Health Resources 
and Services Administration. 
(d) DEFINITIONS.—In this section, the term ‘‘low 
health literacy’’ means the inability of an individual to ob-
tain, process, and understand basic health information 
and services needed to make appropriate health decisions. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2010 through 2014. 
SEC. 104. ASSURANCES FOR RECEIVING FEDERAL FUNDS. 
(a) IN GENERAL.—Entities that receive Federal 
funds under sections 101 or 102 (including under the 
amendments made by such section), in order to ensure the 
right of LEP individuals to receive access to quality health 
care, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in lin-
guistically appropriate service delivery; 
(2) offer and provide appropriate language serv-
ices at no additional charge to each patient with lim-
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ited English proficiency 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 competent interpreter or trans-
lation services which— 
(A) until adoption of the Interpreter and 
Translator Guidelines and Standards described 
in section 3103(c) of the Public Health Service 
Act, are defined in section 3100 of the Public 
Health Service Act; and 
(B) after adoption of the Interpreter and 
Translator Guidelines and Standards described 
in section 3103(c) of the Public Health Service 
Act, meet those guidelines and standards; 
(b) EXEMPTIONS.—The requirements of subsection 
(a)(4) shall not apply as follows: 
(1) When a patient (who has been informed in 
his or her primary language of the availability of 
free interpreter and translation services) requests 
the use of family, friends or other persons untrained 
in interpretation or translation if the following con-
ditions are met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
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(B) The recipient informs the patient that 
he or she has the option of having the recipient 
provide an interpreter for him/her without 
charge, or of using his/her own interpreter. 
(C) The recipient informs the patient that 
the recipient may not require an LEP person to 
use a family member or friend as an inter-
preter. 
(D) The recipient evaluates whether the 
person the patient wishes to use as an inter-
preter is competent. If the recipient has reason 
to believe that the interpreter is not competent, 
the recipient provides its own interpreter to 
protect the recipient from liability if the pa-
tient’s interpreter is later found not competent. 
(E) If the recipient has reason to believe 
that there is a conflict of interest between the 
interpreter and patient, the recipient may not 
use the patient’s interpreter. 
(F) The recipient has the patient sign a 
waiver, witnessed by at least one individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
(E) and is translated into the patient’s lan-
guage. 
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(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; how-
ever, nothing in this subsection shall exempt emer-
gency rooms or similar entities that regularly pro-
vide health care services in medical emergencies 
from having in place systems to provide competent 
interpreter and translation services without undue 
delay. 
SEC. 105. 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 Institute of Medicine for the preparation 
and publication of a report that describes Federal efforts 
to ensure that all individuals with limited English pro-
ficiency have meaningful access to health care and health 
care-related services. Such report shall include— 
(1) a description and evaluation of the activities 
carried out under this Act; 
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(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; 
(3) recommendations on the development and 
implementation of policies and practices by providers 
of health care and health care-related services for 
limited English proficient individuals; 
(4) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(5) 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 
2010 through 2014. 
SEC. 106. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to States for the 
provision of English as a second language (hereafter re-
ferred to as ‘‘ESL’’) instruction and shall determine, after 
consultation with appropriate stakeholders, the mecha-
nism for administering and distributing such grants. 
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(b) APPLICATION.—A State may apply for a grant 
under this section by submitting such information as the 
Secretary may require and in such form and manner as 
the Secretary may require. 
(c) USE OF GRANT.—As a condition of receiving a 
grant under this section, a State shall— 
(1) develop and implement a plan for assuring 
the availability of ESL instruction that effectively 
integrates information about the nature of the 
United States health care system, how to access 
care, and any special language skills that may be re-
quired for them to access and regularly negotiate the 
system effectively; 
(2) develop a plan, including, where appro-
priate, public-private partnerships, for making ESL 
instruction progressively available to all individuals 
seeking instruction; and 
(3) maintain current ESL instruction efforts by 
using the additional funds to supplement rather 
than supplant any funds expended for ESL instruc-
tion in the State as of January 1, 2006. 
(d) ADDITIONAL DUTIES OF THE SECRETARY.—The 
Secretary of Education shall— 
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(1) collect and publicize annual data on how 
much Federal, State, and local governments spend 
on ESL instruction; 
(2) collect data from state and local govern-
ments to identify the unmet needs of English lan-
guage learners for appropriate ESL instruction, in-
cluding— 
(A) the extent of waiting lists including 
how many programs maintain waiting lists and, 
for programs that do not have waiting lists, the 
reasons why not; 
(B) the availability of programs to geo-
graphically isolated communities; 
(C) the impact of course enrollment poli-
cies, including open enrollment, on the avail-
ability of ESL instruction; 
(D) the number individuals in the State 
and each participating locality; 
(E) the effectiveness of the instruction in 
meeting the needs of individuals receiving in-
struction and those needing instruction; 
(F) as assessment of the need for pro-
grams that integrate job training and ESL in-
struction, to assist individuals to obtain better 
jobs; and 
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(G) the availability of ESL slots by State 
and locality; 
(3) determine the cost and most appropriate 
methods of making ESL instruction available to all 
English language learners seeking instruction; and 
(4) within 1 year of the date of enactment of 
this Act, issue a report to Congress that assesses the 
information collected in subparagraphs (1), (2), and 
(3) and makes recommendations on steps that 
should be taken to progressively realize the goal of 
making ESL instruction available to all English lan-
guage learners seeking instruction. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of Edu-
cation for each of fiscal years 2010 through 2013 
$250,000,000 to carry out this section. 
SEC. 107. DEFINITION. 
In this title, the definitions contained in section 3100 
of the Public Health Service Act, as added by section 101, 
shall apply. 
SEC. 108. TREATMENT OF THE MEDICARE PART B PRO-
GRAM UNDER TITLE VI OF THE CIVIL RIGHTS 
ACT OF 1964. 
A payment to a provider of services, physician, or 
other supplier under part B, C, ord D of title XVIII of 
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the Social Security Act shall be deemed a grant, and not 
a contract of insurance or guaranty, for the purposes of 
title VI of the Civil Rights Act of 1964. 
SEC. 109. IMPLEMENTATION. 
(a) GENERAL PROVISIONS.— 
(1) A State shall not be immune under the 
Eleventh Amendment of the Constitution of the 
United States from suit in Federal court for failing 
to provide the language access funded pursuant to 
this Act. 
(2) In a suit against a State for a violation of 
this Act, remedies (including remedies at both at law 
and in equity) are available for such a violation to 
the same extent as such remedies are available for 
such a violation in the suit against any public or pri-
vate entity other than a State. 
(b) RULE OF CONSTRUCTION.—Nothing in this Act 
shall be construed to limit otherwise existing obligations 
of recipients of Federal financial assistance under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 
seq.) or any other statute. 
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TITLE II—HEALTH WORKFORCE 
DIVERSITY 
SEC. 201. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXI of the Public Health Service Act, as 
added by section 201, is amended by adding at the end 
the following: 
‘‘Subtitle A—Diversifying the 
Healthcare Workplace 
‘‘SEC. 3111. REPORT ON WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—Not later than July 1, 2010, and 
biannually thereafter, the Secretary, acting through the 
director of each entity within the Department of Health 
and Human Services, shall prepare and submit to the 
Committee on Health, Education, Labor, and Pensions of 
the Senate and the Committee on Energy and Commerce 
of the House of Representatives a report on health work-
force diversity. 
‘‘(b) REQUIREMENT.—The report under subsection 
(a) shall contain the following information: 
‘‘(1) A description of any grant support that is 
provided by each entity for workforce diversity ini-
tiatives with the following information— 
‘‘(A) the number of grants made; 
‘‘(B) the purpose of the grants; 
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