I 
108TH CONGRESS 
1ST SESSION H. R. 2258
To provide for programs and activities to improve the health of Hispanic 
individuals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 22, 2003
Mr. RODRIGUEZ (for himself, Ms. SOLIS, Mr. GONZALEZ, Mr. BACA, Mr. PAS-
TOR, Mr. GUTIERREZ, Mrs. NAPOLITANO, Ms. ROYBAL-ALLARD, Mr. 
ORTIZ, Mr. BECERRA, Mr. CARDOZA, Mr. REYES, Mr. ACEVEDO-VILA´, 
Mr. SERRANO, Ms. VELA´ZQUEZ, Mr. HINOJOSA, Ms. LINDA T. SA´NCHEZ 
of California, Mr. MENENDEZ, Ms. DEGETTE, Mr. PALLONE, Mrs. 
CHRISTENSEN, and Mr. ISRAEL) introduced the following bill; which was 
referred to the Committee on Energy and Commerce 
A BILL 
To provide for programs and activities to improve the health 
of Hispanic individuals, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Hispanic Health Improvement Act of 2003’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows:
Sec. 1. Short title; table of contents. 
Sec. 2. Findings.
TITLE I—HEALTH CARE COVERAGE 
Subtitle A—Coverage for Children, Parents, and Pregnant Women 
Sec. 101. Coverage of parents and pregnant women under the medicaid pro-
gram and title XXI. 
Sec. 102. Automatic enrollment of children born to title XXI parents. 
Sec. 103. Optional coverage of children through age 20 under the medicaid pro-
gram and title XXI. 
Sec. 104. Technical and conforming amendments to authority to pay medicaid 
expansion costs from title XXI appropriation. 
Sec. 105. Extension of availability of SCHIP allotments for fiscal years 1998 
through 2001. 
Subtitle B—State Option to Provide Coverage to All Individual Below 100 
Percent of Poverty 
Sec. 111. State option to offer medicaid coverage based on need. 
Subtitle C—Outreach and Enrollment 
Sec. 121. Grants to promote innovative outreach and enrollment efforts under 
SCHIP. 
Subtitle D—Immigrant Children and Pregnant Women 
Sec. 131. Optional coverage of legal immigrants under the medicaid program 
and SCHIP. 
Sec. 132. Permitting States and localities to provide health care to all individ-
uals. 
Subtitle E—Eligibility Simplification 
Sec. 141. State option to provide for simplified determinations of a child’s fi-
nancial eligibility for medical assistance under medicaid or 
child health assistance under SCHIP. 
Sec. 142. Application of simplified title XXI procedures under the medicaid 
program. 
Subtitle F—SCHIP Wrap-Around Benefits 
Sec. 151. State option to provide wrap-around SCHIP coverage to children who 
have other health coverage. 
Subtitle G—Immunization Coverage Through SCHIP 
Sec. 161. Eligibility of children enrolled in the State children’s health insurance 
program for the pediatric vaccine distribution program. 
Subtitle H—Limited English Proficient Communities 
Sec. 171. Increased Federal reimbursement for language services under the 
medicaid program and the State children’s health insurance 
program. 
Subtitle I—Binational Public Health Infrastructure and Health Insurance 
Sec. 181. Binational public health infrastructure and health insurance. 
Subtitle J—Migrant Workers and Farmworkers Health
Sec. 191. Demonstration project regarding continuity of coverage of migrant 
workers and farmworkers under medicaid and SCHIP. 
TITLE II—HEALTH DISPARITIES 
Subtitle A—Report on Programs for Improving the Health Status of 
Hispanic Individuals 
Sec. 201. Annual report regarding Hispanic health disparities for chronic and 
communicable diseases. 
Subtitle B—Diabetes Research, Control, and Prevention 
Sec. 211. Treatment. 
Sec. 212. Education. 
Sec. 213. Health promotion, prevention activities, and access. 
Subtitle C—HIV Prevention Activities Regarding Hispanic Individuals 
Sec. 221. Programs of Centers for Disease Control and Prevention; representa-
tion of Hispanic individuals in membership of community plan-
ning groups. 
Sec. 222. AIDS education and training centers funded by Health Resources 
and Services Administration; establishment of center directed 
toward minority populations with HIV. 
Subtitle D—Prevention of Latina Adolescent Suicides 
Sec. 231. Short title. 
Sec. 232. Establishment of program for prevention of Latina adolescent sui-
cides. 
Subtitle E—Cancer Research, Training, and Awareness 
Sec. 241. Redes En Accion: the National Hispanic/Latino Cancer Network and 
other NCI special populations networks initiatives targeting 
cancer; increased authorization of appropriations for activities 
regarding Hispanic individuals. 
Subtitle F—Tuberculosis Control, Prevention, and Treatment 
Sec. 251. Advisory Council for the Elimination of Tuberculosis. 
Sec. 252. National program for tuberculosis elimination. 
Sec. 253. Inclusion of inpatient hospital services for the treatment of TB-in-
fected individuals. 
TITLE III—ACCESS AND AFFORDABILITY 
Subtitle A—Dental Health Services 
Sec. 301. Grants to improve the provision of dental health services through 
community health centers and public health departments. 
Sec. 302. School-based dental sealant program. 
Subtitle B—Border Health 
Sec. 311. Short title. 
Sec. 312. Definitions. 
Sec. 313. Border health services grants.
Sec. 314. Border bioterrorism preparedness grants. 
Sec. 315. United States-Mexico Border Health Commission Act amendments. 
Subtitle C—Patient Navigator, Outreach, and Chronic Disease Prevention 
Sec. 321. Short title. 
Sec. 322. HRSA grants for model community cancer and chronic disease care 
and prevention; HRSA grants for patient navigators. 
Sec. 323. NCI grants for model community cancer and chronic disease care and 
prevention; NCI grants for patient navigators. 
Sec. 324. IHS grants for model community cancer and chronic disease care and 
prevention; IHS grants for patient navigators. 
TITLE IV—STRENGTHENING OUR HEALTH CARE WORKFORCE 
Subtitle A—Hispanic-Serving Health Professions Schools 
Sec. 401. Hispanic-serving health professions schools. 
Subtitle B—Health Career Opportunity Program and Centers of Excellence 
Sec. 411. Educational assistance regarding undergraduates. 
Sec. 412. Centers of excellence. 
Subtitle C—Bilingual Health Professionals 
Sec. 421. Training of bilingual health professionals with respect to minority 
health conditions. 
Subtitle D—Cultural Competence 
Sec. 431. Definition. 
Sec. 432. Activities of Office of Minority Health; Center for Linguistic and Cul-
tural Competence in Health Care. 
Sec. 433. Cultural competence demonstration projects. 
TITLE V—ADDITIONAL PROGRAMS 
Subtitle A—Data Regarding Race and Ethnicity 
Sec. 501. Collection of data. 
Sec. 502. Development of standards; study to measure patient outcomes under 
medicare and medicaid programs. 
Subtitle B—National Assessment of Status of Latino Health 
Sec. 511. National assessment of status of Latino health.
Subtitle C—Office of Minority Health
Sec. 521. Revision and extension of programs of Office of Minority Health. 
Sec. 522. Establishment of individual Offices of Minority Health within agen-
cies of Public Health Service. 
Sec. 523. Assistant Secretary of Health and Human Services for Civil Rights.
SEC. 2. FINDINGS. 
Congress makes the following findings:
(1) The uninsured rates of Hispanic adults and 
children is almost two to three times those for non-
Hispanic whites and more than one-third of all His-
panics lack any form of health insurance. 
(2) Hispanics disproportionately suffer from 
conditions like diabetes, cardiovascular disease, HIV/
AIDS, and other illnesses. 
(3) Hispanic communities are underserved and 
continue to have significantly less access to afford-
able quality medical care. 
(4) The under-representation of Hispanics in 
the health professions and the educational pipeline 
of the health professions affects the current and fu-
ture delivery of culturally competent and sensitive 
health care for Hispanics. 
(5) Therefore there is a need for a comprehen-
sive Federal effort to address the unique health 
needs of the Hispanic community.
TITLE I—HEALTH CARE 
COVERAGE 
Subtitle A—Coverage for Children, 
Parents, and Pregnant Women 
SEC. 101. COVERAGE OF PARENTS AND PREGNANT WOMEN 
UNDER THE MEDICAID PROGRAM AND TITLE 
XXI. 
(a) INCENTIVES TO IMPLEMENT COVERAGE OF PAR-
ENTS AND PREGNANT WOMEN.—
(1) UNDER MEDICAID.—
(A) ESTABLISHMENT OF NEW OPTIONAL 
ELIGIBILITY
CATEGORY.—Section 
1902(a)(10)(A)(ii) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)(A)(ii)) is amended—
(i) by striking ‘‘or’’ at the end of sub-
clause (XVII); 
(ii) by adding ‘‘or’’ at the end of sub-
clause (XVIII); and 
(iii) by adding at the end the fol-
lowing: 
‘‘(XIX) who are individuals de-
scribed in subsection (k)(1) (relating 
to parents of categorically eligible chil-
dren);’’.
(B) PARENTS DESCRIBED.—Section 1902 
of the Social Security Act is further amended 
by inserting after subsection (j) the following: 
‘‘(k)(1)(A) Individuals described in this paragraph 
are individuals—
‘‘(i) who are the parents of an individual who 
is under 19 years of age (or such higher age as the 
State may have elected under section 1902(l)(1)(D)) 
and who is eligible for medical assistance under sub-
section (a)(10)(A); 
‘‘(ii) who are not otherwise eligible for medical 
assistance under such subsection or under a waiver 
approved under section 1115 or otherwise (except 
under 
section 
1931 
or 
under 
subsection 
(a)(10)(A)(ii)(XIX)); and 
‘‘(iii) whose family income exceeds the effective 
income level or resource level applicable under the 
State plan under part A of title IV as in effect as 
of July 16, 1996, but does not exceed the highest ef-
fective income level applicable to a child in the fam-
ily under this title. 
‘‘(B) In establishing an income eligibility level for in-
dividuals described in this paragraph, a State may vary 
such level consistent with the various income levels estab-
lished under subsection (l)(2) based on the ages of chil-
dren described in subsection (l)(1) in order to ensure, to 
the maximum extent possible, that such individuals shall 
be enrolled in the same program as their children. 
‘‘(C) An individual may not be treated as being de-
scribed in this paragraph unless, at the time of the individ-
ual’s enrollment under this title, the child referred to in 
subparagraph (A)(i) of the individual is also enrolled 
under this title. 
‘‘(D) In this subsection, the term ‘parent’ has the 
meaning given the term ‘caretaker relative’ for purposes 
of carrying out section 1931. 
‘‘(2) In the case of a parent described in paragraph 
(1) who is also the parent of a child who is eligible for 
child health assistance under title XXI, the State may 
elect (on a uniform basis) to cover all such parents under 
section 2111 or under this title.’’. 
(C) ENHANCED MATCHING FUNDS AVAIL-
ABLE IF CERTAIN CONDITIONS MET.—Section 
1905 of the Social Security Act (42 U.S.C. 
1396d) is amended—
(i) in the fourth sentence of sub-
section (b), by striking ‘‘or subsection 
(u)(3)’’ and inserting ‘‘, (u)(3), or (u)(4)’’; 
and 
(ii) in subsection (u)—
(I) by redesignating paragraph 
(4) as paragraph (6), and 
(II) by inserting after paragraph 
(3) the following:
‘‘(4) For purposes of subsection (b) and section 
2105(a)(1): 
‘‘(A) PARENTS AND PREGNANT WOMEN.—The 
expenditures described in this subparagraph are the 
expenditures described in the following clauses (i) 
and (ii): 
‘‘(i) PARENTS.—If the conditions described 
in clause (iii) are met, expenditures for medical 
assistance for parents described in section 
1902(k)(1) and for parents who would be de-
scribed in such section but for the fact that 
they are eligible for medical assistance under 
section 1931 or under a waiver approved under 
section 1115. 
‘‘(ii) CERTAIN PREGNANT WOMEN.—If the 
conditions described in clause (iv) are met, ex-
penditures for medical assistance for pregnant 
women described in subsection (n) or under sec-
tion 1902(l)(1)(A) in a family the income of 
which exceeds the effective income level applica-
ble under subsection (a)(10)(A)(i)(III) or
(l)(2)(A) of section 1902 to a family of the size 
involved as of January 1, 2003. 
‘‘(iii) CONDITIONS
FOR
EXPENDITURES 
FOR
PARENTS.—The conditions described in 
this clause are the following: 
‘‘(I) The State has a State child 
health plan under title XXI which (wheth-
er implemented under such title or under 
this title) has an effective income level for 
children that is at least 200 percent of the 
poverty line. 
‘‘(II) State child health plan does not 
limit the acceptance of applications, does 
not use a waiting list for children who 
meet eligibility standards to qualify for as-
sistance, and provides benefits to all chil-
dren in the State who apply for and meet 
eligibility standards. 
‘‘(III) The State plans under this title 
and title XXI do not provide coverage for 
parents with higher family income without 
covering parents with a lower family in-
come. 
‘‘(IV) The State does not apply an in-
come level for parents that is lower than
the effective income level (expressed as a 
percent of the poverty line) that has been 
specified under the State plan under title 
XIX (including under a waiver authorized 
by 
the 
Secretary 
or 
under 
section 
1902(r)(2)), as of January 1, 2003, to be 
eligible for medical assistance as a parent 
under this title. 
‘‘(iv) CONDITIONS
FOR
EXPENDITURES 
FOR CERTAIN PREGNANT WOMEN.—The condi-
tions described in this clause are the following: 
‘‘(I) The State plans under this title 
and title XXI do not provide coverage for 
pregnant women described in subpara-
graph (A)(ii) with higher family income 
without covering such pregnant women 
with a lower family income. 
‘‘(II) The State does not apply an in-
come level for pregnant women that is 
lower than the effective income level (ex-
pressed as a percent of the poverty line 
and considering applicable income dis-
regards) that has been specified under the 
State 
plan 
under 
subsection 
(a)(10)(A)(i)(III) or (l)(2)(A) of section
1902, as of January 1, 2003, to be eligible 
for medical assistance as a pregnant 
woman. 
‘‘(III) The State satisfies the condi-
tions described in subclauses (I) and (II) 
of clause (iii). 
‘‘(v) DEFINITIONS.—For purposes of this 
subsection: 
‘‘(I) The term ‘parent’ has the mean-
ing given such term for purposes of section 
1902(k)(1). 
‘‘(II) The term ‘poverty line’ has the 
meaning given such term in section 
2110(c)(5).’’. 
(D) APPROPRIATION FROM TITLE XXI AL-
LOTMENT
FOR
MEDICAID
EXPANSION
COSTS 
FOR
PARENTS; 
ELIMINATION
OF
COUNTING 
MEDICAID
CHILD
PRESUMPTIVE
ELIGIBILITY 
COSTS AGAINST TITLE XXI ALLOTMENT.—Sub-
paragraph (B) of section 2105(a)(1) of the So-
cial Security Act, as amended by section 
104(a), is amended to read as follows: 
‘‘(B) PARENTS AND PREGNANT WOMEN.—
Expenditures for medical assistance that are at-
tributable to expenditures described in section 
1905(u)(4)(A).’’. 
(E) ONLY COUNTING ENHANCED PORTION 
FOR
COVERAGE
OF
ADDITIONAL
PREGNANT 
WOMEN.—Section 1905 of the Social Security 
Act (42 U.S.C. 1396d) is amended—
(i) in the fourth sentence of sub-
section (b), by inserting ‘‘(except in the 
case of expenditures described in sub-
section (u)(5))’’ after ‘‘do not exceed’’; 
(ii) in subsection (u), by inserting 
after paragraph (4) (as inserted by sub-
paragraph (C)), the following: 
‘‘(5) For purposes of the fourth sentence of sub-
section (b) and section 2105(a), the following payments 
under this title do not count against a State’s allotment 
under section 2104: 
‘‘(A) REGULAR FMAP FOR EXPENDITURES FOR 
PREGNANT WOMEN WITH INCOME ABOVE JANUARY 
1, 2003 INCOME LEVEL.—The portion of the pay-
ments made for expenditures described in paragraph 
(4)(A)(ii) that represents the amount that would 
have been paid if the enhanced FMAP had not been 
substituted for the Federal medical assistance per-
centage.’’.
(2) UNDER TITLE XXI.—
(A) PARENTS
AND
PREGNANT
WOMEN 
COVERAGE.—Title XXI of the Social Security 
Act (42 U.S.C. 1397aa et seq.) is amended by 
adding at the end the following: 
‘‘SEC. 2111. OPTIONAL COVERAGE OF PARENTS OF TAR-
GETED LOW-INCOME CHILDREN OR TAR-
GETED LOW-INCOME PREGNANT WOMEN. 
‘‘(a) OPTIONAL COVERAGE.—Notwithstanding any 
other provision of this title, a State may provide for cov-
erage, through an amendment to its State child health 
plan under section 2102, of parent health assistance for 
targeted low-income parents, pregnancy-related assistance 
for targeted low-income pregnant women, or both, in ac-
cordance with this section, but only if—
‘‘(1) with respect to the provision of parent 
health assistance, the State meets the conditions de-
scribed in clause (iii) of section 1905(u)(4)(A); 
‘‘(2) with respect to the provision of pregnancy-
related assistance, the State meets the conditions de-
scribed in clause (iv) of section 1905(u)(4)(A); and 
‘‘(3) in the case of parent health assistance for 
targeted low-income parents, the State elects to pro-
vide 
medical 
assistance 
under 
section 
1902(a)(10)(A)(ii)(XIX), under section 1931, or
under a waiver under section 1115 to individuals de-
scribed in section 1902(k)(1)(A)(i) and elects an ef-
fective income level that, consistent with paragraphs 
(1)(B) and (2) of section 1902(k), ensures to the 
maximum extent possible, that such individuals shall 
be enrolled in the same program as their children 
if their children are eligible for coverage under title 
XIX (including under a waiver authorized by the 
Secretary or under section 1902(r)(2)).’’. 
‘‘(b) DEFINITIONS.—For purposes of this title: 
‘‘(1) PARENT HEALTH ASSISTANCE.—The term 
‘parent health assistance’ has the meaning given the 
term child health assistance in section 2110(a) as if 
any reference to targeted low-income children were 
a reference to targeted low-income parents. 
‘‘(2) PARENT.—The term ‘parent’ has the 
meaning given the term ‘caretaker relative’ for pur-
poses of carrying out section 1931. 
‘‘(3) PREGNANCY-RELATED ASSISTANCE.—The 
term ‘pregnancy-related assistance’ has the meaning 
given the term child health assistance in section 
2110(a) as if any reference to targeted low-income 
children were a reference to targeted low-income 
pregnant women, except that the assistance shall be 
limited to services related to pregnancy (which in-
clude prenatal, delivery, and postpartum services 
and services described in section 1905(a)(4)(C)) and 
to other conditions that may complicate pregnancy. 
‘‘(4) TARGETED
LOW-INCOME
PARENT.—The 
term ‘targeted low-income parent’ has the meaning 
given the term targeted low-income child in section 
2110(b) as if the reference to a child were deemed 
a reference to a parent (as defined in paragraph (3)) 
of the child; except that in applying such section—
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2003, 
shall be substituted for July 1, 1997; and 
‘‘(C) in paragraph (4), January 1, 2003, 
shall be substituted for March 31, 1997. 
‘‘(5) 
TARGETED
LOW-INCOME
PREGNANT 
WOMAN.—The term ‘targeted low-income pregnant 
woman’ has the meaning given the term targeted 
low-income child in section 2110(b) as if any ref-
erence to a child were a reference to a woman dur-
ing pregnancy and through the end of the month in 
which the 60-day period beginning on the last day
of her pregnancy ends; except that in applying such 
section—
‘‘(A) there shall be substituted for the in-
come level described in paragraph (1)(B)(ii)(I) 
the applicable income level in effect for a tar-
geted low-income child; 
‘‘(B) in paragraph (3), January 1, 2003, 
shall be substituted for July 1, 1997; and 
‘‘(C) in paragraph (4), January 1, 2003, 
shall be substituted for March 31, 1997. 
‘‘(6) PARENT.—The term ‘parent’ has the 
meaning given the term ‘caretaker relative’ for pur-
poses of carrying out section 1931. 
‘‘(c) 
REFERENCES
TO
TERMS
AND
SPECIAL 
RULES.—In the case of, and with respect to, a State pro-
viding for coverage of parent health assistance to targeted 
low-income parents or pregnancy-related assistance to tar-
geted low-income pregnant women under subsection (a), 
the following special rules apply: 
‘‘(1) Any reference in this title (other than in 
subsection (b)) to a targeted low-income child is 
deemed to include a reference to a targeted low-in-
come parent or a targeted low-income pregnant 
woman (as applicable).
‘‘(2) Any such reference to child health assist-
ance—
‘‘(A) with respect to such parents is 
deemed a reference to parent health assistance; 
and 
‘‘(B) with respect to such pregnant women, 
is deemed a reference to pregnancy-related as-
sistance.
‘‘(3) In applying section 2103(e)(3)(B) in the 
case of a family or pregnant woman provided cov-
erage under this section, the limitation on total an-
nual aggregate cost-sharing shall be applied to the 
entire family or such pregnant woman. 
‘‘(4) In applying section 2110(b)(4), any ref-
erence to ‘section 1902(l)(2) or 1905(n)(2) (as se-
lected by a State)’ is deemed a reference to the ef-
fective income level applicable to parents under sec-
tion 1931 or under a waiver approved under section 
1115, or, in the case of a pregnant woman, the in-
come level established under section 1902(l)(2)(A). 
‘‘(5) In applying section 2102(b)(3)(B), any 
reference to children found through screening to be 
eligible for medical assistance under the State med-
icaid plan under title XIX is deemed a reference to 
parents and pregnant women.’’.
(B) ADDITIONAL ALLOTMENT FOR STATES 
PROVIDING COVERAGE OF PARENTS OR PREG-
NANT WOMEN.—
(i) IN GENERAL.—Section 2104 of the 
Social Security Act (42 U.S.C. 1397dd) is 
amended by inserting after subsection (c) 
the following: 
‘‘(d) ADDITIONAL ALLOTMENTS FOR STATE COV-
ERAGE OF PARENTS OR PREGNANT WOMEN.—
‘‘(1) APPROPRIATION; TOTAL
ALLOTMENT.—
For the purpose of providing additional allotments 
to States under this title, there is appropriated, out 
of any money in the Treasury not otherwise appro-
priated—
‘‘(A) for fiscal year 2004, $3,000,000,000; 
‘‘(B) for fiscal year 2005, $3,000,000,000; 
and 
‘‘(C) for fiscal year 2006, $4,000,000,000; 
‘‘(D) for fiscal year 2007, $5,000,000,000. 
‘‘(2) STATE AND TERRITORIAL ALLOTMENTS.—
‘‘(A) IN GENERAL.—In addition to the al-
lotments provided under subsections (b) and 
(c), subject to paragraphs (3) and (4), of the 
amount available for the additional allotments 
under paragraph (1) for a fiscal year, the Sec-
retary shall allot to each State with a State 
child health plan approved under this title—
‘‘(i) in the case of such a State other 
than a commonwealth or territory de-
scribed in subparagraph (B), the same pro-
portion as the proportion of the State’s al-
lotment under subsection (b) (determined 
without regard to subsection (f)) to the 
total amount of the allotments under sub-
section (b) for such States eligible for an 
allotment under this paragraph for such 
fiscal year; and 
‘‘(ii) in the case of a commonwealth or 
territory described in subsection (c)(3), the 
same proportion as the proportion of the 
commonwealth’s or territory’s allotment 
under subsection (c) (determined without 
regard to subsection (f)) to the total 
amount of the allotments under subsection 
(c) for commonwealths and territories eligi-
ble for an allotment under this paragraph 
for such fiscal year. 
‘‘(B) AVAILABILITY AND REDISTRIBUTION 
OF
UNUSED
ALLOTMENTS.—In applying sub-
sections (e) and (f) with respect to additional
allotments made available under this subsection, 
the procedures established under such sub-
sections shall ensure such additional allotments 
are only made available to States which have 
elected to provide coverage under section 2111. 
‘‘(3) USE OF ADDITIONAL ALLOTMENT.—Addi-
tional allotments provided under this subsection are 
not available for amounts expended before October 
1, 2003. Such amounts are available for amounts ex-
pended on or after such date for child health assist-
ance for targeted low-income children, as well as for 
parent health assistance for targeted low-income 
parents, and pregnancy-related assistance for tar-
geted low-income pregnant women. 
‘‘(4) REQUIRING ELECTION TO PROVIDE COV-
ERAGE.—No payments may be made to a State 
under this title from an allotment provided under 
this subsection unless the State has made an elec-
tion to provide parent health assistance for targeted 
low-income parents, or pregnancy-related assistance 
for targeted low-income pregnant women.’’. 
(ii) 
CONFORMING
AMENDMENTS.—
Section 2104 of the Social Security Act 
(42 U.S.C. 1397dd) is amended—
(I) in subsection (a), by inserting 
‘‘subject to subsection (d),’’ after 
‘‘under this section,’’; 
(II) in subsection (b)(1), by in-
serting ‘‘and subsection (d)’’ after 
‘‘Subject to paragraph (4)’’; and 
(III) in subsection (c)(1), by in-
serting ‘‘subject to subsection (d),’’ 
after ‘‘for a fiscal year,’’. 
(C) NO COST-SHARING FOR PREGNANCY-
RELATED
BENEFITS.—Section 2103(e)(2) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1397cc(e)(2)) is amended—
(i) in the heading, by inserting ‘‘AND 
PREGNANCY-RELATED
SERVICES’’ 
after 
‘‘PREVENTIVE SERVICES’’; and 
(ii) by inserting before the period at 
the end the following: ‘‘and for pregnancy-
related services’’.
(b) OPTIONAL APPLICATION OF PRESUMPTIVE ELI-
GIBILITY PROVISIONS TO PARENTS.—Section 1920A of 
the Social Security Act (42 U.S.C. 1396r–1a) is amended 
by adding at the end the following: 
‘‘(e) A State may elect to apply the previous provi-
sions of this section to provide for a period of presumptive
eligibility for medical assistance for a parent (as defined 
for purposes of section 1902(k)(1)) of a child with respect 
to whom such a period is provided under this section.’’. 
(c) CONFORMING AMENDMENTS.—
(1) 
ELIGIBILITY
CATEGORIES.—Section 
1905(a) of the Social Security Act (42 U.S.C. 
1396d(a)) is amended, in the matter before para-
graph (1)—
(A) by striking ‘‘or’’ at the end of clause 
(xii); 
(B) by inserting ‘‘or’’ at the end of clause 
(xiii); and 
(C) by inserting after clause (xiii) the fol-
lowing: 
‘‘(xiv) who are parents described (or treated as 
if described) in section 1902(k)(1),’’. 
(2) INCOME LIMITATIONS.—Section 1903(f)(4) 
of the Social Security Act (42 U.S.C. 1396b(f)(4)) 
is amended by inserting ‘‘1902(a)(10)(A)(ii)(XIX),’’ 
after ‘‘1902(a)(10)(A)(ii)(XVIII),’’.
(3) CONFORMING
AMENDMENT
RELATING
TO 
NO WAITING PERIOD FOR PREGNANT WOMEN.—Sec-
tion 2102(b)(1)(B) of the Social Security Act (42 
U.S.C. 1397bb(b)(1)(B)) is amended—
(A) by striking ‘‘, and’’ at the end of 
clause (i) and inserting a semicolon; 
(B) by striking the period at the end of 
clause (ii) and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(iii) may not apply a waiting period 
(including a waiting period to carry out 
paragraph (3)(C)) in the case of a targeted 
low-income parent who is pregnant.’’. 
(d) 
EXEMPTION
FOR
PUERTO
RICO.—Section 
1108(g) of the Social Security Act (42 U.S.C. 1308(g)) 
is amended by adding at the end the following: 
‘‘(3) CERTAIN
PAYMENTS
DISREGARDED.—
Paragraph (2) shall be applied without regard to 
any 
payments 
made 
under 
sections 
1902(a)(10)(A)(ii)(XIX) and 1903(v).’’. 
(e) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003, without regard 
to whether regulations implementing such amendments 
have been issued. 
SEC. 102. AUTOMATIC ENROLLMENT OF CHILDREN BORN 
TO TITLE XXI PARENTS. 
(a) TITLE XXI.—Section 2102(b)(1) of the Social 
Security Act (42 U.S.C. 1397bb(b)(1)) is amended by 
adding at the end the following:
‘‘(C) AUTOMATIC
ELIGIBILITY
OF
CHIL-
DREN BORN TO PREGNANT WOMEN.—Such eli-
gibility standards shall provide for automatic 
coverage of a child born to an individual who is 
provided assistance under this title in the same 
manner as medical assistance would be provided 
under section 1902(e)(4) to a child described in 
such section.’’. 
(b) CONFORMING AMENDMENT TO MEDICAID.—Sec-
tion 1902(e)(4) of the Social Security Act (42 U.S.C. 
1396a(e)(4)) is amended in the first sentence by striking 
‘‘so long as the child is a member of the woman’s house-
hold and the woman remains (or would remain if preg-
nant) eligible for such assistance’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003, without regard 
to whether regulations implementing such amendments 
have been issued. 
SEC. 103. OPTIONAL COVERAGE OF CHILDREN THROUGH 
AGE 20 UNDER THE MEDICAID PROGRAM AND 
TITLE XXI. 
(a) MEDICAID.—
(1) IN GENERAL.—Section 1902(l)(1)(D) of the 
Social Security Act (42 U.S.C. 1396a(l)(1)(D)) is 
amended by inserting ‘‘(or, at the election of a
State, 20 or 21 years of age)’’ after ‘‘19 years of 
age’’. 
(2) CONFORMING AMENDMENTS.—
(A) Section 1902(e)(3)(A) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(3)(A)) is 
amended by inserting ‘‘(or 1 year less than the 
age the State has elected under subsection 
(l)(1)(D))’’ after ‘‘18 years of age’’. 
(B) Section 1902(e)(12) of the Social Se-
curity Act (42 U.S.C. 1396a(e)(12)) is amend-
ed by inserting ‘‘or such higher age as the State 
has elected under subsection (l)(1)(D)’’ after 
‘‘19 years of age’’. 
(C) Section 1920A(b)(1) of the Social Se-
curity Act (42 U.S.C. 1396r–1a(b)(1)) is 
amended by inserting ‘‘or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D)’’ after ‘‘19 years of age’’. 
(D) Section 1928(h)(1) of the Social Secu-
rity Act (42 U.S.C. 1396s(h)(1)) is amended by 
inserting ‘‘or 1 year less than the age the State 
has elected under section 1902(l)(1)(D)’’ before 
the period at the end. 
(E) Section 1932(a)(2)(A) of the Social 
Security Act (42 U.S.C. 1396u–2(a)(2)(A)) is
amended by inserting ‘‘(or such higher age as 
the 
State 
has 
elected 
under 
section 
1902(l)(1)(D))’’ after ‘‘19 years of age’’. 
(b) TITLE XXI.—Section 2110(c)(1) of the Social 
Security Act (42 U.S.C. 1397jj(c)(1)) is amended by in-
serting ‘‘(or such higher age as the State has elected under 
section 1902(l)(1)(D))’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003, without regard 
to whether regulations implementing such amendments 
have been issued. 
SEC. 104. TECHNICAL AND CONFORMING AMENDMENTS TO 
AUTHORITY TO PAY MEDICAID EXPANSION 
COSTS FROM TITLE XXI APPROPRIATION. 
(a) AUTHORITY TO PAY MEDICAID EXPANSION 
COSTS
FROM
TITLE
XXI APPROPRIATION.—Section 
2105(a) of the Social Security Act (42 U.S.C. 1397ee(a)) 
is amended to read as follows: 
‘‘(a) ALLOWABLE EXPENDITURES.—
‘‘(1) IN GENERAL.—Subject to the succeeding 
provisions of this section, the Secretary shall pay to 
each State with a plan approved under this title, 
from its allotment under section 2104, an amount 
for each quarter equal to the enhanced FMAP of the 
following expenditures in the quarter:
‘‘(A) CHILD HEALTH ASSISTANCE UNDER 
MEDICAID.—Expenditures for child health as-
sistance under the plan for targeted low-income 
children in the form of providing medical assist-
ance for expenditures described in the fourth 
sentence of section 1905(b). 
‘‘(B) RESERVED.—[reserved]. 
‘‘(C) CHILD HEALTH ASSISTANCE UNDER 
THIS TITLE.—Expenditures for child health as-
sistance under the plan for targeted low-income 
children in the form of providing health benefits 
coverage that meets the requirements of section 
2103. 
‘‘(D) ASSISTANCE
AND
ADMINISTRATIVE 
EXPENDITURES SUBJECT TO LIMIT.—Expendi-
tures only to the extent permitted consistent 
with subsection (c)—
‘‘(i) for other child health assistance 
for targeted low-income children; 
‘‘(ii) for expenditures for health serv-
ices initiatives under the plan for improv-
ing the health of children (including tar-
geted low-income children and other low-
income children);
‘‘(iii) for expenditures for outreach ac-
tivities as provided in section 2102(c)(1) 
under the plan; and 
‘‘(iv) for other reasonable costs in-
curred by the State to administer the plan. 
‘‘(2) ORDER OF PAYMENTS.—Payments under a 
subparagraph of paragraph (1) from a State’s allot-
ment for expenditures described in each such sub-
paragraph shall be made on a quarterly basis in the 
order of such subparagraph in such paragraph. 
‘‘(3) NO DUPLICATIVE PAYMENT.—In the case 
of expenditures for which payment is made under 
paragraph (1), no payment shall be made under title 
XIX.’’. 
(b) CONFORMING AMENDMENTS.—
(1) SECTION
1905(u).—Section 1905(u)(1)(B) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(u)(1)(B)) is amended by inserting ‘‘and sec-
tion 2105(a)(1)’’ after ‘‘subsection (b)’’. 
(2) SECTION 2105(c).—Section 2105(c)(2)(A) of 
the Social Security Act (42 U.S.C. 1397ee(c)(2)(A)) 
is amended by striking ‘‘subparagraphs (A), (C), 
and (D) of’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall be effective as if included in the enact-
ment of the Balanced Budget Act of 1997 (Public Law 
105–33; 111 Stat. 251), whether or not regulations imple-
menting such amendments have been issued. 
SEC. 105. EXTENSION OF AVAILABILITY OF SCHIP ALLOT-
MENTS FOR FISCAL YEARS 1998 THROUGH 
2001. 
(a) EXTENDING AVAILABILITY OF SCHIP ALLOT-
MENTS FOR FISCAL YEARS 1998 THROUGH 2001.—
(1) RETAINED
AND
REDISTRIBUTED
ALLOT-
MENTS FOR FISCAL YEARS 1998 AND 1999.—Para-
graphs (2)(A)(i) and (2)(A)(ii) of section 2104(g) of 
the Social Security Act (42 U.S.C. 1397dd(g)) are 
each amended by striking ‘‘fiscal year 2002’’ and in-
serting ‘‘fiscal year 2004’’. 
(2) EXTENSION AND REVISION OF RETAINED 
AND
REDISTRIBUTED
ALLOTMENTS
FOR
FISCAL 
YEAR 2000.—
(A) PERMITTING AND EXTENDING RETEN-
TION OF PORTION OF FISCAL YEAR 2000 ALLOT-
MENT.—Paragraph (2) of such section 2104(g) 
is amended—
(i) in the heading, by striking ‘‘AND 
1999’’ and inserting ‘‘THROUGH 2000’’; and 
(ii) by adding at the end of subpara-
graph (A) the following:
‘‘(iii) FISCAL
YEAR
2000
ALLOT-
MENT.—Of the amounts allotted to a State 
pursuant to this section for fiscal year 
2000 that were not expended by the State 
by the end of fiscal year 2002, 50 percent 
of that amount shall remain available for 
expenditure by the State through the end 
of fiscal year 2004.’’. 
(B) REDISTRIBUTED ALLOTMENTS.—Para-
graph (1) of such section 2104(g) is amended—
(i) in subparagraph (A), by inserting 
‘‘or for fiscal year 2000 by the end of fis-
cal year 2002,’’ after ‘‘fiscal year 2001,’’; 
(ii) in subparagraph (A), by striking 
‘‘1998 or 1999’’ and inserting ‘‘1998, 
1999, or 2000’’; 
(iii) in subparagraph (A)(i)—
(I) by striking ‘‘or’’ at the end of 
subclause (I), 
(II) by striking the period at the 
end of subclause (II) and inserting ‘‘; 
or’’; and 
(III) by adding at the end the 
following new subclause:
‘‘(III) the fiscal year 2000 allot-
ment, the amount specified in sub-
paragraph (C)(i) (less the total of the 
amounts under clause (ii) for such fis-
cal year), multiplied by the ratio of 
the amount specified in subparagraph 
(C)(ii) for the State to the amount 
specified in subparagraph (C)(iii).’’; 
(iv) in subparagraph (A)(ii), by strik-
ing ‘‘or 1999’’ and inserting ‘‘, 1999, or 
2000’’; 
(v) in subparagraph (B), by striking 
‘‘with respect to fiscal year 1998 or 1999’’; 
(vi) in subparagraph (B)(ii)—
(I) by inserting ‘‘with respect to 
fiscal year 1998, 1999, or 2000,’’ 
after ‘‘subsection (e),’’; and 
(II) by striking ‘‘2002’’ and in-
serting ‘‘2004’’; and 
(vii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(C) AMOUNTS USED IN COMPUTING RE-
DISTRIBUTIONS
FOR
FISCAL
YEAR
2000.—For 
purposes of subparagraph (A)(i)(III)—
‘‘(i) the amount specified in this 
clause is the amount specified in para-
graph (2)(B)(i)(I) for fiscal year 2000, less 
the total amount remaining available pur-
suant to paragraph (2)(A)(iii); 
‘‘(ii) the amount specified in this 
clause for a State is the amount by which 
the State’s expenditures under this title in 
fiscal years 2000, 2001, and 2002 exceed 
the State’s allotment for fiscal year 2000 
under subsection (b); and 
‘‘(iii) the amount specified in this 
clause is the sum, for all States entitled to 
a redistribution under subparagraph (A) 
from the allotments for fiscal year 2000, of 
the amounts specified in clause (ii).’’. 
(C) CONFORMING
AMENDMENTS.—Such 
section 2104(g) is further amended—
(i) in its heading, by striking ‘‘AND 
1999’’ and inserting ‘‘, 1999, AND 2000’’; 
and 
(ii) in paragraph (3)—
(I) by striking ‘‘or fiscal year 
1999’’ and inserting ‘‘, fiscal year 
1999, or fiscal year 2000’’; and
(II) by striking ‘‘or November 
30, 2001’’ and inserting ‘‘November 
30, 2001, or November 30, 2002’’, re-
spectively. 
(3) EXTENSION AND REVISION OF RETAINED 
AND
REDISTRIBUTED
ALLOTMENTS
FOR
FISCAL 
YEAR 2001.—
(A) PERMITTING AND EXTENDING RETEN-
TION OF PORTION OF FISCAL YEAR 2001 ALLOT-
MENT.—Paragraph (2) of such section 2104(g), 
as amended in paragraph (2)(A)(ii), is further 
amended—
(i) in the heading, by striking ‘‘2000’’ 
and inserting ‘‘2001’’; and 
(ii) by adding at the end of subpara-
graph (A) the following: 
‘‘(iv) 
FISCAL
YEAR
2001
ALLOT-
MENT.—Of the amounts allotted to a State 
pursuant to this section for fiscal year 
2001 that were not expended by the State 
by the end of fiscal year 2003, 50 percent 
of that amount shall remain available for 
expenditure by the State through the end 
of fiscal year 2005.’’.
(B) REDISTRIBUTED ALLOTMENTS.—Para-
graph (1) of such section 2104(g), as amended 
in paragraph (2)(B), is further amended—
(i) in subparagraph (A), by inserting 
‘‘or for fiscal year 2001 by the end of fis-
cal year 2003,’’ after ‘‘fiscal year 2002,’’; 
(ii) in subparagraph (A), by striking 
‘‘1999, or 2000’’ and inserting ‘‘1999, 
2000, or 2001’’; 
(iii) in subparagraph (A)(i)—
(I) by striking ‘‘or’’ at the end of 
subclause (II), 
(II) by striking the period at the 
end of subclause (III) and inserting ‘‘; 
or’’; and 
(III) by adding at the end the 
following new subclause: 
‘‘(IV) the fiscal year 2001 allot-
ment, the amount specified in sub-
paragraph (D)(i) (less the total of the 
amounts under clause (ii) for such fis-
cal year), multiplied by the ratio of 
the amount specified in subparagraph 
(D)(ii) for the State to the amount 
specified in subparagraph (D)(iii).’’;
(iv) in subparagraph (A)(ii), by strik-
ing ‘‘or 2000’’ and inserting ‘‘2000, or 
2001’’; 
(v) in subparagraph (B)—
(I) by striking ‘‘and’’ at the end 
of clause (ii); 
(II) by redesignating clause (iii) 
as clause (iv); and 
(III) by inserting after clause (ii) 
the following new clause: 
‘‘(iii) notwithstanding subsection (e), 
with respect to fiscal year 2001, shall re-
main available for expenditure by the State 
through the end of fiscal year 2005; and’’; 
and 
(vi) by adding at the end the following 
new subparagraph: 
‘‘(D) AMOUNTS USED IN COMPUTING RE-
DISTRIBUTIONS
FOR
FISCAL
YEAR
2001.—For 
purposes of subparagraph (A)(i)(IV)—
‘‘(i) the amount specified in this 
clause is the amount specified in para-
graph (2)(B)(i)(I) for fiscal year 2001, less 
the total amount remaining available pur-
suant to paragraph (2)(A)(iv);
‘‘(ii) the amount specified in this 
clause for a State is the amount by which 
the State’s expenditures under this title in 
fiscal years 2001, 2002, and 2003 exceed 
the State’s allotment for fiscal year 2001 
under subsection (b); and 
‘‘(iii) the amount specified in this 
clause is the sum, for all States entitled to 
a redistribution under subparagraph (A) 
from the allotments for fiscal year 2001, of 
the amounts specified in clause (ii).’’. 
(C) CONFORMING
AMENDMENTS.—Such 
section 2104(g) is further amended—
(i) in its heading, by striking ‘‘AND 
2000’’ and inserting ‘‘2000, AND 2001’’; 
and 
(ii) in paragraph (3)—
(I) by striking ‘‘or fiscal year 
2000’’ and inserting ‘‘fiscal year 
2000, or fiscal year 2001’’; and 
(II) by striking ‘‘or November 
30, 2002,’’ and inserting ‘‘November 
30, 2002, or November 30, 2003,’’, 
respectively.
(4) EFFECTIVE
DATE.—This subsection, and 
the amendments made by this subsection, shall be 
effective as if this subsection had been enacted on 
September 30, 2002, and amounts under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.) from allotments for fiscal years 1998 through 
2000 are available for expenditure on and after Oc-
tober 1, 2002, under the amendments made by this 
subsection as if this subsection had been enacted on 
September 30, 2002. 
(b) AUTHORITY FOR QUALIFYING STATES TO USE 
PORTION OF SCHIP FUNDS FOR MEDICAID EXPENDI-
TURES.—Section 2105 of the Social Security Act (42 
U.S.C. 1397ee) is amended by adding at the end the fol-
lowing: 
‘‘(g) AUTHORITY FOR QUALIFYING STATES TO USE 
CERTAIN FUNDS FOR MEDICAID EXPENDITURES.—
‘‘(1) STATE OPTION.—
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of law, with respect to allot-
ments for fiscal years 1998, 1999, 2000, 2001, 
for fiscal years in which such allotments are 
available under subsections (e) and (g) of sec-
tion 2104, a qualifying State (as defined in 
paragraph (2)) may elect to use not more than
20 percent of such allotments (instead of for 
expenditures under this title) for payments for 
such fiscal year under title XIX in accordance 
with subparagraph (B). 
‘‘(B) PAYMENTS TO STATES.—
‘‘(i) IN GENERAL.—In the case of a 
qualifying State that has elected the option 
described in subparagraph (A), subject to 
the total amount of funds described with 
respect to the State in subparagraph (A), 
the Secretary shall pay the State an 
amount each quarter equal to the addi-
tional amount that would have been paid 
to the State under title XIX for expendi-
tures of the State for the fiscal year de-
scribed in clause (ii) if the enhanced 
FMAP (as determined under subsection 
(b)) had been substituted for the Federal 
medical assistance percentage (as defined 
in section 1905(b)) of such expenditures. 
‘‘(ii) EXPENDITURES
DESCRIBED.—
For purposes of clause (i), the expendi-
tures described in this clause are expendi-
tures for such fiscal years for providing 
medical assistance under title XIX to indi-
viduals who have not attained age 19 and 
whose family income exceeds 150 percent 
of the poverty line. 
‘‘(iii) NO IMPACT ON DETERMINATION 
OF BUDGET NEUTRALITY FOR WAIVERS.—
In the case of a qualifying State that uses 
amounts paid under this subsection for ex-
penditures described in clause (ii) that are 
incurred under a waiver approved for the 
State, any budget neutrality determina-
tions with respect to such waiver shall be 
determined 
without 
regard 
to 
such 
amounts paid. 
‘‘(2) QUALIFYING STATE.—In this subsection, 
the term ‘qualifying State’ means a State that—
‘‘(A) as of April 15, 1997, has an income 
eligibility standard with respect to any 1 or 
more categories of children (other than infants) 
who are eligible for medical assistance under 
section 1902(a)(10)(A) or under a waiver under 
section 1115 implemented on January 1, 1994, 
that is up to 185 percent of the poverty line or 
above; and 
‘‘(B) satisfies the requirements described 
in paragraph (3).
‘‘(3) REQUIREMENTS.—The requirements de-
scribed in this paragraph are the following: 
‘‘(A) SCHIP INCOME
ELIGIBILITY.—The 
State has a State child health plan that (wheth-
er implemented under title XIX or this title)—
‘‘(i) as of January 1, 2001, has an in-
come eligibility standard that is at least 
200 percent of the poverty line or has an 
income eligibility standard that exceeds 
200 percent of the poverty line under a 
waiver under section 1115 that is based on 
a child’s lack of health insurance; 
‘‘(ii) subject to subparagraph (B), 
does not limit the acceptance of applica-
tions for children; and 
‘‘(iii) provides benefits to all children 
in the State who apply for and meet eligi-
bility standards on a statewide basis. 
‘‘(B) NO WAITING LIST IMPOSED.—With 
respect to children whose family income is at or 
below 200 percent of the poverty line, the State 
does not impose any numerical limitation, wait-
ing list, or similar limitation on the eligibility of 
such children for child health assistance under 
such State plan.
‘‘(C) ADDITIONAL
REQUIREMENTS.—The 
State has implemented at least 3 of the fol-
lowing policies and procedures (relating to cov-
erage of children under title XIX and this title): 
‘‘(i) UNIFORM, SIMPLIFIED APPLICA-
TION FORM.—With respect to children who 
are eligible for medical assistance under 
section 1902(a)(10)(A), the State uses the 
same uniform, simplified application form 
(including, if applicable, permitting appli-
cation other than in person) for purposes 
of establishing eligibility for benefits under 
title XIX and this title. 
‘‘(ii) ELIMINATION OF ASSET TEST.—
The State does not apply any asset test for 
eligibility under section 1902(l) or this title 
with respect to children. 
‘‘(iii) ADOPTION OF 12-MONTH CON-
TINUOUS
ENROLLMENT.—The State pro-
vides that eligibility shall not be regularly 
redetermined more often than once every 
year under this title or for children de-
scribed in section 1902(a)(10)(A). 
‘‘(iv) SAME VERIFICATION AND REDE-
TERMINATION POLICIES; AUTOMATIC REAS-
SESSMENT OF ELIGIBILITY.—With respect 
to children who are eligible for medical as-
sistance under section 1902(a)(10)(A), the 
State provides for initial eligibility deter-
minations and redeterminations of eligi-
bility using the same verification policies 
(including with respect to face-to-face 
interviews), forms, and frequency as the 
State uses for such purposes under this 
title, and, as part of such redetermina-
tions, provides for the automatic reassess-
ment of the eligibility of such children for 
assistance under title XIX and this title. 
‘‘(v) OUTSTATIONING
ENROLLMENT 
STAFF.—The State provides for the receipt 
and initial processing of applications for 
benefits under this title and for children 
under title XIX at facilities defined as dis-
proportionate share hospitals under section 
1923(a)(1)(A) 
and 
Federally-qualified 
health 
centers 
described 
in 
section 
1905(l)(2)(B) 
consistent 
with 
section 
1902(a)(55).’’.
Subtitle B—State Option To Pro-
vide Coverage to All Individuals 
Below 100 Percent of Poverty 
SEC. 111. STATE OPTION TO OFFER MEDICAID COVERAGE 
BASED ON NEED. 
(a) STATE OPTION TO PROVIDE COVERAGE.—Sec-
tion 1902(a)(10)(A)(ii) of the Social Security Act (42 
U.S.C. 1396a), as amended by section 531(a)(1)(A), is 
amended—
(1) by striking ‘‘or’’ at the end of subclause 
(XIX); 
(2) by adding ‘‘or’’ at the end of subclause 
(XX); and 
(3) by adding at the end the following: 
‘‘(XXI) whose income does not 
exceed 100 percent of the income offi-
cial poverty line (as defined by the Of-
fice of Management and Budget, and 
revised annually in accordance with 
section 673(2) of the Omnibus Budget 
Reconciliation Act of 1981) applicable 
to a family of the size involved;’’. 
(b) CONFORMING AMENDMENTS.—Section 1905(a) 
of the Social Security Act (42 U.S.C. 1396d(a)), as
amended by section 501(d)(1), is amended in the matter 
preceding paragraph (1)—
(1) by striking ‘‘or’’ at the end of clause (xiii); 
(2) by adding ‘‘or’’ at the end of clause (xiv); 
and 
(3) by inserting after clause (xiv) the following: 
‘‘(xv) individuals who are eligible for medical 
assistance 
on 
the 
basis 
of 
section 
1902(a)(10)(A)(ii)(XXI);’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section apply to medical assistance provided on and 
after October 1, 2003. 
Subtitle C—Outreach and 
Enrollment 
SEC. 121. GRANTS TO PROMOTE INNOVATIVE OUTREACH 
AND ENROLLMENT EFFORTS UNDER SCHIP. 
(a) IN GENERAL.—Section 2104(f) of the Social Se-
curity Act (42 U.S.C. 1397dd(f)) is amended—
(1) by striking ‘‘The Secretary’’ and inserting 
the following: 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
the Secretary’’; and 
(2) by adding at the end the following: 
‘‘(2) GRANTS TO PROMOTE INNOVATIVE OUT-
REACH AND ENROLLMENT EFFORTS.—
‘‘(A) IN
GENERAL.—Prior to any redis-
tribution under paragraph (1) of unexpended 
allotments made to States under subsection (b) 
or (c) for fiscal year 2001 and any fiscal year 
thereafter, the Secretary shall—
‘‘(i) reserve from such unexpended al-
lotments the lesser of $50,000,000 or the 
total amount of such unexpended allot-
ments for grants under this paragraph for 
the fiscal year in which the redistribution 
occurs; and 
‘‘(ii) subject to subparagraph (B), use 
such reserved funds to make grants to na-
tional local and community-based public or 
nonprofit organizations (including organi-
zations involved in women’s health, pedi-
atric advocacy, local and county govern-
ments, public health departments, Feder-
ally-qualified health centers, children’s hos-
pitals, and hospitals defined as dispropor-
tionate share hospitals under the State 
plan under title XIX) to conduct innova-
tive outreach and enrollment efforts that 
are consistent with section 2102(c) and to 
promote understanding of the importance
of health insurance coverage for prenatal 
care and children. 
‘‘(B) PRIORITY FOR GRANTS IN CERTAIN 
AREAS.—In making grants under subparagraph 
(A)(ii), the Secretary shall give priority to grant 
applicants that propose to target the outreach 
and enrollment efforts funded under the grant 
to geographic areas—
‘‘(i) with high rates of eligible but 
unenrolled children, including such chil-
dren who reside in rural areas; or 
‘‘(ii) with high rates of families for 
whom English is not their primary lan-
guage. 
‘‘(C) 
APPLICATIONS.—An 
organization 
that desires to receive a grant under this para-
graph shall submit an application to the Sec-
retary in such form and manner, and con-
taining such information, as the Secretary may 
decide.’’. 
(b) EXTENDING USE OF OUTSTATIONED WORKERS 
TO
ACCEPT
TITLE
XXI 
APPLICATIONS.—Section 
1902(a)(55) of such Act (42 U.S.C. 1396a(a)(55)) is 
amended by inserting ‘‘, and applications for child health 
assistance under title XXI’’ after ‘‘(a)(10)(A)(ii)(IX)’’.
Subtitle D—Immigrant Children 
and Pregnant Women 
SEC. 131. OPTIONAL COVERAGE OF LEGAL IMMIGRANTS 
UNDER THE MEDICAID PROGRAM AND SCHIP. 
(a) MEDICAID PROGRAM.—Section 1903(v) of the 
Social Security Act (42 U.S.C. 1396b(v)) is amended—
(1) in paragraph (1), by striking ‘‘paragraph 
(2)’’ and inserting ‘‘paragraphs (2) and (4)’’; and 
(2) by adding at the end the following: 
‘‘(4)(A) A State may elect (in a plan amendment 
under this title) to provide medical assistance under this 
title for aliens who are lawfully residing in the United 
States (including battered aliens described in section 
431(c) of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996) and who are otherwise 
eligible for such assistance, within any of the following eli-
gibility categories: 
‘‘(i) PREGNANT WOMEN.—Women during preg-
nancy (and during the 60-day period beginning on 
the last day of the pregnancy). 
‘‘(ii) CHILDREN.—Children (as defined under 
such plan), including optional targeted low-income 
children described in section 1905(u)(2)(B). 
‘‘(B)(i) In the case of a State that has elected to pro-
vide medical assistance to a category of aliens under sub-
paragraph (A), no debt shall accrue under an affidavit of 
support against any sponsor of such an alien on the basis 
of provision of assistance to such category and the cost 
of such assistance shall not be considered as an unreim-
bursed cost. 
‘‘(ii) The provisions of sections 401(a), 402(b), 403, 
and 421 of the Personal Responsibility and Work Oppor-
tunity Reconciliation Act of 1996 shall not apply to a 
State that makes an election under subparagraph (A).’’. 
(b) TITLE XXI.—Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended by add-
ing at the end the following: 
‘‘(E) Section 1903(v)(4) (relating to op-
tional coverage of permanent resident alien chil-
dren), but only if the State has elected to apply 
such section to that category of children under 
title XIX.’’.
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003, and apply to 
medical assistance and child health assistance furnished 
on or after such date.
SEC. 132. PERMITTING STATES AND LOCALITIES TO PRO-
VIDE HEALTH CARE TO ALL INDIVIDUALS. 
(a) IN GENERAL.—Section 411 of the Personal Re-
sponsibility and Work Opportunity Reconciliation Act of 
1996 (8 U.S.C. 1621) is amended—
(1) in subsection (b)—
(A) by striking paragraphs (1) and (3); 
and 
(B) by redesignating paragraphs (2) and 
(4) as paragraphs (1) and (2), respectively; and 
(2) in subsection (c)—
(A) in paragraph (1)—
(i) in the matter preceding subpara-
graph (A), by striking ‘‘(2) and (3)’’ and 
inserting ‘‘(2), (3), and (4)’’; and 
(ii) in subparagraph (B), by striking 
‘‘health,’’; and 
(B) by adding at the end the following new 
paragraph 
‘‘(4) Such term does not include any health 
benefit for which payments or assistance are pro-
vided to an individual, household, or family eligibility 
unit by an agency of a State or local government or 
by appropriated funds of a State or local govern-
ment.’’.
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to health care furnished before, 
on, or after the date of the enactment of this Act. 
Subtitle E—Eligibility 
Simplification 
SEC. 141. STATE OPTION TO PROVIDE FOR SIMPLIFIED DE-
TERMINATIONS OF A CHILD’S FINANCIAL ELI-
GIBILITY FOR MEDICAL ASSISTANCE UNDER 
MEDICAID OR CHILD HEALTH ASSISTANCE 
UNDER SCHIP. 
(a) MEDICAID.—Section 1902(e) of the Social Secu-
rity Act (42 U.S.C. 1396a(e)) is amended by adding at 
the end the following: 
‘‘(13)(A) At the option of the State, the plan 
may provide that financial eligibility requirements 
for medical assistance are met for an individual who 
is under an age specified by the State (not to exceed 
21 years of age) by using a determination (made 
within a reasonable period, as found by the State, 
before its use for this purpose) of the individual’s 
family or household income or resources, notwith-
standing any differences in budget unit, disregard, 
deeming, or other methodology, by a Federal or 
State agency (or a public or private entity making 
such determination on behalf of such agency) speci-
fied by the plan, including but not limited to the 
agencies administering the Food Stamp Act of 1977, 
the Richard B. Russell National School Lunch Act, 
and the Child Nutrition Act of 1966, provided that 
such agency has fiscal liabilities or responsibilities 
affected or potentially affected by such determina-
tions and provided that all information furnished by 
such agency pursuant to this subparagraph is used 
solely for purposes of determining eligibility for med-
ical assistance under the State plan approved under 
this title or for child health assistance under a State 
plan approved under title XXI. 
‘‘(B) Nothing in subparagraph (A) shall be con-
strued—
‘‘(i) to authorize the denial of medical as-
sistance under a State plan approved under this 
title or of child health assistance under a State 
plan approved under title XXI to an individual 
who, without the application of this paragraph 
or an option exercised thereunder, would qualify 
for such assistance; 
‘‘(ii) to relieve a State of the obligation 
under subsection (a)(8) to furnish assistance 
with reasonable promptness after the submis-
sion of an initial application that is evaluated or
for which evaluation is requested pursuant to 
this paragraph; or 
‘‘(iii) to relieve a State of the obligation to 
determine eligibility on other grounds for an in-
dividual found to be ineligible under this para-
graph. 
‘‘(C) At the option of a State, the financial eli-
gibility process described in subparagraph (A) may 
apply to an individual who is older than age 21 if 
such individual’s eligibility for medical assistance is 
based on pregnancy or if such individual is a parent, 
guardian, or other caretaker relative of an individual 
found eligible under subparagraph (A).’’. 
(b) SCHIP.—Section 2107(e)(1) of the Social Secu-
rity Act (42 U.S.C. 1397gg(e)(1)) is amended by adding 
at the end the following: 
‘‘(E) Section 1902(e)(13) (relating to the 
State option to base a child’s eligibility for as-
sistance on financial determinations made by a 
program providing nutrition or other public as-
sistance).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section take effect on October 1, 2003.
SEC. 142. APPLICATION OF SIMPLIFIED TITLE XXI PROCE-
DURES UNDER THE MEDICAID PROGRAM. 
(a) PRESUMPTIVE ELIGIBILITY.—
(1) IN GENERAL.—Section 1920A(b)(3)(A)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396r–
1a(b)(3)(A)(i)) is amended by inserting ‘‘a child care 
resource and referral agency,’’ after ‘‘a State or trib-
al child support enforcement agency,’’. 
(2) APPLICATION TO PRESUMPTIVE ELIGIBILITY 
FOR PREGNANT WOMEN UNDER MEDICAID.—Section 
1920(b) of the Social Security Act (42 U.S.C. 
1396r–1(b)) is amended by adding at the end after 
and below paragraph (2) the following flush sen-
tence: 
‘‘The term ‘qualified provider’ includes a qualified entity 
as defined in section 1920A(b)(3).’’.
(3) APPLICATION UNDER TITLE XXI.—Section 
2107(e)(1)(D) of the Social Security Act (42 U.S.C. 
1397gg(e)(1)) is amended to read as follows: 
‘‘(D) Sections 1920 and 1920A (relating to 
presumptive eligibility).’’. 
(b) AUTOMATIC REASSESSMENT OF ELIGIBILITY FOR 
TITLE XXI AND MEDICAID BENEFITS FOR CHILDREN 
LOSING MEDICAID OR TITLE XXI ELIGIBILITY.—
(1) LOSS OF MEDICAID ELIGIBILITY.—Section 
1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended—
(A) by striking the period at the end of 
paragraph (65) and inserting ‘‘; and’’, and 
(B) by inserting after paragraph (65) the 
following: 
‘‘(66) provide, in the case of a State with a 
State child health plan under title XXI, that before 
medical assistance to a child (or a parent of a child) 
is discontinued under this title, a determination of 
whether the child (or parent) is eligible for benefits 
under title XXI shall be made and, if determined to 
be so eligible, the child (or parent) shall be auto-
matically enrolled in the program under such title 
without the need for a new application.’’. 
(2) LOSS OF TITLE XXI ELIGIBILITY AND CO-
ORDINATION WITH MEDICAID.—Section 2102(b) of 
the Social Security Act (42 U.S.C. 1397bb(b)) is 
amended—
(A) in paragraph (3), by redesignating 
subparagraphs (D) and (E) as subparagraphs 
(E) and (F), respectively, and by inserting after 
subparagraph (C) the following:
‘‘(D) that before health assistance to a 
child (or a parent of a child) is discontinued 
under this title, a determination of whether the 
child (or parent) is eligible for benefits under 
title XIX is made and, if determined to be so 
eligible, the child (or parent) is automatically 
enrolled in the program under such title with-
out the need for a new application;’’; 
(B) by redesignating paragraph (4) as 
paragraph (5); and 
(C) by inserting after paragraph (3) the 
following new paragraph: 
‘‘(4) COORDINATION
WITH
MEDICAID.—The 
State shall coordinate the screening and enrollment 
of individuals under this title and under title XIX 
consistent with the following: 
‘‘(A) Information that is collected under 
this title or under title XIX which is needed to 
make an eligibility determination under the 
other title shall be transmitted to the appro-
priate administering entity under such other 
title in a timely manner so that coverage is not 
delayed and families do not have to submit the 
same information twice. Families shall be pro-
vided the information they need to complete the
application process for coverage under both ti-
tles and be given appropriate notice of any de-
terminations made on their applications for 
such coverage. 
‘‘(B) If a State does not use a joint appli-
cation under this title and such title, the State 
shall—
‘‘(i) promptly inform a child’s parent 
or caretaker in writing and, if appropriate, 
orally, that a child has been found likely to 
be eligible under title XIX; 
‘‘(ii) provide the family with an appli-
cation for medical assistance under such 
title and offer information about what (if 
any) further information, documentation, 
or other steps are needed to complete such 
application process; 
‘‘(iii) offer assistance in completing 
such application process; and 
‘‘(iv) promptly transmit the separate 
application under this title or the informa-
tion obtained through such application, 
and all other relevant information and doc-
umentation, including the results of the 
screening process, to the State agency
under title XIX for a final determination 
on eligibility under such title. 
‘‘(C) Applicants are notified in writing 
of—
‘‘(i) benefits (including restrictions on 
cost-sharing) under title XIX; and 
‘‘(ii) eligibility rules that prohibit chil-
dren who have been screened eligible for 
medical assistance under such title from 
being enrolled under this title, other than 
provisional temporary enrollment while a 
final eligibility determination is being made 
under such title. 
‘‘(D) If the agency administering this title 
is different from the agency administering a 
State plan under title XIX, such agencies shall 
coordinate the screening and enrollment of ap-
plicants for such coverage under both titles. 
‘‘(E) The coordination procedures estab-
lished between the program under this title and 
under title XIX shall apply not only to the ini-
tial eligibility determination of a family but also 
to any renewals or redeterminations of such eli-
gibility.’’.
(3) EFFECTIVE DATE.—The amendments made 
by paragraphs (1) and (2) apply to individuals who 
lose eligibility under the medicaid program under 
title XIX, or under a State child health insurance 
plan under title XXI, respectively, of the Social Se-
curity Act on or after October 1, 2003, without re-
gard to whether regulations implementing such 
amendments have been issued. 
(c) PROVISION OF MEDICAID AND CHIP APPLICA-
TIONS AND INFORMATION UNDER THE SCHOOL LUNCH 
PROGRAM.—Section 9(b)(2)(B) of the Richard B. Russell 
National School Lunch Act (42 U.S.C. 1758(b)(2)(B)) is 
amended—
(1) by striking ‘‘(B) Applications’’ and inserting 
‘‘(B)(i) Applications’’; and 
(2) by adding at the end the following:
‘‘(ii)(I) Applications for free and reduced price 
lunches that are distributed pursuant to clause (i) to par-
ents or guardians of children in attendance at schools par-
ticipating in the school lunch program under this Act shall 
also contain information on the availability of medical as-
sistance under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) and of child health and other assist-
ance under title XXI of such Act, including information
on how to obtain an application for assistance under such 
programs. 
‘‘(II) Information on the programs referred to in sub-
clause (I) shall be provided on a form separate from the 
application form for free and reduced price lunches under 
clause (i).’’. 
Subtitle F—SCHIP Wrap-Around 
Benefits 
SEC. 151. STATE OPTION TO PROVIDE WRAP-AROUND 
SCHIP COVERAGE TO CHILDREN WHO HAVE 
OTHER HEALTH COVERAGE. 
(a) IN GENERAL.—
(1) SCHIP.—
(A) STATE
OPTION
TO
PROVIDE
WRAP-
AROUND
COVERAGE.—Section 2110(b) of the 
Social Security Act (42 U.S.C. 1397jj(b)) is 
amended—
(i) in paragraph (1)(C), by inserting 
‘‘, subject to paragraph (5),’’ after ‘‘under 
title XIX or’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(5) STATE OPTION TO PROVIDE WRAP-AROUND 
COVERAGE.—A State may waive the requirement of 
paragraph (1)(C) that a targeted low-income child
may not be covered under a group health plan or 
under health insurance coverage, if the State satis-
fies the conditions described in subsection (c)(8). 
The State may waive such requirement in order to 
provide—
‘‘(A) dental services; 
‘‘(B) cost-sharing protection; or 
‘‘(C) all services.
In waiving such requirement, a State may limit the 
application of the waiver to children whose family in-
come does not exceed a level specified by the State, 
so long as the level so specified does not exceed the 
maximum income level otherwise established for 
other children under the State child health plan.’’; 
and 
(B) 
CONDITIONS
DESCRIBED.—Section 
2105(c) of such Act (42 U.S.C. 1397ee(c)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(8) CONDITIONS
FOR
PROVISION
OF
WRAP 
AROUND
COVERAGE.—For 
purposes 
of 
section 
2110(b)(5), the conditions described in this para-
graph are the following:
‘‘(A) INCOME
ELIGIBILITY.—The State 
child health plan (whether implemented under 
title XIX or this XXI)—
‘‘(i) has an income eligibility standard 
not less than that described in paragraph 
(4) of such section; 
‘‘(ii) subject to subparagraph (B), 
does not limit the acceptance of applica-
tions for children; and 
‘‘(iii) provides benefits to all children 
in the State who apply for and meet eligi-
bility standards. 
‘‘(B) NO WAITING LIST IMPOSED.—With 
respect to children whose family income is at or 
below 200 percent of the poverty line, the State 
does not impose any numerical limitation, wait-
ing list, or similar limitation on the eligibility of 
such children for child health assistance under 
such State plan. 
‘‘(C) NO MORE FAVORABLE TREATMENT.—
The State child health plan may not provide 
more favorable coverage of dental services to 
the children covered under section 2110(b)(5) 
than to children otherwise covered under this 
title.’’.
(C) STATE OPTION TO WAIVE WAITING PE-
RIOD.—Section 2102(b)(1)(B) of such Act (42 
U.S.C. 1397bb(b)(1)(B)), as amended by sec-
tion 101(c)(3), is amended—
(i) in clause (ii), by striking ‘‘and’’ at 
the end; 
(ii) in clause (iii), by striking the pe-
riod and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing new clause: 
‘‘(iv) at State option, may not apply a 
waiting period in the case of child de-
scribed in section 2110(b)(5), if the State 
satisfies 
the 
requirements 
of 
section 
2105(c)(8).’’. 
(2) APPLICATION OF ENHANCED MATCH UNDER 
MEDICAID.—Section 1905 of such Act (42 U.S.C. 
1396d), as amended by section 101(a)(1)(C), is 
amended—
(A) in subsection (b), in the fourth sen-
tence, by striking ‘‘or (u)(4)’’ and inserting 
‘‘(u)(4), or (u)(5)’’; and 
(B) in subsection (u), by inserting after 
paragraph (4) the following new paragraph:
‘‘(5) For purposes of subsection (b), the expenditures 
described in this paragraph are expenditures for items and 
services for children described in section 2110(b)(5), but 
only in the case of a State that satisfies the requirements 
of section 2105(c)(8).’’. 
(3) APPLICATION OF SECONDARY PAYOR PROVI-
SIONS.—Section 2107(e)(1) of such Act (42 U.S.C. 
1397gg(e)(1)), as amended by section 121(b), is 
amended—
(A) by redesignating subparagraphs (B) 
through (E) as subparagraphs (C) through (F), 
respectively; and 
(B) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) Section 1902(a)(25) (relating to co-
ordination of benefits and secondary payor pro-
visions) with respect to children covered under 
a waiver described in section 2110(b)(5).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall take effect on January 1, 2004, and 
shall apply to child health assistance and medical assist-
ance provided on or after that date.
Subtitle G—Immunization 
Coverage Through SCHIP 
SEC. 161. ELIGIBILITY OF CHILDREN ENROLLED IN THE 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAM FOR THE PEDIATRIC VACCINE DIS-
TRIBUTION PROGRAM. 
(a) IN GENERAL.—Section 1928(b)(2)(B)(ii)(I) of 
the Social Security Act (42 U.S.C. 1396s(b)(2)(B)(ii)(I)) 
is amended by inserting ‘‘(other than a State child health 
plan under title XXI)’’ after ‘‘policy or plan’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) applies with respect to vaccines adminis-
tered on or after the date of the enactment of this Act. 
Subtitle H—Limited English 
Proficient Communities 
SEC. 171. INCREASED FEDERAL REIMBURSEMENT FOR 
LANGUAGE SERVICES UNDER THE MEDICAID 
PROGRAM 
AND 
THE 
STATE 
CHILDREN’S 
HEALTH INSURANCE PROGRAM. 
(a) MEDICAID.—Section 1903(a)(3) of the Social Se-
curity Act (42 U.S.C. 1396b(a)(3)) is amended—
(1) in subparagraph (D), by striking ‘‘plus’’ at 
the end and inserting ‘‘and’’; and 
(2) by adding at the end the following:
‘‘(E) 90 percent of the sums expended with 
respect to costs incurred during such quarter as 
are attributable to the provision of language 
services, including oral interpretation, trans-
lations of written materials, and other language 
services, for individuals with limited English 
proficiency who apply for, or receive, medical 
assistance under the State plan; plus’’. 
(b) SCHIP.—Section 2105(a)(1) of the Social Secu-
rity Act (42 U.S.C. 1397ee(a)(1)), as amended by section 
104(a), is amended—
(1) in the matter preceding subparagraph (A), 
by inserting ‘‘or, in the case of expenditures de-
scribed in subparagraph (D)(iv), 90 percent’’ after 
‘‘enhanced FMAP’’; and 
(2) in subparagraph (D)—
(A) in clause (iii), by striking ‘‘and’’ at the 
end; 
(B) be redesignating clause (iv) as clause 
(v); and 
(C) by inserting after clause (iii) the fol-
lowing: 
‘‘(iv) for expenditures attributable to 
the provision of language services, includ-
ing oral interpretation, translations of
written materials, and other language serv-
ices, for individuals with limited English 
proficiency who apply for, or receive, child 
health assistance under the plan; and’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on October 1, 2004. 
Subtitle 
I—Binational 
Public 
Health 
Infrastructure 
and 
Health Insurance 
SEC. 181. BINATIONAL PUBLIC HEALTH INFRASTRUCTURE 
AND HEALTH INSURANCE. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall enter into a contract with the Insti-
tute of Medicine for the conduct of a study concerning 
binational public health infrastructure and health insur-
ance efforts. In conducting such study, the Institute shall 
solicit input from border health experts and health insur-
ance companies. 
(b) REPORT.—Not later than 1 year after the date 
on which the Secretary of Health and Human Services en-
ters into the contract under subsection (a), the Institute 
of Medicine shall submit to the Secretary and the appro-
priate committees of Congress a report concerning the 
study conducted under subsection (a). Such report shall 
include the recommendations of the Institute on ways to
expand or improve binational public health infrastructure 
and health insurance efforts. 
Subtitle J—Migrant Workers and 
Farmworkers Health 
SEC. 191. DEMONSTRATION PROJECT REGARDING CON-
TINUITY OF COVERAGE OF MIGRANT WORK-
ERS AND FARMWORKERS UNDER MEDICAID 
AND SCHIP. 
(a) AUTHORITY
TO
CONDUCT
DEMONSTRATION 
PROJECT.—
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall conduct a demonstration 
project for the purpose of evaluating methods for 
strengthening the health coverage of, and continuity 
of coverage of, migrant workers and farmworkers 
under the medicaid and State children’s health in-
surance programs (42 U.S.C. 1396 et seq., 1397aa 
et seq.). 
(2) WAIVER
AUTHORITY.—The Secretary of 
Health and Human Services shall waive compliance 
with the requirements of titles XI, XIX, and XXI of 
the Social Security Act (42 U.S.C. 1301 et seq, 
1396 et seq., 1397aa et seq.) to such extent and for 
such period as the Secretary determines is necessary
to conduct the demonstration project under this sec-
tion. 
(b) REQUIREMENTS.—The demonstration project 
conducted under this section shall provide for—
(1) uniform eligibility criteria under the med-
icaid and State children’s health insurance programs 
with respect to migrant workers and farmworkers; 
and 
(2) the portability of coverage of such workers 
under those programs between participating States. 
(c) REPORT.—Not later than March 31, 2005, the 
Secretary of Health and Human Services shall submit a 
report to Congress on the demonstration project con-
ducted under this section that contains such recommenda-
tions for legislative action as the Secretary determines is 
appropriate. 
TITLE II—HEALTH DISPARITIES 
Subtitle A—Report on Programs 
for Improving the Health Status 
of Hispanic Individuals 
SEC. 201. ANNUAL REPORT REGARDING HISPANIC HEALTH 
DISPARITIES FOR CHRONIC AND COMMU-
NICABLE DISEASES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this Act referred to as the ‘‘Sec-
retary’’) shall annually submit to Congress a report on 
programs carried out through the Public Health Service 
with respect to improving the health status of Hispanic 
individuals regarding diabetes, cancer, asthma, HIV infec-
tion, AIDS, tuberculosis, injuries (unintentional and in-
tentional), obesity, immunization rates, oral health, sub-
stance abuse, and mental health, including—
(1) prevention programs carried out through 
the Centers for Disease Control and Prevention and 
the Substance Abuse and Mental Health Services 
Administration; 
(2) treatment programs carried out through the 
Health Resources and Services Administration and 
the Substance Abuse and Mental Health Services 
Administration; 
(3) research programs carried out through the 
National Institutes of Health, the National Center 
on Minority Health and Health Disparities, the 
Agency for Healthcare Quality and Research, the 
Maternal Child Health Bureau, and the Centers for 
Medicare & Medicaid Services; and 
(4) activities of the Office of Public Health and 
Science, including activities of the Office of Minority 
Health.
(b) DATA COLLECTION.—Each report under sub-
section (a) shall include information on programs carried 
out through the Public Health Service to collect data that 
relates to the health status of Hispanic individuals regard-
ing diabetes, cancer, asthma, HIV infection, AIDS, tuber-
culosis, injuries (unintentional and intentional), obesity, 
immunization rates, oral health, substance abuse, and 
mental health. 
Subtitle B—Diabetes Research, 
Control, and Prevention 
SEC. 211. TREATMENT. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 399P. DIABETES; TREATMENT FOR MINORITY POPU-
LATIONS. 
‘‘(a) IN GENERAL.—The Secretary shall conduct and 
support programs to treat diabetes in minority popu-
lations. 
‘‘(b) NATIONAL INSTITUTES OF HEALTH.—With re-
spect to the National Institutes of Health, activities under 
subsection (a) regarding the treatment of diabetes in mi-
nority populations shall include the following: 
‘‘(1) Through the National Institute of Mental 
Health, providing for comprehensive mental health
services and treatment for individuals within such 
populations who experience mental barriers to prop-
er diabetes care. 
‘‘(2) Through the National Center on Minority 
Health and Health Disparities, recommending and 
disseminating the guidelines of the American Diabe-
tes Association for nutrition exercise and diet for di-
abetes treatment and prevention. 
‘‘(c) OTHER AGENCIES.—Activities under subsection 
(a) regarding the treatment of diabetes in minority popu-
lations shall include the following: 
‘‘(1) Through the Substance Abuse and Mental 
Health Services Administration and the National In-
stitute of Mental Health, providing for comprehen-
sive mental health services and treatment for minori-
ties who experience mental barriers to proper diabe-
tes care. 
‘‘(2) Promoting early detection as a cost-saving 
mechanism, including making grants to community 
health centers and clinics to specifically treat type 2 
diabetes and complications, including eye disease, 
kidney failure, heart disease and stroke, nerve dam-
age, and limb amputations. 
‘‘(3) Through the Health Resources and Serv-
ices Administration and the Centers for Disease
Control and Prevention, carrying out a collaborative 
program to encourage preventive care. Such pro-
gram shall not be limited to primary prevention, and 
shall include secondary and tertiary prevention. Such 
program shall include the award of grants to com-
munity health centers and clinics to specifically treat 
diabetes, with an emphasis on type 2 diabetes, and 
diabetic complications, including eye disease, kidney 
failure, heart disease and stroke, nerve damage, and 
limb amputation. 
‘‘(d) DEFINITION.—For purposes of this section, the 
term ‘minority populations’ means racial and ethnic mi-
nority groups within the meaning of section 1707. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out subsections (a) and (c), there are author-
ized to be appropriated such sums as may be nec-
essary for fiscal year 2003 and each subsequent fis-
cal year. 
‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For 
the purpose of carrying out subsection (b), there are 
authorized to be appropriated such sums as may be 
necessary for fiscal year 2004 and each subsequent 
fiscal year.’’.
SEC. 212. EDUCATION. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended by section 211, is 
further amended by adding at the end the following: 
‘‘SEC. 399Q. DIABETES; EDUCATION REGARDING MINORITY 
POPULATIONS. 
‘‘(a) IN GENERAL.—The Secretary shall conduct and 
support programs to educate the public on the causes of 
effects of diabetes in minority populations. 
‘‘(b) NATIONAL INSTITUTES OF HEALTH.—With re-
spect to the National Institutes of Health, activities under 
subsection (a) regarding education on diabetes in minority 
populations shall include the following: 
‘‘(1) Through the National Center on Minority 
Health and Health Disparities—
‘‘(A) making grants to programs funded 
under section 485F (relating to centers of ex-
cellence) for the purpose of establishing a men-
toring program for health care professionals to 
be more involved in weight counseling, obesity 
research, and nutrition; 
‘‘(B) providing for the participation of mi-
nority health professionals in diabetes-focused 
research programs; and
‘‘(C) providing for the participation of mi-
nority health professionals in diabetes-focused 
research programs. 
‘‘(2) Making grants for programs to establish a 
pipeline from high school to professional school that 
will increase minority representation in diabetes-fo-
cused health fields by expanding Minority Access to 
Research Careers (MARC) program internships and 
mentoring opportunities for recruitment. 
‘‘(c) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION.—With respect to the Centers for Disease Control 
and Prevention, activities under subsection (a) regarding 
education on diabetes in minority populations shall include 
the following: 
‘‘(1) Making grants for diabetes-focused edu-
cation classes or training programs on cultural sen-
sitivity and patient care within such populations for 
health care providers. 
‘‘(2) Carrying out public awareness campaigns 
directed toward such populations to aggressively em-
phasize the importance and impact of physical activ-
ity and diet in regard to diabetes and diabetes-re-
lated complications. 
‘‘(d) HEALTH RESOURCES AND SERVICES ADMINIS-
TRATION.—With respect to the Health Resources and
Services Administration, activities under subsection (a) re-
garding education on diabetes in minority populations 
shall include the following: 
‘‘(1) Providing additional funds for the Health 
Careers Opportunity Program, Centers for Excel-
lence, and the Minority Faculty Fellowship Program
to partner with the Office of Minority Health under 
section 1707 and the National Institutes of Health 
to strengthen programs for career opportunities 
within minority populations focused on diabetes 
treatment and care. 
‘‘(2) In partnership with the Health Resources 
and Services Administration, develop a diabetes 
focus within, and provide additional funds for, the 
National Health Service Corps Scholarship program 
to place individuals in areas that are disproportion-
ately affected by diabetes, to provide health care 
services. 
‘‘(3) Establishing a diabetes ambassador pro-
gram for recruitment efforts to increase the number 
of underrepresented minorities currently serving in 
student, faculty, or administrative positions in insti-
tutions of higher learning, hospitals, and community 
health centers.
‘‘(4) Establishing a loan repayment program 
that focuses on diabetes care and prevention. 
‘‘(e) ADDITIONAL PROGRAMS.—Activities under sub-
section (a) regarding education on diabetes in minority 
populations shall include the following: 
‘‘(1) Through collaboration between the Health 
Resources and Services Administration and the In-
dian Health Service, establishing a joint scholarship 
and loan-repayment program for American Indians 
health profession students. 
‘‘(2) Providing funds for new and existing dia-
betes-focused education grants and programs for 
present and future students and clinicians in the 
medical field from minority populations, including 
the following: 
‘‘(A) Federal and State loan repayment 
programs for health profession students within 
communities of color. 
‘‘(B) Providing funds to the Office of Mi-
nority Health under section 1707 for training 
health profession students to focus on diabetes 
within such populations. 
‘‘(C) Providing funds to State and local 
entities to establish diabetes awareness week or 
day every month in schools, nursing homes, and
colleges through partnerships with the Office of 
Minority Health under section 1707 and the 
Health Resources and Services Administration. 
‘‘(f) DEFINITION.—For purposes of this section, the 
term ‘minority populations’ means racial and ethnic mi-
nority groups within the meaning of section 1707. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN
GENERAL.—For the purpose of car-
rying out subsections (a) and (e), there are author-
ized to be appropriated such sums as may be nec-
essary for fiscal year 2004 and each subsequent fis-
cal year. 
‘‘(2) NATIONAL INSTITUTES OF HEALTH.—For 
the purpose of carrying out subsection (b), there are 
authorized to be appropriated such sums as may be 
necessary for fiscal year 2004 and each subsequent 
fiscal year. 
‘‘(3) CENTERS
FOR
DISEASE
CONTROL
AND 
PREVENTION.—For the purpose of carrying out sub-
section (c), there are authorized to be appropriated 
such sums as may be necessary for fiscal year 2004 
and each subsequent fiscal year. 
‘‘(4) HEALTH RESOURCES AND SERVICES AD-
MINISTRATION.—For the purpose of carrying out 
subsection (c), there are authorized to be appro-
priated such sums as may be necessary for fiscal 
year 2004 and each subsequent fiscal year.’’. 
SEC. 213. HEALTH PROMOTION, PREVENTION ACTIVITIES, 
AND ACCESS. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended by section 212, is 
amended by adding at the end the following: 
‘‘SEC. 399R. DIABETES; HEALTH PROMOTION, PREVENTION 
ACTIVITIES, AND ACCESS REGARDING MI-
NORITY POPULATIONS. 
‘‘(a) NATIONAL INSTITUTES OF HEALTH. 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the National Institutes of 
Health, shall provide access to proper care of diabe-
tes for minority populations. 
‘‘(2) CERTAIN
ACTIVITIES.—Activities under 
paragraph (1) regarding proper care of diabetes in 
minority populations shall include the following: 
‘‘(A) Providing funds for research to as-
sess and identify the number of individuals af-
fected by socioeconomic and environmental bar-
riers to diabetes health care access, including 
research regarding language, transportation, 
daily routine, lifestyle, and housing.
‘‘(B) Through the National Center on Mi-
nority Health and Health Disparities, identi-
fying the manner in which health care pro-
viders, community health centers, and hospitals 
provide proper options and education on avail-
able services for diabetes care, management, 
and prevention, including identifying the effects 
of differences in the cultures of staff and pa-
tients on clinical and other workforce encoun-
ters. 
‘‘(b) CENTERS FOR DISEASE CONTROL AND PREVEN-
TION. 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall carry out culturally 
appropriate diabetes health promotion and preven-
tion programs for minority populations. 
‘‘(2) CERTAIN
ACTIVITIES.—Activities under 
paragraph (1) regarding culturally appropriate dia-
betes health promotion and prevention programs for 
minority populations shall include the following: 
‘‘(A) Expanding the Diabetes Control Pro-
gram (currently existing in all the States and 
territories).
‘‘(B) Providing funds for the Diabetes 
Today program to adapt community planning 
tools within such populations. 
‘‘(C) Providing funds for Racial and Eth-
nic Approaches to Community Health (REACH 
2010) grants to develop and evaluate diabetes 
prevention and control community programs fo-
cused on such populations. 
‘‘(D) Providing funds to community health 
centers for a monthly diabetes week program of 
diabetes services, including screenings. 
‘‘(E) Providing funds for free diabetes self-
management education classes in hospitals, clin-
ics, and community health centers. 
‘‘(F) Providing funds for education and 
community outreach on diabetes. 
‘‘(G) Providing funds for the United States 
and Mexico Border Diabetes project to develop 
culturally appropriate diabetes prevention and 
control interventions for Minority populations in 
the border region. 
‘‘(H) Providing funds for an aggressive 
prevention campaign that focuses on physical 
inactivity and diet and its relation to type 2 di-
abetes within such populations.
‘‘(I) Providing funds for surveillance sys-
tems and strategies for strengthening existing 
systems to improve the quality, accuracy, and 
timelines of morbidity and mortality diabetes 
data for such populations. 
‘‘(c) DEFINITION.—For purposes of this section, the 
term ‘minority populations’ means racial and ethnic mi-
nority groups within the meaning of section 1707. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) NATIONAL INSTITUTES OF HEALTH.—For 
the purpose of carrying out subsection (b), there are 
authorized to be appropriated such sums as may be 
necessary for fiscal year 2004 and each subsequent 
fiscal year. 
‘‘(2) CENTERS
FOR
DISEASE
CONTROL
AND 
PREVENTION.—For the purpose of carrying out sub-
section (c), there are authorized to be appropriated 
such sums as may be necessary for fiscal year 2004 
and each subsequent fiscal year.’’.
Subtitle C—HIV Prevention Activi-
ties Regarding Hispanic Individ-
uals 
SEC. 221. PROGRAMS OF CENTERS FOR DISEASE CONTROL 
AND PREVENTION; REPRESENTATION OF HIS-
PANIC INDIVIDUALS IN MEMBERSHIP OF 
COMMUNITY PLANNING GROUPS. 
(a) IN GENERAL.—With respect to community plan-
ning groups that the Centers for Disease Control and Pre-
vention utilizes in carrying out programs for the preven-
tion of HIV infection, the Secretary, acting through the 
Director of such Centers, shall carry out the following: 
(1) The Secretary shall identify community 
planning groups for which Hispanic individuals are 
underrepresented as members in relation to the 
number of Hispanic individuals with HIV who reside 
in the communities involved. 
(2) The Secretary shall develop a plan to in-
crease the representation of Hispanic individuals in 
the membership of the community planning groups 
identified under paragraph (1). Such plan may pro-
vide for facilitating the participation of Hispanic in-
dividuals as members in such groups by assisting the 
individuals with the incidental costs incurred by the
individuals in being such members, such as the costs 
of transportation and child-care services. 
(3) The plan shall include a strategy and de-
tailed timeline for implementing the plan. 
(b) DEFINITION.—In this section, the term ‘‘commu-
nity planning group’’ has the meaning that applies for 
purposes of programs established pursuant to the Ryan 
White Comprehensive AIDS Resources Emergency Act of 
1990 (including title XXVI of the Public Health Service 
Act). 
SEC. 222. AIDS EDUCATION AND TRAINING CENTERS FUND-
ED BY HEALTH RESOURCES AND SERVICES 
ADMINISTRATION; ESTABLISHMENT OF CEN-
TER DIRECTED TOWARD MINORITY POPU-
LATIONS WITH HIV. 
(a) IN GENERAL.—In carrying out section 2692 of 
the Public Health Service Act (42 U.S.C. 300ff–111), the 
Secretary, acting through the Administrator of the Health 
Resources and Services Administration, shall make grants 
to eligible Hispanic-serving institutions for the purpose of 
carrying out projects under such section with respect to 
HIV in racial and ethnic minority groups. 
(b) CULTURAL
COMPETENCE.—A condition for 
grants under subsection (a) is that the applicants involved 
agree that the education and training provided through
projects under such subsection will be provided in a cul-
turally competent manner (as defined in section 331). 
(c) ELIGIBLE INSTITUTIONS.—In this section: 
(1) 
ELIGIBLE
HISPANIC-SERVING
INSTITU-
TION.—The term ‘‘eligible Hispanic-serving institu-
tion’’ means a Hispanic-serving institution that has 
a record of carrying out HIV-related activities with 
respect to Hispanic individuals. 
(2) 
HISPANIC-SERVING
INSTITUTION.—The 
term ‘‘Hispanic-serving institution’’ has the meaning 
given such term in section 502 of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1101a). 
Subtitle D—Prevention of Latina 
Adolescent Suicides 
SEC. 231. SHORT TITLE. 
This subtitle may be cited as the ‘‘Latina Adolescent 
Suicide Prevention Act’’. 
SEC. 232. ESTABLISHMENT OF PROGRAM FOR PREVENTION 
OF LATINA ADOLESCENT SUICIDES. 
Title V of the Public Health Service Act (42 U.S.C. 
290aa et seq.) is amended by inserting after section 520A 
the following section:
‘‘SEC. 520B. PREVENTION OF LATINA ADOLESCENT SUI-
CIDES. 
‘‘(a) IN GENERAL.—The Secretary shall carry out a 
program to make awards of grants, cooperative agree-
ments, or contracts to public and nonprofit private entities 
for the purpose of reducing suicide attempts and deaths 
among Latina adolescents and for the purpose of dealing 
with depression and other related emotional conditions 
which may contribute to suicide. 
‘‘(b) COLLABORATION.—The Secretary shall ensure 
that the program carried out under this section is devel-
oped in collaboration with the relevant institutes at the 
National Institutes of Health, the Health Resources and 
Services Administration, the Centers for Disease Control 
and Prevention, and the Administration on Children and 
Families. 
‘‘(c) PREFERENCE.—In making awards under sub-
section (a), the Secretary shall give preference to appli-
cants that—
‘‘(1) demonstrate a strong linkage with schools 
and are actually supported by and operated within 
a school facility or associated setting; 
‘‘(2) provide direct services to Latina adoles-
cents and their family members when appropriate; 
and
‘‘(3) serve geographic areas that already have a 
high 
concentration 
of 
underserved 
adolescent 
Latinas or a rapidly growing Hispanic population, 
based on the latest census data. 
‘‘(d) REQUIREMENTS.—A condition for the receipt of 
an award under subsection (a) is that the applicant in-
volved demonstrate that the project to be carried out with 
the award will—
‘‘(1) provide for the timely assessment and 
treatment of Latina adolescents at risk for suicide; 
‘‘(2) use evidenced-based strategies;
‘‘(3) be based on exemplary practices that are 
adapted to the unique characteristics and needs of 
the local community; 
‘‘(4) be integrated into the existing health care 
system in the community, including primary health 
care, mental health services, and substance abuse 
services as appropriate; 
‘‘(5) be integrated into other systems in the 
community to address the needs of Latina adoles-
cents including the educational system, juvenile jus-
tice, and recreation; 
‘‘(6) provide support services to the families 
and friends of those who plan, attempt, or actually 
commit suicide;
‘‘(7) provide culturally, linguistically, and devel-
opmentally appropriate services; 
‘‘(8) agree to outcomes evaluation to determine 
the success of the program and the possibility of 
replication to other adolescent girls at risk of sui-
cide; 
‘‘(9) provide or ensure referral for mental 
health and substance abuse services as needed; and 
‘‘(10) ensure that staff used in the program are 
trained in suicide prevention and in the identifica-
tion of conditions which left untreated may lead to 
suicide, are capable of providing culturally and lin-
guistically appropriate services, and that profes-
sionals involved in the system of care are given 
training in identifying persons at risk of suicide. 
‘‘(e) COORDINATION.—A condition for the receipt of 
an award under subsection (a) is that the applicant in-
volved demonstrate that—
‘‘(1) the application has the support of the local 
communities and the approval of the political sub-
division to be served by the project to be carried out 
under the award; and 
‘‘(2) the applicant has discussed the application 
with local and State mental health officials.
‘‘(f) MATCHING REQUIREMENT.—With respect to the 
costs to be incurred by an applicant in carrying out a 
project under subsection (a), the Secretary may require 
as a condition of the receipt of the award that the appli-
cant make available (directly or through donations from 
public or private entities) non-Federal contributions to-
ward such costs in an amount that is not less than 25 
percent of such costs ($1 for each $3 of Federal funds 
provided under the award). 
‘‘(g) EVALUATION.—The Secretary shall ensure that 
entities receiving awards under subsection (a) submit an 
evaluation of the project carried out under the award that 
includes an evaluation of—
‘‘(1) the efficacy of project strategies; and 
‘‘(2) short, intermediate, and long-term out-
comes, including the overall impact of the project on 
the self-esteem of Latina adolescents, their emo-
tional well-being and development, ability to deal in 
a positive and confident manner with their families, 
peers, and social environment, and to make con-
structive and personally fulfilling life choices. 
‘‘(h) DISSEMINATION AND EDUCATION.—The Sec-
retary shall ensure that the findings from the program 
carried out under this section are disseminated to State
and local governmental agencies and private providers of 
mental health and substance abuse services. 
‘‘(i) DURATION OF PROJECTS.—With respect to an 
award under subsection (a), the period during which pay-
ments under such award are made may not exceed 5 years. 
‘‘(j) DEFINITION.—In this section, the term ‘adoles-
cent’ means an individual between the ages of 11 and 17 
(inclusive). 
‘‘(k) FUNDING.—
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of carrying out this section, there 
are authorized to be appropriated $10,000,000 for 
fiscal year 2004, and such sums as may be nec-
essary for each of the fiscal years 2005 and 2006. 
‘‘(2) ALLOCATION
FOR
PROGRAM
MANAGE-
MENT.—Of the amount appropriated under para-
graph (1) for a fiscal year, the Secretary may re-
serve not more than 1 percent for administering the 
program under this section.’’.
Subtitle E—Cancer Research, 
Training, and Awareness 
SEC. 241. REDES EN ACCION: THE NATIONAL HISPANIC/
LATINO CANCER NETWORK AND OTHER NCI 
SPECIAL POPULATIONS NETWORKS INITIA-
TIVES TARGETING CANCER; INCREASED AU-
THORIZATION OF APPROPRIATIONS FOR AC-
TIVITIES 
REGARDING 
HISPANIC 
INDIVID-
UALS. 
(a) IN GENERAL.—For the purpose of carrying out 
and increasing the activities of the Special Populations 
Networks of the National Cancer Institute’s Center for 
Cancer Health Disparities, specifically Redes En Accion: 
The National Hispanic/Latino Cancer Network, and other 
programs in the Special Populations Network initiative 
promoting cancer research, cancer research training, and 
cancer awareness among the Hispanic/Latino population, 
there are authorized to be appropriated $2,500,000 for fis-
cal year 2004, and for each of the fiscal years 2005 
through 2008. Such authorization of appropriations is in 
addition to any other authorizations of appropriations that 
are available for such purposes. 
(b) PURPOSE.—Amounts appropriated under sub-
section (a) shall be used to continue to provide and in-
crease support of Redes En Accion: The National His-
panic/Latino Cancer Network and other Special Popu-
lations Network initiatives targeting cancer among His-
panics to achieve the following: 
(1) Prioritize cancer issues impacting His-
panics. 
(2) Foster cancer pilot and other research 
projects based on these priorities. 
(3) Establish cancer research training opportu-
nities for Hispanic undergraduate students, pre- and 
post-doctoral individuals and junior faculty mem-
bers. 
(4) Develop and support cancer awareness ac-
tivities among Hispanic communities. 
Subtitle F—Tuberculosis Control, 
Prevention, and Treatment 
SEC. 251. ADVISORY COUNCIL FOR THE ELIMINATION OF 
TUBERCULOSIS. 
Section 317E(f) of the Public Health Service Act (42 
U.S.C. 247b–6(f)) is amended—
(1) by redesignating paragraph (5) as para-
graph (6); and 
(2) by striking paragraphs (2) through (4), and 
inserting the following: 
‘‘(2) DUTIES.—For the purpose of making 
progress toward the goal of eliminating tuberculosis
from the United States, the Council shall provide to 
the Secretary and other appropriate Federal officials 
advice on coordinating the activities of the Public 
Health Service and other Federal agencies that re-
late to such disease and on efficiently utilizing the 
Federal resources involved. 
‘‘(3) NATIONAL PLAN.—In carrying out para-
graph (2), the Council, in consultation with appro-
priate public and private entities, shall make rec-
ommendations on the development, revision, and im-
plementation of a national plan to eliminate tuber-
culosis in the United States. In carrying out this 
paragraph, the Council shall—
‘‘(A) consider the recommendations of the 
Institute of Medicine regarding the elimination 
of tuberculosis; 
‘‘(B) address the development and applica-
tion of new technologies; and 
‘‘(C) review the extent to which progress 
has been made toward eliminating tuberculosis. 
‘‘(4) GLOBAL
ACTIVITIES.—In carrying out 
paragraph (2), the Council, in consultation with ap-
propriate public and private entities, shall make rec-
ommendations for the development and implementa-
tion of a plan to guide the involvement of the United
States in global and cross border tuberculosis-control 
activities, including recommendations regarding poli-
cies, strategies, objectives, and priorities. Such rec-
ommendations for the plan shall have a focus on 
countries where a high incidence of tuberculosis di-
rectly affects the United States, such as Mexico, and 
on access to a comprehensive package of tuberculosis 
control measures, as defined by the World Health 
Organization directly observed treatment, short 
course strategy (commonly known as DOTS). 
‘‘(5) COMPOSITION.—The Council shall be com-
posed of—
‘‘(A) representatives from the Centers for 
Disease Control and Prevention, the National 
Institutes of Health, the Agency for Healthcare 
Research and Quality, the Health Resources 
and Services Administration, the U.S.-Mexico 
Border Health Commission, and other Federal 
departments and agencies that carry out signifi-
cant activities relating to tuberculosis; and 
‘‘(B) members appointed from among indi-
viduals who are not officers or employees of the 
Federal Government.’’.
124
‘‘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