1563 
‘‘(C) working with trial sponsors to increase the 
number of recruitment events for members of minor-
ity groups; 
‘‘(D) conducting outreach to national, State, 
and local physician professional organizations, espe-
cially for members of such organizations who are 
primary care physicians or physicians who specialize 
in dementia, to increase awareness of clinical re-
search opportunities for members of minority 
groups; and 
‘‘(E) using community-based participatory re-
search methodologies to engage with minority popu-
lations.’’. 
(B) RESOURCE
CENTERS
FOR
MINORITY 
AGING RESEARCH.—Section 444(c) of the Pub-
lic Health Service Act (42 U.S.C. 285e–1(c)) is 
amended— 
(i) by striking ‘‘(c)’’ and inserting 
‘‘(c)(1)’’; and 
(ii) by adding at the end the following 
new paragraph: 
‘‘(2) The Director, acting through the Resource Cen-
ters for Minority Aging Research of the Institute, shall 
carry out public outreach, education efforts, and dissemi-
nation of information for members of minority groups 
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about participation in clinical research on Alzheimer’s dis-
ease carried out or supported under this subpart.’’. 
(b) INCENTIVES TO INCREASE DIVERSITY IN ALZ-
HEIMER’S DISEASE RESEARCH THROUGH PRINCIPAL IN-
VESTIGATORS
AND
RESEARCHERS
FROM
UNDERREP-
RESENTED POPULATIONS.— 
(1) ALZHEIMER’S
CLINICAL
RESEARCH
AND 
TRAINING
AWARDS.—Section 445I of the Public 
Health Service Act (42 U.S.C. 285e–10a) is amend-
ed by adding at the end the following new sub-
section: 
‘‘(d) ENHANCING THE PARTICIPATION OF PRINCIPAL 
INVESTIGATORS AND RESEARCHERS WHO ARE MEMBERS 
OF UNDERREPRESENTED POPULATIONS.— 
‘‘(1) IN GENERAL.—The Director shall enhance 
diversity in the conduct or support of clinical re-
search on Alzheimer’s disease under this subpart by 
encouraging the participation of individuals from 
groups that are underrepresented in the biomedical, 
clinical, behavioral, and social sciences as principal 
investigators of such clinical research, as researchers 
for such clinical research, or both. 
‘‘(2) TRAINING
FOR
PRINCIPAL
INVESTIGA-
TORS.—The Director of the Institute shall provide 
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training for principal investigators who are members 
of a minority group with respect to skills for— 
‘‘(A) the design and conduct of clinical re-
search and clinical protocols; 
‘‘(B) applying for grants for clinical re-
search; and 
‘‘(C) such other areas as the Director de-
termines to be appropriate.’’. 
(2) SENIOR
RESEARCHER
AWARDS.—Section 
445B(a) of the Public Health Service Act (42 
U.S.C. 285e–4(a)) is amended by inserting ‘‘, in-
cluding senior researchers who are members of a mi-
nority group’’ before the period at the end of the 
first sentence. 
(c) INCENTIVES TO INCREASE DIVERSITY IN ALZ-
HEIMER’S DISEASE RESEARCH THROUGH TRIAL SITES.— 
Section 444(d) of the Public Health Service Act (42 
U.S.C. 285e–1(d)) is amended— 
(1) by striking ‘‘(d)’’ and inserting ‘‘(d)(1)’’; 
and 
(2) by adding at the end the following new 
paragraphs: 
‘‘(2) In conducting or supporting clinical research on 
Alzheimer’s disease for purposes of this subpart, in addi-
tion to requirements otherwise imposed under this title, 
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1566 
including under section 492B, the Director of the Institute 
shall increase the participation of members of minority 
groups in such clinical research through one or more of 
the activities described in paragraph (3). 
‘‘(3)(A) The Director of the Institute shall provide 
incentives for the support of clinical research on Alz-
heimer’s disease with clinical trial sites established in 
areas with a higher concentration of minority groups, in-
cluding rural areas if practicable. 
‘‘(B) In determining whether to conduct or support 
clinical research on Alzheimer’s disease, the Director of 
the Institute shall encourage the conduct of clinical re-
search with clinical trial sites in areas described in sub-
paragraph (A) as a higher-level priority criterion among 
the criteria established to evaluate whether to conduct or 
support clinical research. 
‘‘(C) In determining the amount of funding to be pro-
vided for the conduct or support of such clinical research, 
the Director of the Institute shall provide additional fund-
ing for the conduct of such clinical research with clinical 
trial sites in areas described in subparagraph (A). 
‘‘(D) In determining whether an area is an area with 
a higher concentration of minority groups, the Director 
of the Institute— 
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1567 
‘‘(i) shall consider the most recent data col-
lected by the Bureau of the Census; and 
‘‘(ii) may also consider— 
‘‘(I) data from the Centers for Medicare & 
Medicaid Services on the incidence of Alz-
heimer’s disease in the United States by region; 
and 
‘‘(II) such other data as the Director de-
termines appropriate. 
‘‘(4) In order to facilitate the participation of mem-
bers of minority groups in clinical research supported 
under this subpart, in addition to activities described in 
paragraph (3), the Director of the Institute shall— 
‘‘(A) ensure that such clinical research uses 
community-based participatory research methodolo-
gies; and 
‘‘(B) encourage the use of remote health tech-
nologies, including telehealth, remote patient moni-
toring, and mobile technologies, that reduce or elimi-
nate barriers to participation of members of minor-
ity groups in such clinical research. 
‘‘(5)(A) Clinical research on Alzheimer’s disease con-
ducted or supported under this subpart shall ensure that 
such research includes outreach activities designed to in-
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1568 
crease the participation of members of minority groups in 
such research. 
‘‘(B)(i) Each applicant for a grant under this subpart 
for clinical research on Alzheimer’s disease shall submit 
to the Director of the Institute in the application for such 
grant— 
‘‘(I) a budget for outreach activities to members 
of minority populations with respect to participation 
in such clinical research; and 
‘‘(II) a description of the plan to conduct such 
outreach. 
‘‘(ii) The Director of the Institute shall encourage ap-
plicants for, and recipients of, grants under this subpart 
to conduct clinical research on Alzheimer’s disease to en-
gage with community-based organizations to increase par-
ticipation of minority populations in such research. 
‘‘(6) For purposes of this subpart: 
‘‘(A) The term ‘clinical research’ includes a 
clinical trial. 
‘‘(B) The term ‘minority group’ has the mean-
ing given such term by reason of section 492B(g).’’. 
(d) PARTICIPANT ELIGIBILITY CRITERIA.—Section 
445I of the Public Health Service Act (42 U.S.C. 285e– 
10a), as amended by subsection (b)(1), is further amended 
by adding at the end the following new subsection: 
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1570 
clinical trials, such as older adults, individuals with 
a mild form of disease, individuals at the extremes 
of the weight range, or children, unless there is a 
strong clinical or scientific justification to exclude 
them. 
‘‘(3) USE OF ADAPTIVE DESIGN.—Encouraging 
the use of an adaptive clinical trial design that— 
‘‘(A) starts with a defined population 
where there are concerns about safety; and 
‘‘(B) may expand to a broader population 
based on initial data from the trial and external 
data.’’. 
(e) RESOURCE CENTER FOR SUCCESSFUL STRATE-
GIES
TO
INCREASE
PARTICIPATION
OF
UNDERREP-
RESENTED
POPULATIONS
IN
ALZHEIMER’S
DISEASE 
CLINICAL RESEARCH.—Section 444 of the Public Health 
Service Act (42 U.S.C. 285e–1) is amended by adding at 
the end the following new subsection: 
‘‘(e)(1) Acting through the Office of Special Popu-
lations and in consultation with the Division of Extra-
mural Activities, the Director of the Institute shall support 
resource information and technical assistance to grantees 
under section 445 (relating to Alzheimer’s disease cen-
ters), other grantees, and prospective grantees, designed 
to increase the participation of minority populations in 
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1571 
clinical research on Alzheimer’s disease conducted or sup-
ported under this subpart. 
‘‘(2) The resource information and technical assist-
ance provided under paragraph (1) shall include the main-
tenance of a central resource library in order to collect, 
prepare, analyze, and disseminate information relating to 
strategies and best practices used by recipients of grants 
under this subpart and other researchers in the develop-
ment of the clinical research designed to increase the par-
ticipation of minority populations in such clinical re-
search.’’. 
(f) ANNUAL REPORTS.—Section 444 of the Public 
Health Service Act (42 U.S.C. 285e–1), as amended by 
subsection (e), is further amended by adding at the end 
the following new subsection: 
‘‘(f)(1)(A) The Director of the Institute shall submit 
annual reports to the Congress on the impact of the 
amendments made to this subpart by the ENACT Act of 
2021. 
‘‘(B) The Secretary shall transmit a copy of each 
such report to the Advisory Council on Alzheimer’s Re-
search, Care, and Services established under section 2(e) 
of the National Alzheimer’s Project Act (Public Law 111– 
375). 
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1572 
‘‘(2) In each report under paragraph (1), the Director 
of the Institute shall include information and data on the 
following matters with respect to clinical trials on Alz-
heimer’s disease conducted during the preceding year: 
‘‘(A) The number of participants who are mem-
bers of a minority group in such clinical trials. 
‘‘(B) The number of such clinical trials for 
which incentives under subsection (d)(3) were made 
available, the nature of such incentives, the amount 
of increased funding (if any) made available for re-
search on Alzheimer’s disease, and the training pro-
vided to principal investigators who are members of 
a minority group and the amount of funding (if any) 
for such training. 
‘‘(C) The number of such clinical trials for 
which the principal investigator is a member of a mi-
nority group. 
‘‘(D) The number of such clinical trials for 
which a significant percentage of researchers are 
members of a minority group. 
‘‘(E) Modifications to patient eligibility criteria 
in clinical trial designs under section 445I(e). 
‘‘(F) Outreach and education efforts conducted 
under section 445(b)(3). 
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1573 
‘‘(3) The Director of the Institute shall make each 
report under paragraph (1) available to the public, includ-
ing through posting on the appropriate website of the De-
partment of Health and Human Services.’’. 
(g) AUTHORIZATION OF APPROPRIATIONS.—For each 
of fiscal years 2022 through 2026, there is authorized to 
be appropriated to the Secretary of Health and Human 
Services $60,000,000 to carry out the amendments made 
by this section, to remain available until expended. 
TITLE VIII—HEALTH 
INFORMATION TECHNOLOGY 
SEC. 8001. DEFINITIONS. 
In this title: 
(1) CERTIFIED ELECTRONIC HEALTH RECORD 
TECHNOLOGY.—The term ‘‘certified EHR tech-
nology’’ has the meaning given such term in section 
3000 of the Public Health Service Act (42 U.S.C. 
300jj). 
(2) EHR.—The term ‘‘EHR’’ means an elec-
tronic health record. 
(3) INTEROPERABILITY.—The term ‘‘interoper-
ability’’ has the meaning given such term in section 
3000 of the Public Health Service Act (42 U.S.C. 
300jj). Evaluation and measurement of interoper-
ability shall consider exchange of electronic health 
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1574 
information, usability of exchanged electronic health 
information, effective application and use of the ex-
changed electronic health information, and impact 
on outcomes of interoperability. 
(4) ACCESS.—The term ‘‘access’’, with respect 
to health information, means access described in sec-
tion 164.524 of title 45, Code of Federal Regula-
tions (or any successor regulations). 
(5) CERTIFIED ELECTRONIC HEALTH RECORD 
TECHNOLOGY; EHR.—The terms ‘‘certified electronic 
health record technology’’ and ‘‘EHR’’ include the 
health information infrastructure for interoper-
ability, access, exchange, and use of electronic health 
information required under title XXX of the Public 
Health Service Act (42 U.S.C. 300jj et seq.), and 
are not limited to electronic health records main-
tained by doctors. 
Subtitle A—Reducing Health 
Disparities Through Health IT 
SEC. 8101. HRSA ASSISTANCE TO HEALTH CENTERS FOR 
PROMOTION OF HEALTH IT. 
The Secretary of Health and Human Services, acting 
through the Administrator of the Health Resources and 
Services Administration, shall expand and intensify the 
programs and activities of the Administration (directly or 
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through grants or contracts) to provide technical assist-
ance and resources to health centers (as defined in section 
330(a) of the Public Health Service Act (42 U.S.C. 
254b(a))) to adopt and meaningfully use certified EHR 
technology for the management of chronic diseases and 
health conditions and reduction of health disparities. 
Funding initiatives may include establishing basic 
connectivity such as 5G internet for telemedicine capabili-
ties, grant funding to implement the next generation 
EHR, and funding for technology hardware. 
SEC. 8102. ASSESSMENT OF IMPACT OF HEALTH IT ON RA-
CIAL AND ETHNIC MINORITY COMMUNITIES; 
OUTREACH AND ADOPTION OF HEALTH IT IN 
SUCH COMMUNITIES. 
(a) NATIONAL COORDINATOR FOR HEALTH INFOR-
MATION TECHNOLOGY.— 
(1) IN GENERAL.—Not later than 18 months 
after the date of enactment of this Act, the National 
Coordinator for Health Information Technology (re-
ferred to in this title as the ‘‘National Coordinator’’) 
shall— 
(A) conduct an evaluation of the level of 
interoperability, access, use, and accessibility of 
electronic health records in racial and ethnic 
minority communities, focusing on whether pa-
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1576 
tients in such communities have providers who 
use electronic health records, and the degree to 
which patients in such communities can access, 
exchange, and use without special effort their 
health information in those electronic health 
records, and indicating whether such pro-
viders— 
(i) are participating in the Medicare 
program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) or 
a State plan under title XIX of such Act 
(42 U.S.C. 1396 et seq.) (or a waiver of 
such plan); 
(ii) have received incentive payments 
or incentive payment adjustments under 
Medicare and Medicaid Electronic Health 
Records Incentive Programs (as defined in 
subsection (c)(2)); 
(iii) are MIPS eligible professionals, 
as defined in paragraph (1)(C) of section 
1848(q) of the Social Security Act (42 
U.S.C. 1395w–4(q)), for purposes of the 
Merit-Based Incentive Payment System 
under such section; or 
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1577 
(iv) have been recruited by any of the 
Health Information Technology Regional 
Extension Centers established under sec-
tion 3012 of the Public Health Service Act 
(42 U.S.C. 300jj–32); and 
(B) publish the results of such evaluation 
including the race and ethnicity of such pro-
viders and the populations served by such pro-
viders. 
(2) CERTIFICATION
CRITERION.—Not later 
than 1 year after the date of enactment of this Act, 
the National Coordinator shall— 
(A) promulgate a certification criterion and 
module of certified EHR technology that strati-
fies quality measures for purposes of the Merit- 
Based Incentive Payment System by disparity 
characteristics, including race, ethnicity, lan-
guage, gender, gender identity, sexual orienta-
tion, socio-economic status, and disability sta-
tus, as such characteristics are defined for pur-
poses of certified EHR technology; and 
(B) report to the Centers for Medicare & 
Medicaid Services the quality measures strati-
fied by race and at least 2 other disparity char-
acteristics. 
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1578 
(b) NATIONAL CENTER FOR HEALTH STATISTICS.— 
As soon as practicable after the date of enactment of this 
Act, the Director of the National Center for Health Statis-
tics shall provide to Congress a more detailed analysis of 
the data presented in National Center for Health Statis-
tics data brief entitled ‘‘Adoption of Certified Electronic 
Health Record Systems and Electronic Information Shar-
ing in Physician Offices: United States, 2013 and 2014’’ 
(NCHS Data Brief No. 236). 
(c) CENTERS FOR MEDICARE & MEDICAID SERV-
ICES.— 
(1) IN GENERAL.—As part of the process of 
collecting information, with respect to a provider, at 
registration and attestation for purposes of Medicare 
and Medicaid Electronic Health Records Incentive 
Programs (as defined in paragraph (2)) or the 
Merit-Based Incentive Payment System under sec-
tion 1848(q) of the Social Security Act (42 U.S.C. 
1395w–4(q)), the Secretary of Health and Human 
Services shall collect the race and ethnicity of such 
provider. 
(2) MEDICARE
AND
MEDICAID
ELECTRONIC 
HEALTH
RECORDS
INCENTIVE
PROGRAMS
DE-
FINED.—For purposes of paragraph (1), the term 
‘‘Medicare and Medicaid Electronic Health Records 
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1579 
Incentive Programs’’ means the incentive programs 
under section 1814(l)(3), subsections (a)(7) and (o) 
of section 1848, subsections (l) and (m) of section 
1853, subsections (b)(3)(B)(ix)(I) and (n) of section 
1886, and subsections (a)(3)(F) and (t) of section 
1903 of the Social Security Act (42 U.S.C. 
1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 
1396b). 
(d) NATIONAL COORDINATOR’S ASSESSMENT OF IM-
PACT
OF HIT.—Section 3001(c)(6)(C) of the Public 
Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 
amended— 
(1) in the heading by inserting ‘‘, RACIAL AND 
ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 
DISPARITIES’’; 
(2) by inserting ‘‘, in communities with a high 
proportion of individuals from racial and ethnic mi-
nority groups (as defined in section 1707(g)), in-
cluding people with disabilities in such groups,’’ 
after ‘‘communities with health disparities’’; 
(3) by striking ‘‘The National Coordinator’’ and 
inserting the following: 
‘‘(i) IN GENERAL.—The National Co-
ordinator’’; and 
(4) by adding at the end the following: 
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1580 
‘‘(ii) CRITERIA.—In any publication 
under clause (i), the National Coordinator 
shall include best practices for encouraging 
partnerships between the Federal Govern-
ment, States, private entities, national 
nonprofit intermediaries, and community- 
based organizations to expand outreach 
and education for and the adoption of cer-
tified EHR technology in communities with 
a high proportion of individuals from racial 
and ethnic minority groups (as defined in 
section 1707(g)), while also maintaining 
the accessibility requirements of section 
508 of the Rehabilitation Act of 1973 to 
encourage patient involvement in patient 
health care. The National Coordinator 
shall— 
‘‘(I) not later than 6 months 
after the submission of the report re-
quired under section 8302 of the 
Health Equity and Accountability Act 
of 2022, establish criteria for evalu-
ating the impact of health information 
technology on communities with a 
high proportion of individuals from 
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1581 
racial and ethnic minority groups (as 
so defined) taking into account the 
findings in such report; and 
‘‘(II) not later than 1 year after 
the submission of such report, publish 
the results of an evaluation of such 
impact.’’. 
SEC. 8103. NONDISCRIMINATION AND HEALTH EQUITY IN 
HEALTH INFORMATION TECHNOLOGY. 
(a) IN GENERAL.—Covered entities shall ensure that 
electronic and information technology in their health pro-
grams or activities does not exclude individuals from par-
ticipation in, deny individuals the benefits of, or subject 
individuals to discrimination under any health program or 
activity on the basis of race, color, national origin, sex, 
age, or disability. 
(b) COVERED ENTITIES.—In this section, the term 
‘‘covered entity’’ means— 
(1) an entity that operates a health program or 
activity, any part of which receives Federal financial 
assistance; 
(2) an entity established under title I of the Pa-
tient Protection and Affordable Care Act (Public 
Law 114–148) that administers a health program or 
activity; or 
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1582 
(3) the Department of Health and Human 
Services. 
SEC. 8104. LANGUAGE ACCESS IN HEALTH INFORMATION 
TECHNOLOGY. 
The National Coordinator shall— 
(1) not later than 18 months after the date of 
enactment of this Act, propose a rule for providing 
access to patients, through certified EHR tech-
nology, to their personal health information in a 
computable format, including using patient portals 
or third-party applications (as described in section 
3009(e) of the Public Health Service Act (42 U.S.C. 
300jj–19(e))), in the 10 most common non-English 
languages; 
(2) hold a public hearing to identify best prac-
tices for carrying out paragraph (1); and 
(3) not later than 6 months after the public 
hearing under paragraph (2), promulgate a final 
regulation with respect to paragraph (1). 
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1583 
Subtitle 
B—Modifications 
To 
Achieve Parity in Existing Pro-
grams 
SEC. 8201. EXTENDING FUNDING TO STRENGTHEN THE 
HEALTH IT INFRASTRUCTURE IN RACIAL 
AND ETHNIC MINORITY COMMUNITIES. 
Section 3011 of the Public Health Service Act (42 
U.S.C. 300jj–31) is amended— 
(1) in subsection (a), in the matter preceding 
paragraph (1), by inserting ‘‘, including with respect 
to communities with a high proportion of individuals 
from racial and ethnic minority groups (as defined 
in section 1707(g))’’ before the colon at the end; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) ANNUAL REPORT
ON EXPENDITURES.—The 
National Coordinator shall report annually to Congress on 
activities and expenditures under this section.’’. 
SEC. 8202. EXTENDING COMPETITIVE GRANTS FOR THE DE-
VELOPMENT OF LOAN PROGRAMS TO FACILI-
TATE ADOPTION OF CERTIFIED EHR TECH-
NOLOGY BY PROVIDERS SERVING RACIAL 
AND ETHNIC MINORITY GROUPS. 
Section 3014(e) of the Public Health Service Act (42 
U.S.C. 300jj–34(e)) is amended, in the matter preceding 
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1584 
paragraph (1), by inserting ‘‘, including with respect to 
communities with a high proportion of individuals from 
racial and ethnic minority groups (as defined in section 
1707(g))’’ after ‘‘health care provider to’’. 
SEC. 8203. AUTHORIZATION OF APPROPRIATIONS. 
Section 3018 of the Public Health Service Act (42 
U.S.C. 300jj–38) is amended by striking ‘‘fiscal years 
2009 through 2013’’ and inserting ‘‘fiscal years 2023 
through 2028’’. 
Subtitle C—Additional Research 
and Studies 
SEC. 8301. DATA COLLECTION AND ASSESSMENTS CON-
DUCTED IN COORDINATION WITH MINORITY- 
SERVING INSTITUTIONS. 
Section 3001(c)(6) of the Public Health Service Act 
(42 U.S.C. 300jj–11(c)(6)) is amended by adding at the 
end the following new subparagraph: 
‘‘(F) DATA
COLLECTION
AND
ASSESS-
MENTS
CONDUCTED
IN
COORDINATION
WITH 
MINORITY-SERVING INSTITUTIONS.— 
‘‘(i) IN
GENERAL.—In carrying out 
subparagraph (C) with respect to commu-
nities with a high proportion of individuals 
from racial and ethnic minority groups (as 
defined in section 1707(g)), the National 
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Coordinator shall, to the greatest extent 
possible, coordinate with an entity de-
scribed in clause (ii). 
‘‘(ii) 
MINORITY-SERVING
INSTITU-
TIONS.—For purposes of clause (i), an en-
tity described in this clause is a historically 
black college or university, a Hispanic-serv-
ing institution, a Tribal College or Univer-
sity, or an Asian-American-, Native Amer-
ican-, or Pacific Islander-serving institu-
tion with an accredited public health, 
health policy, or health services research 
program.’’. 
SEC. 8302. STUDY OF HEALTH INFORMATION TECHNOLOGY 
IN 
MEDICALLY 
UNDERSERVED 
COMMU-
NITIES. 
(a) IN GENERAL.—Not later than 2 years after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall— 
(1) enter into an agreement with the National 
Academies of Sciences, Engineering, and Medicine to 
conduct a study on the development, implementa-
tion, and effectiveness of health information tech-
nology within medically underserved areas (as de-
scribed in subsection (c)); and 
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(5) examine the impact of health information 
technology on improving health care-related deci-
sions by both patients and providers in such areas; 
(6) identify specific best practices for using 
health information technology to foster the con-
sistent provision of physical accessibility and reason-
able policy accommodations in health care to individ-
uals with disabilities in such areas; 
(7) assess the feasibility and costs associated 
with the use of health information technology in 
such areas; 
(8) evaluate whether the adoption and use of 
qualified electronic health records (as defined in sec-
tion 3000 of the Public Health Service Act (42 
U.S.C. 300jj)) is effective in reducing health dispari-
ties, including analysis of clinical quality measures 
reported by providers who are participating in the 
Medicare program under title XVIII of the Social 
Security Act (42 U.S.C. 1395 et seq.) or a State 
plan under title XIX of such Act (42 U.S.C. 1396 
et seq.) (or a waiver of such plan), pursuant to pro-
grams to encourage the adoption and use of certified 
EHR technology; 
(9) identify providers in medically underserved 
areas that are not electing to adopt and use elec-
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tronic health records and determine what barriers 
are preventing those providers from adopting and 
using such records; and 
(10) examine urban and rural community 
health systems and determine the impact that health 
information technology may have on the capacity of 
primary health providers in those systems. 
(c) MEDICALLY UNDERSERVED AREA.—The term 
‘‘medically underserved area’’ means— 
(1) a population that has been designated as a 
medically underserved population under section 
330(b)(3) of the Public Health Service Act (42 
U.S.C. 254b(b)(3)); 
(2) an area that has been designated as a 
health professional shortage area under section 332 
of the Public Health Service Act (42 U.S.C. 254e); 
(3) an area or population that has been des-
ignated as a medically underserved community under 
section 799B of the Public Health Service Act (42 
U.S.C. 295p); or 
(4) another area or population that— 
(A) experiences significant barriers to ac-
cessing quality health services; and 
(B) has a high prevalence of diseases or 
conditions described in title VII, with such dis-
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eases or conditions having a disproportionate 
impact on racial and ethnic minority groups (as 
defined in section 1707(g) of the Public Health 
Service Act (42 U.S.C. 300u–6(g))) or a sub-
group of people with disabilities who have spe-
cific functional impairments. 
SEC. 8303. ASSESSMENT OF USE AND MISUSE OF DE-IDEN-
TIFIED HEALTH DATA. 
(a) IN GENERAL.—Not later than 18 months after 
the date of enactment of this Act, the Secretary of Health 
and Human Services shall— 
(1) enter into an agreement with the Office of 
the National Coordinator to conduct a study, in con-
sultation with relevant stakeholders, on the impact 
of digital health technology on medically underserved 
areas (as described in section 8302(c)); and 
(2) submit a report to Congress describing the 
results of such study, including any recommenda-
tions for legislative or administrative action. 
(b) STUDY.—The study described in subsection 
(a)(1) shall— 
(1) examine the overall prevalence, and histor-
ical and existing practices and their respective preva-
lence, of use and misuse of de-identified protected 
health information, as defined in section 160.103, 
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title 45, Code of Federal Regulations (or any suc-
cessor regulations), to discriminate against or ben-
efit medically underserved areas; 
(2) identify best practices and tools to leverage 
the benefits and prevent misuse of de-identified pro-
tected health information to discriminate against 
medically underserved areas; 
(3) examine the overall prevalence, and histor-
ical and existing practices and their respective preva-
lence, of use and misuse of de-identified personal 
health information other than protected health infor-
mation, as defined in section 160.103, title 45, Code 
of Federal Regulations (or any successor regula-
tions), to discriminate against or benefit medically 
underserved areas; and 
(4) identify best practices and tools to leverage 
the benefits and prevent misuse of de-identified per-
sonal health information other than protected health 
information to discriminate against medically under-
served areas. 
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Subtitle D—Closing Gaps in 
Funding To Adopt Certified EHRs 
SEC. 8401. EXTENDING MEDICAID EHR INCENTIVE PAY-
MENTS 
TO 
REHABILITATION 
FACILITIES, 
LONG-TERM CARE FACILITIES, AND HOME 
HEALTH AGENCIES. 
(a) IN GENERAL.—Section 1903(t)(2)(B) of the So-
cial Security Act (42 U.S.C. 1396b(t)(2)(B)) is amend-
ed— 
(1) in clause (i), by striking ‘‘, or’’ and insert-
ing a semicolon; 
(2) in clause (ii), by striking the period at the 
end and inserting a semicolon; and 
(3) by inserting after clause (ii) the following 
new clauses: 
‘‘(iii) a rehabilitation facility (as defined in sec-
tion 1886(j)(1)) that furnishes acute or subacute re-
habilitation services; 
‘‘(iv) a long-term care hospital (as defined in 
section 1886(d)(1)(B)(iv)); or 
‘‘(v) a home health agency (as defined in sec-
tion 1861(o)).’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to amounts ex-
pended under section 1903(a)(3)(F) of the Social Security 
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Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be-
ginning on or after the date of the enactment of this Act. 
SEC. 8402. EXTENDING PHYSICIAN ASSISTANT ELIGIBILITY 
FOR 
MEDICAID 
ELECTRONIC 
HEALTH 
RECORD INCENTIVE PAYMENTS. 
(a) IN GENERAL.—Section 1903(t)(3)(B)(v) of the 
Social Security Act (42 U.S.C. 1396b(t)(3)(B)(v)) is 
amended to read as follows: 
‘‘(v) physician assistant.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply with respect to amounts ex-
pended under section 1903(a)(3)(F) of the Social Security 
Act (42 U.S.C. 1396b(a)(3)(F)) for calendar quarters be-
ginning on or after the date of the enactment of this Act. 
Subtitle E—Expanding Access to 
Telehealth Services 
SEC. 8501. REMOVING GEOGRAPHIC REQUIREMENTS FOR 
TELEHEALTH SERVICES. 
Section 1834(m)(4)(C) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)) is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by inserting ‘‘and clause (iii)’’ after ‘‘and 
(9)’’; and 
(2) by adding at the end the following new 
clause: 
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1593 
‘‘(iii) REMOVAL OF GEOGRAPHIC RE-
QUIREMENTS.—The 
geographic 
require-
ments described in clause (i) shall not 
apply with respect to telehealth services 
furnished on or after the date of the enact-
ment of this clause.’’. 
SEC. 8502. EXPANDING ORIGINATING SITES. 
(a) EXPANDING
THE HOME
AS
AN ORIGINATING 
SITE.—Section 1834(m)(4)(C)(ii)(X) of the Social Secu-
rity Act (42 U.S.C. 1395m(m)(4)(C)(ii)(X)) is amended 
to read as follows: 
‘‘(X)(aa) Prior to the date of en-
actment of the Health Equity and Ac-
countability Act of 2022, the home of 
an individual but only for purposes of 
section 1881(b)(3)(B) or telehealth 
services described in paragraph (7). 
‘‘(bb) On or after such date of 
enactment, the home of an indi-
vidual.’’. 
(b) ALLOWING ADDITIONAL ORIGINATING SITES.— 
Section 1834(m)(4)(C)(ii) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)(ii)) is amended by adding at the 
end the following new subclause: 
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1594 
‘‘(XII) Any other site determined 
appropriate by the Secretary at which 
an eligible telehealth individual is lo-
cated at the time a telehealth service 
is furnished via a telecommunications 
system.’’. 
(c) PARAMETERS FOR NEW ORIGINATING SITES.— 
Section 1834(m)(4)(C) of the Social Security Act (42 
U.S.C. 1395m(m)(4)(C)), as amended by section 102, is 
amended by adding at the end the following new clause: 
‘‘(iv) 
REQUIREMENTS
FOR
NEW 
SITES.— 
‘‘(I) IN
GENERAL.—The Sec-
retary may establish requirements for 
the furnishing of telehealth services at 
sites described in clause (ii)(XII) to 
provide for beneficiary and program 
integrity protections. 
‘‘(II) CLARIFICATION.—Nothing 
in this clause shall be construed to 
preclude the Secretary from estab-
lishing requirements for other origi-
nating sites described in clause (ii)’’. 
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1595 
(d) NO ORIGINATING SITE FACILITY FEE FOR NEW 
SITES.—Section 1834(m)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395m(m)(2)(B)(ii)) is amended— 
(1) in the heading, by striking ‘‘IF ORIGINATING 
SITE IS THE HOME’’ and inserting ‘‘FOR CERTAIN 
SITES’’; and 
(2) by striking ‘‘paragraph (4)(C)(ii)(X)’’ and 
inserting ‘‘subclause (X) or (XII) of paragraph 
(4)(C)’’. 
TITLE IX—ACCOUNTABILITY 
AND EVALUATION 
SEC. 9001. PROHIBITION ON DISCRIMINATION IN FEDERAL 
ASSISTED HEALTH CARE SERVICES AND RE-
SEARCH ON THE BASIS OF SEX (INCLUDING 
SEXUAL ORIENTATION, GENDER IDENTITY, 
AND PREGNANCY, INCLUDING TERMINATION 
OF PREGNANCY), RACE, COLOR, NATIONAL 
ORIGIN, MARITAL STATUS, FAMILIAL STATUS, 
OR DISABILITY STATUS. 
(a) IN GENERAL.—No person in the United States 
shall, on the basis of sex (including sexual orientation, 
gender identity, and pregnancy, including termination of 
pregnancy), race, color, national origin, marital status, fa-
milial status, sexual orientation, gender identity, or dis-
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1596 
ability status, be excluded from participation in, be denied 
the benefits of, or be subjected to discrimination under— 
(1) any health program or activity, including 
any health research program or activity, receiving 
Federal financial assistance, including credits, sub-
sidies, or contracts of insurance; or 
(2) any health program or activity that is ad-
ministered by an executive agency. 
(b) DEFINITION.—In this section, the term ‘‘familial 
status’’ means, with respect to one or more individuals— 
(1) being domiciled with any individual related 
by blood or affinity whose close association with the 
individual is the equivalent of a family relationship; 
(2) being in the process of securing legal cus-
tody of any individual; or 
(3) being pregnant. 
SEC. 9002. TREATMENT OF MEDICARE PAYMENTS UNDER 
TITLE VI OF THE CIVIL RIGHTS ACT OF 1964. 
For the purposes of title VI of the Civil Rights Act 
of 1964 (42 U.S.C. 2000d-1 et seq.), a payment made 
under part A, B, C, or D of title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.) to a provider of services, 
physician, or other supplier (including a payment made 
to a subcontractor of the provider of services, physician, 
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1597 
or other supplier) shall be deemed a grant, not a contract 
of insurance or guaranty. 
SEC. 9003. ACCOUNTABILITY AND TRANSPARENCY WITHIN 
THE DEPARTMENT OF HEALTH AND HUMAN 
SERVICES. 
Title XXXIV of the Public Health Service Act, as 
amended by titles I, II, III, and IV of this Act, is further 
amended by inserting after subtitle C the following: 
‘‘Subtitle E—Strengthening 
Accountability 
‘‘SEC. 3451. ELEVATION OF THE OFFICE FOR CIVIL RIGHTS 
AND HEALTH EQUITY. 
‘‘(a) IN GENERAL.— 
‘‘(1) NAME OF OFFICE.—Beginning on the date 
of enactment of this Act, the Office for Civil Rights 
of the Department of Health and Human Services 
shall be known as the ‘Office for Civil Rights and 
Health Equity’ of the Department of Health and 
Human Services. Any reference to the Office for 
Civil Rights of the Department of Health and 
Human Services in any law, regulation, map, docu-
ment, record, or other paper of the United States 
shall be deemed to be a reference to the Office for 
Civil Rights and Health Equity. 
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1598 
‘‘(2) HEAD OF OFFICE.—The head of the Office 
for Civil Rights and Health Equity shall be the Di-
rector for Civil Rights and Health Equity, to be ap-
pointed by the President. Any reference to the Di-
rector of the Office for Civil Rights of the Depart-
ment of Health and Human Services in any law, 
regulation, map, document, record, or other paper of 
the United States shall be deemed to be a reference 
to the Director for Civil Rights and Health Equity. 
‘‘(b) PURPOSE.—The Director for Civil Rights and 
Health Equity shall ensure that the health programs, ac-
tivities, policies, projects, procedures, and operations of 
health entities that receive Federal financial assistance are 
in compliance with title VI of the Civil Rights Act of 1964, 
including through the following activities: 
‘‘(1) The development and implementation of 
an action plan to address racial and ethnic health 
care disparities. Such plan shall— 
‘‘(A) address concerns relating to the Of-
fice for Civil Rights and Health Equity as re-
leased by the United States Commission on 
Civil Rights in the report entitled ‘Health Care 
Challenge: 
Acknowledging 
Disparity, 
Con-
fronting Discrimination, and Ensuring Equity’ 
(September 1999), in conjunction with existing 
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and future reports of the National Academy of 
Medicine (formerly known as the Institute of 
Medicine) including the reports titled ‘Unequal 
Treatment: Confronting Racial and Ethnic Dis-
parities in Health Care’, ‘Crossing the Quality 
Chasm: A New Health System for the 21st 
Century’, ‘In the Nation’s Compelling Interest: 
Ensuring Diversity in the Health Care Work-
force’, ‘The National Partnership for Action to 
End Health Disparities’, and ‘The Health of 
Lesbian, Gay, Bisexual, and Transgender Peo-
ple’, and other related reports of the National 
Academies of Sciences, Engineering, and Medi-
cine; 
‘‘(B) be issued in proposed form for public 
review and comment; and 
‘‘(C) be finalized taking into consideration 
any comments or concerns that are received by 
the Office. 
‘‘(2) Investigative and enforcement actions 
against intentional or in effect discrimination and 
policies and practices that have a disparate impact 
on racial or ethnic minorities and communities of 
color pursuant to section 9007 of the Health Equity 
and Accountability Act of 2022. 
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1600 
‘‘(3) The review of racial, ethnic, gender iden-
tity, sexual orientation, sex, disability status, socio-
economic status, and primary language health data 
collected by Federal health agencies to assess health 
care disparities related to intentional discrimination 
and policies and practices that have a disparate im-
pact on minorities. Such review shall include an as-
sessment of health disparities in communities with a 
combination of these classes. 
‘‘(4) Outreach and education activities relating 
to compliance with title VI of the Civil Rights Act, 
including the process of filing a complaint. 
‘‘(5) The provision of technical assistance for 
health entities to facilitate compliance with title VI 
of the Civil Rights Act. 
‘‘(6) Coordination and oversight of activities of 
the civil rights compliance offices established under 
section 3452. 
‘‘(7) Ensuring— 
‘‘(A) at a minimum, compliance with the 
most recent version of the Office of Manage-
ment and Budget statistical policy directive en-
titled ‘Standards for Maintaining, Collecting, 
and Presenting Federal Data on Race and Eth-
nicity’; and 
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1601 
‘‘(B) consideration of available data and 
language standards such as— 
‘‘(i) the standards for collecting, mon-
itoring, and reporting data under section 
3101; and 
‘‘(ii) the National Standards on Cul-
turally 
and 
Linguistically 
Appropriate 
Services of the Office of Minority Health. 
‘‘(c) FUNDING AND STAFF.—The Secretary shall en-
sure the effectiveness of the Office for Civil Rights and 
Health Equity by ensuring that the Office is provided 
with— 
‘‘(1) adequate funding to enable the Office to 
carry out its duties under this section; and 
‘‘(2) staff with expertise in— 
‘‘(A) epidemiology; 
‘‘(B) statistics; 
‘‘(C) health quality assurance; 
‘‘(D) minority health and health dispari-
ties; 
‘‘(E) health equity; 
‘‘(F) cultural and linguistic competency; 
‘‘(G) civil rights; and 
‘‘(H) social, political, mental, behavioral, 
economic, and related determinants of health, 
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including education access and quality, health 
care access and quality, neighborhood and built 
environment, and social and community context. 
‘‘(d) ADVISORY BOARD.— 
‘‘(1) ESTABLISHMENT.—The Secretary, in col-
laboration with the Director Civil Rights and Health 
Equity and the Deputy Assistant Secretary for Mi-
nority Health, shall establish an advisory board (in 
this subsection referred to as the ‘advisory board’) 
to report in accordance with paragraph (2). 
‘‘(2) REPORTS TO CONGRESS.—Not later than 
December 31, 2023, and annually thereafter, the ad-
visory board shall publish and submit to the Office, 
other Federal agencies, and the Congress a report 
that includes— 
‘‘(A) the number of complaints filed during 
the reporting period under title VI of the Civil 
Rights Act, broken down by category; 
‘‘(B) the number of such complaints inves-
tigated and closed by the Office; 
‘‘(C) the outcomes of such complaints in-
vestigated; 
‘‘(D) the staffing levels of the Office in-
cluding staff credentials; 
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‘‘(E) the number of such complaints that 
are pending (including backlogged complaints) 
in which civil rights inequities can be dem-
onstrated and an explanation of why such com-
plaints remain pending; and 
‘‘(F) trends among filed complaints and 
other systemic patterns or themes, including an 
analysis from the Department of Justice about 
litigation concerning such complaints. 
‘‘(3) COMPOSITION.—The members of the advi-
sory board shall include— 
‘‘(A) representatives of stakeholders; and 
‘‘(B) subject matter- and disciplinary-ap-
propriate experts. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2023 through 2027. 
‘‘SEC. 3452. ESTABLISHMENT OF HEALTH PROGRAM OF-
FICES FOR CIVIL RIGHTS WITHIN AGENCIES 
OF DEPARTMENT OF HEALTH AND HUMAN 
SERVICES. 
‘‘(a) IN GENERAL.—The Secretary shall establish 
civil rights compliance offices in each agency within the 
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Department of Health and Human Services that admin-
isters health programs. 
‘‘(b) PURPOSE OF OFFICES.—Each office established 
under subsection (a) shall ensure that recipients of Fed-
eral financial assistance under Federal health programs 
administer programs, and determine and implement poli-
cies, services, and activities, in a manner that— 
‘‘(1) does not discriminate, either intentionally 
or in effect, on the basis of race, color, national ori-
gin, language, ethnicity, sex, age, disability status, 
sexual orientation, or gender identity; and 
‘‘(2) promotes the reduction and elimination of 
disparities in health and health care based on race, 
color, national origin, language, ethnicity, sex, age, 
disability status, sexual orientation, or gender iden-
tity. 
‘‘(c) POWERS AND DUTIES.—The offices established 
in subsection (a) shall, with respect to the applicable agen-
cy, have the following powers and duties: 
‘‘(1) The establishment of compliance and pro-
gram participation standards for recipients of Fed-
eral financial assistance under each program admin-
istered by the agency, including the establishment of 
disparity reduction standards to encompass dispari-
ties in health and health care related to race, color, 
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national origin, language, ethnicity, sex, age, dis-
ability, sexual orientation, or gender identity. 
‘‘(2) The development and implementation of 
policies, procedures, and program-specific guidelines 
that interpret and apply Department of Health and 
Human Services guidance under title VI of the Civil 
Rights Act of 1964 and section 1557 of the Patient 
Protection and Affordable Care Act to each Federal 
health program administered by the agency. 
‘‘(3) The development of a disparity-reduction 
impact analysis methodology that shall— 
‘‘(A) be applied to every rule issued by the 
agency and published as part of the formal 
rulemaking process under sections 555, 556, 
and 557 of title 5, United States Code; and 
‘‘(B) include an analysis of the intersecting 
forms of discrimination. 
‘‘(4) Oversight of data collection, reporting, 
analysis, and publication requirements for all recipi-
ents of Federal financial assistance under each Fed-
eral health program administered by the agency; 
compliance with, at a minimum, the most recent 
version of the Office of Management and Budget 
statistical policy directive entitled ‘Standards for 
Maintaining, Collecting, and Presenting Federal 
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1606 
Data on Race and Ethnicity’; and consideration of 
available data and language standards such as— 
‘‘(A) the standards for collecting and re-
porting data under section 3101; 
‘‘(B) the National Standards on Culturally 
and Linguistically Appropriate Services of the 
Office of Minority Health; and 
‘‘(C) the disaggregation of all health and 
health care data by racial and ethnic minority 
population group. 
‘‘(5) The conduct of publicly available studies 
regarding discrimination within Federal health pro-
grams administered by the agency as well as dis-
parity reduction initiatives by recipients of Federal 
financial assistance under Federal health programs. 
‘‘(6) Annual reports to the Committee on 
Health, Education, Labor, and Pensions and the 
Committee on Finance of the Senate and the Com-
mittee on Energy and Commerce and the Committee 
on Ways and Means of the House of Representatives 
on the progress in reducing disparities in health and 
health care through the Federal programs adminis-
tered by the agency. 
‘‘(d) RELATIONSHIP TO OFFICE FOR CIVIL RIGHTS 
IN THE DEPARTMENT OF JUSTICE.— 
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1607 
‘‘(1) DEPARTMENT
OF
HEALTH
AND
HUMAN 
SERVICES.—The Office for Civil Rights of the De-
partment of Health and Human Services shall pro-
vide standard-setting and compliance review inves-
tigation support services to each civil rights compli-
ance office established under subsection (a), subject 
to paragraph (2). 
‘‘(2) DEPARTMENT
OF
JUSTICE.—The Office 
for Civil Rights of the Department of Justice may, 
as appropriate, institute formal proceedings when a 
civil rights compliance office established under sub-
section (a) determines that a recipient of Federal fi-
nancial assistance is not in compliance with the dis-
parity reduction standards of the applicable agency. 
‘‘(e) DEFINITION.—In this section, the term ‘Federal 
health programs’ mean programs— 
‘‘(1) under the Social Security Act (42 U.S.C. 
301 et seq.) that pay for health care and services; 
and 
‘‘(2) under this Act that— 
‘‘(A) provide Federal financial assistance 
for health care, biomedical research, or health 
services research; or 
‘‘(B) are designed to improve the public’s 
health, including health service programs.’’. 
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1608 
SEC. 9004. UNITED STATES COMMISSION ON CIVIL RIGHTS. 
(a) COORDINATION WITHIN DEPARTMENT OF JUS-
TICE
OF
ACTIVITIES
REGARDING
HEALTH
DISPARI-
TIES.—Section 3(a) of the Civil Rights Commission Act 
of 1983 (42 U.S.C. 1975a(a)) is amended— 
(1) in paragraph (1), by striking ‘‘and’’ at the 
end; 
(2) in paragraph (2), by striking the period at 
the end and inserting ‘‘; and’’; and 
(3) by adding at the end the following: 
‘‘(3) shall, with respect to activities carried out 
in health care and correctional facilities toward the 
goal of eliminating health disparities between the 
general population and members of minority groups 
based on race or color, promote coordination of such 
activities of— 
‘‘(A) the Office for Civil Rights within the 
Office of Justice Programs of the Department 
of Justice; 
‘‘(B) the Office of Justice Programs within 
the Department of Justice; 
‘‘(C) the Office for Civil Rights within the 
Department of Health and Human Services; 
and 
‘‘(D) the Office of Minority Health within 
the Department of Health and Human Services 
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1609 
(headed by the Deputy Assistant Secretary for 
Minority Health).’’. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
5 of the Civil Rights Commission Act of 1983 (42 U.S.C. 
1975c) is amended by striking the first sentence and in-
serting the following: ‘‘For the purpose of carrying out 
this Act, there are authorized to be appropriated 
$30,000,000 for fiscal year 2023, and such sums as may 
be necessary for each of the fiscal years 2024 through 
2028.’’. 
SEC. 9005. SENSE OF CONGRESS CONCERNING FULL FUND-
ING OF ACTIVITIES TO ELIMINATE RACIAL 
AND ETHNIC HEALTH DISPARITIES. 
(a) FINDINGS.—The Congress makes the following 
findings: 
(1) The health status of the population of the 
United States is declining, and the United States 
currently ranks below most industrialized nations in 
health status measured by longevity, sickness, and 
mortality. 
(2) Racial and ethnic minority populations tend 
to have the poorest health status and face substan-
tial cultural, social, political, and economic barriers 
to obtaining high-quality health care. 
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1610 
(3) Racial and ethnic minority populations ex-
perience and suffer from the extreme and egregious 
health disparities and inequities that are caused by 
racism, discrimination, and implicit racial and ethnic 
bias in and throughout the health care system. 
(4) Communities of color with intersecting iden-
tities and backgrounds, including children, older 
adults, women, people with disabilities, people with 
limited English proficiency, immigrants, lesbian, 
gay, bisexual, transgender, queer, and questioning 
populations, and people with lower incomes experi-
ence significant personal and structural barriers to 
obtaining affordable, high-quality health care. 
(5) Efforts to reduce and eliminate racial and 
ethnic health disparities and inequities, and improve 
minority health, have been limited by inadequate re-
sources (funding, staffing, and stewardship), a lack 
of prioritization, and a lack of accountability from 
the Federal Government, particularly due to stag-
nant or declining appropriations that are not in line 
with the dire need faced by communities that are 
impacted. 
(b) SENSE OF CONGRESS.—It is the sense of the 
Congress that— 
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1611 
(1) health disparities negatively impact out-
comes for health and human security of the Nation; 
(2) reducing racial, ethnic, age, sexual, and 
gender disparities in prevention and treatment are 
unique civil and human rights challenges and, as 
such, Federal agencies and health care entities and 
systems receiving Federal funds should be account-
able for their role in causing disparities and in-
equity; 
(3) funding for the National Institute on Mi-
nority Health and Health Disparities, the Office of 
Civil Rights in the Department of Health and 
Human Services, the National Institute of Nursing 
Research, and the Office of Minority Health should 
be doubled by fiscal year 2023, to effectively address 
racial and ethnic disparities elimination in health 
and health care as a matter of health and national 
security; 
(4) adequate funding by fiscal year 2023, and 
subsequent funding increases, should be provided for 
health and human service professions training pro-
grams, the Racial and Ethnic Approaches to Com-
munity Health Initiative at the Centers for Disease 
Control and Prevention, the Minority HIV/AIDS 
Initiative, the Excellence Centers to Eliminate Eth-
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1612 
nic/Racial Disparities Program at the Agency for 
Healthcare Research and Quality, and the National 
Health Service Corps Scholarship Program initia-
tives, programs, policies, projects, and activities that 
are the backbone of the Nation’s agenda to eliminate 
racial and ethnic health disparities and inequities; 
(5) adequate funding for fiscal year 2023 and 
increased funding for future years should be pro-
vided for the Racial and Ethnic Approaches to Com-
munity Health Initiative’s United States Risk Fac-
tor Survey to ensure adequate data collection to 
track health disparities, and there should be appro-
priate avenues provided to disseminate findings to 
the general public; 
(6) current and newly created health disparity 
elimination incentives, programs, agencies, and de-
partments under this Act (and the amendments 
made by this Act) should receive adequate staffing 
and funding by fiscal year 2023; and 
(7) stewardship and accountability should be 
provided to the Congress and the President for 
measurable and sustainable progress toward health 
disparity elimination under programs under this Act, 
including increased data collection and reporting, ca-
pacity building for impacted communities, technical 
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1613 
assistance, training programs, and avenues to dis-
seminate program details and successes to the public 
and to policymakers. 
SEC. 9006. GAO AND NIH REPORTS. 
(a) GAO REPORT ON NIH GRANT RACIAL AND ETH-
NIC DIVERSITY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States shall conduct a study on the racial 
and ethnic diversity among the following groups: 
(A) All applicants for grants, contracts, 
and cooperative agreements awarded by the Na-
tional Institutes of Health during the period be-
ginning on January 1, 2023, and ending De-
cember 31, 2032. 
(B) All recipients of such grants, con-
tracts, and cooperative agreements during such 
period. 
(C) All members of the peer review panels 
of such applicants and recipients, respectively. 
(2) REPORT.—Not later than 6 months after 
the date of enactment of this Act, the Comptroller 
General shall complete the study under paragraph 
(1) and submit to the Congress a report containing 
the results of such study. 
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1614 
(b) NIH REPORT ON CERTAIN AUTHORITY OF NA-
TIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH 
DISPARITIES.—Not later than 6 months after the date of 
enactment of this Act, and biennially thereafter, the Direc-
tor of the National Institutes of Health, in collaboration 
with the Director of the National Institute on Minority 
Health and Health Disparities, shall submit to the Con-
gress a report that details and evaluates— 
(1) the steps taken during the applicable report 
period by the Director of the National Institutes of 
Health to plan, coordinate, review, and evaluate all 
minority health and health disparity research that is 
conducted or supported by the institutes and centers 
at the National Institutes of Health; and 
(2) the outcomes of such steps. 
(c) GAO REPORT RELATED
TO RECIPIENTS
OF 
PPACA FUNDING.—Not later than one year after the 
date of enactment of this Act and biennially thereafter, 
the Comptroller General of the United States shall submit 
to the Congress a report that identifies— 
(1) the racial and ethnic diversity of commu-
nity-based organizations that applied for Federal en-
rollment funding provided pursuant to the Patient 
Protection and Affordable Care Act (Public Law 
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1615 
111–148) (including the amendments made by such 
Act); 
(2) the percentage of such organizations that 
were awarded such funding; and 
(3) the impact of such community-based organi-
zations’ enrollment efforts on the insurance status of 
their communities. 
(d) ANNUAL REPORT ON ACTIVITIES OF NATIONAL 
INSTITUTE ON MINORITY HEALTH AND HEALTH DIS-
PARITIES.—The Director of the National Institute on Mi-
nority Health and Health Disparities shall prepare an an-
nual report on the activities carried out or to be carried 
out by such institute, and shall submit each such report 
to the Committee on Health, Education, Labor, and Pen-
sions of the Senate, the Committee on Energy and Com-
merce of the House of Representatives, the Secretary of 
Health and Human Services, and the Director of the Na-
tional Institutes of Health. With respect to the fiscal year 
involved, the report shall— 
(1) describe and evaluate the progress made in 
health disparities research conducted or supported 
by institutes and centers of the National Institutes 
of Health; 
(2) summarize and analyze expenditures made 
for activities with respect to health disparities re-
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1616 
search conducted or supported by the National Insti-
tutes of Health; 
(3) include a separate statement applying the 
requirements of paragraphs (1) and (2) specifically 
to minority health disparities research; and 
(4) contain such recommendations as the Direc-
tor of the Institute considers appropriate. 
SEC. 9007. INVESTIGATIVE AND ENFORCEMENT ACTIONS. 
(a) IN GENERAL.—In carrying out the investigative 
and enforcement actions of section 3451(b)(2) of the Pub-
lic Health Service Act, as added by section 9003 of this 
Act, the Director for Civil Rights and Health Equity shall 
pursue such investigative and enforcements actions pursu-
ant to this section. 
(b) ADMINISTRATIVE COMPLAINT AND CONCILIATION 
PROCESS.— 
(1) COMPLAINTS AND ANSWERS.— 
(A) IN
GENERAL.—An aggrieved person 
may, not later than 1 year after an alleged vio-
lation of subsection (a) has occurred or con-
cluded, file a complaint with the Director alleg-
ing inequitable provision of health care by a 
provider described in subsection (a). 
(B) COMPLAINT.—A complaint submitted 
pursuant to subparagraph (A) shall be in writ-
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1617 
ing and shall contain such information and be 
in such form as the Director requires. 
(C) OATH
OR
AFFIRMATION.—The com-
plaint and any answer made under this sub-
section shall be made under oath or affirmation, 
and may be reasonably and fairly modified at 
any time. 
(2) RESPONSE TO COMPLAINTS.— 
(A) IN GENERAL.—Upon the filing of a 
complaint under this subsection, the following 
procedures shall apply: 
(i) COMPLAINANT NOTICE.—The Di-
rector shall serve notice upon the com-
plainant acknowledging receipt of such fil-
ing and advising the complainant of the 
time limits and procedures provided under 
this section. 
(ii) RESPONDENT NOTICE.—The Di-
rector shall, not later than 30 days after 
receipt of such filing— 
(I) serve on the respondent a no-
tice of the complaint, together with a 
copy of the original complaint; and 
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1618 
(II) advise the respondent of the 
procedural rights and obligations of 
respondents under this section. 
(iii) ANSWER.—The respondent may 
file, not later than 60 days after receipt of 
the notice from the Director, an answer to 
such complaint. 
(iv) INVESTIGATIVE DUTIES.—The Di-
rector shall— 
(I) make an investigation of the 
alleged inequitable provision of health 
care; and 
(II) complete such investigation 
within 180 days (unless it is impracti-
cable to complete such investigation 
within 180 days) after the filing of 
the complaint. 
(B) INVESTIGATIONS.— 
(i) PATTERN
OR
PRACTICE.—In the 
course of investigating the complaint, the 
Director may seek records of care provided 
to patients other than the complainant if 
necessary to demonstrate or disprove an 
allegation of inequitable provision of health 
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1619 
care or to determine whether there is a 
pattern or practice of such care. 
(ii) ACCOUNTING FOR SOCIAL DETER-
MINANTS
OF
HEALTH.—In investigating 
the complaint and reaching a determina-
tion on the validity of the complaint, the 
Director shall account for social deter-
minants of health and the effect of such 
social determinants on health care out-
comes. 
(iii) INABILITY TO COMPLETE INVES-
TIGATION.—If the Director is unable to 
complete (or finds it is impracticable to 
complete) the investigation within 180 
days after the filing of the complaint (or, 
if the Secretary takes further action under 
paragraph (6)(B) with respect to a com-
plaint, within 180 days after the com-
mencement of such further action), the Di-
rector shall notify the complainant and re-
spondent in writing of the reasons in-
volved. 
(iv) REPORT
TO
STATE
LICENSING 
AUTHORITIES.—On concluding each inves-
tigation under this subparagraph, the Di-
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1620 
rector shall provide to the State licensing 
authorities that were notified under sub-
paragraph (A), information specifying the 
results of the investigation. 
(C) REPORT.— 
(i) FINAL
REPORT.—On completing 
each investigation under this paragraph, 
the Director shall prepare a final investiga-
tive report. 
(ii) MODIFICATION
OF
REPORT.—A 
final report under this subparagraph may 
be modified if additional evidence is later 
discovered. 
(3) CONCILIATION.— 
(A) IN GENERAL.—During the period be-
ginning on the date on which a complaint is 
filed under this subsection and ending on the 
date of final disposition of such complaint (in-
cluding during an investigation under para-
graph (2)(B)), the Director shall, to the extent 
feasible, engage in conciliation with respect to 
such complaint. 
(B) CONCILIATION
AGREEMENT.—A con-
ciliation agreement arising out of such concilia-
tion shall be an agreement between the re-
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1621 
spondent and the complainant, and shall be 
subject to approval by the Director. 
(C) RIGHTS
PROTECTED.—The Director 
shall approve a conciliation agreement only if 
the agreement protects the rights of the com-
plainant and other persons similarly situated. 
(D) PUBLICLY AVAILABLE AGREEMENT.— 
(i) IN
GENERAL.—Subject to clause 
(ii), the Secretary shall make available to 
the public a copy of a conciliation agree-
ment entered into pursuant to this sub-
section unless the complainant and re-
spondent otherwise agree, and the Sec-
retary determines, that disclosure is not re-
quired to further the purposes of this sub-
section. 
(ii) 
LIMITATION.—A 
conciliation 
agreement that is made available to the 
public pursuant to clause (i) may not dis-
close individually identifiable health infor-
mation. 
(4) FAILURE TO COMPLY WITH CONCILIATION 
AGREEMENT.—Whenever the Director has reason-
able cause to believe that a respondent has breached 
a conciliation agreement, the Director shall refer the 
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1624 
(aa) the date a conciliation 
agreement is reached under sub-
section (b); 
(bb) the date of a final dis-
position of a complaint under 
subsection (b); or 
(cc) 180 days after the first 
day of the alleged violation; and 
(II) not later than 2 years after 
the final day of the alleged violation. 
(ii) STATUTE OF LIMITATIONS.—The 
computation of such 2-year period shall 
not include any time during which an ad-
ministrative proceeding (including inves-
tigation or conciliation) under subsection 
(b) was pending with respect to a com-
plaint under such subsection. 
(B) BARRING SUIT.—If the Director has 
obtained a conciliation agreement under sub-
section (b) regarding an alleged violation of 
subsection (a), no action may be filed under 
this paragraph by the complainant involved 
with respect to the alleged violation except for 
the purpose of enforcing the terms of such an 
agreement. 
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1625 
(2) RELIEF WHICH MAY BE GRANTED.— 
(A) IN GENERAL.—In a civil action under 
paragraph (1), if the court finds that a viola-
tion of subsection (a) or breach of a conciliation 
agreement has occurred, the court may award 
to the plaintiff actual and punitive damages, 
and may grant as relief, as the court deter-
mines to be appropriate, any permanent or tem-
porary injunction, temporary restraining order, 
or other order (including an order enjoining the 
defendant from engaging in a practice violating 
subsection (a) or ordering such affirmative ac-
tion as may be appropriate). 
(B) FEES AND COSTS.—In a civil action 
under paragraph (1), the court, in its discre-
tion, may allow the prevailing party, other than 
the United States, a reasonable attorney’s fee 
and costs. The United States shall be liable for 
such fees and costs to the same extent as a pri-
vate person. 
(3) INTERVENTION BY ATTORNEY GENERAL.— 
Upon timely application, the Attorney General may 
intervene in a civil action under paragraph (1), if 
the Attorney General certifies that the case is of 
general public importance. 
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1626 
(d) ENFORCEMENT BY THE ATTORNEY GENERAL.— 
(1) COMMENCEMENT OF ACTIONS.— 
(A) PATTERN OR PRACTICE CASES.—The 
Attorney General may commence a civil action 
in any appropriate district court of the United 
States if the Attorney General has reasonable 
cause to believe that any health care provider 
covered by subsection (a)— 
(i) is engaged in a pattern or practice 
that violates such subsection; or 
(ii) is engaged in a violation of such 
subsection that raises an issue of signifi-
cant public importance. 
(B) CASES BY REFERRAL.—The Director 
may determine, based on a pattern of com-
plaints, a pattern of violations, a review of data 
reported by a health care provider covered by 
subsection (a), or any other means, that there 
is reasonable cause to believe a health care pro-
vider is engaged in a pattern or practice that 
violates subsection (a). If the Director makes 
such a determination, the Director shall refer 
the related findings to the Attorney General. If 
the Attorney General finds that such reasonable 
cause exists, the Attorney General may com-
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1627 
mence a civil action in any appropriate district 
court of the United States. 
(2) ENFORCEMENT OF SUBPOENAS.—The At-
torney General, on behalf of the Director, or another 
party at whose request a subpoena is issued under 
this subsection, may enforce such subpoena in ap-
propriate proceedings in the district court of the 
United States for the district in which the person to 
whom the subpoena was addressed resides, was 
served, or transacts business. 
(3) RELIEF WHICH MAY BE GRANTED IN CIVIL 
ACTIONS.— 
(A) IN GENERAL.—In a civil action under 
paragraph (1), the court— 
(i) may award such preventive relief, 
including a permanent or temporary in-
junction, temporary restraining order, or 
other order against the person responsible 
for a violation of subsection (a) as is nec-
essary to assure the full enjoyment of the 
rights granted by this subsection; 
(ii) may award such other relief as the 
court determines to be appropriate, includ-
ing monetary damages, to aggrieved per-
sons; and 
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1628 
(iii) may, to vindicate the public inter-
est, assess punitive damages against the 
respondent— 
(I) in an amount not exceeding 
$500,000, for a first violation; and 
(II) in an amount not exceeding 
$1,000,000, for any subsequent viola-
tion. 
(B) FEES AND COSTS.—In a civil action 
under this subsection, the court, in its discre-
tion, may allow the prevailing party, other than 
the United States, a reasonable attorney’s fee 
and costs. The United States shall be liable for 
such fees and costs to the extent provided by 
section 2412 of title 28, United States Code. 
(4) INTERVENTION IN CIVIL ACTIONS.—Upon 
timely application, any person may intervene in a 
civil action commenced by the Attorney General 
under paragraphs (1) and (2) if the action involves 
an alleged violation of subsection (a) with respect to 
which such person is an aggrieved person (including 
a person who is a complainant under subsection (b)) 
or a conciliation agreement to which such person is 
a party. 
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1629 
SEC. 9008. FEDERAL HEALTH EQUITY COMMISSION. 
(a) ESTABLISHMENT OF COMMISSION.— 
(1) IN
GENERAL.—There is established the 
Federal Health Equity Commission (hereinafter in 
this section referred to as the ‘‘Commission’’). 
(2) MEMBERSHIP.— 
(A) IN GENERAL.—The Commission shall 
be composed of— 
(i) 8 voting members appointed under 
subparagraph (B); and 
(ii) the nonvoting, ex officio members 
listed in subparagraph (C). 
(B) VOTING MEMBERS.—Not more than 4 
of the members described in subparagraph 
(A)(i) shall at any one time be of the same po-
litical party. Such members shall have recog-
nized expertise in and personal experience with 
racial and ethnic health inequities, health care 
needs of vulnerable and marginalized popu-
lations, and health equity as a vehicle for im-
proving health status and health outcomes. 
Such members shall be appointed to the Com-
mission as follows: 
(i) Four members of the Commission 
shall be appointed by the President. 
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1632 
graph (2)(B), designate a Vice Chairperson 
from among the members of the Commis-
sion appointed under such paragraph. The 
Vice Chairperson may not be a member of 
the same political party as the Chair-
person. 
(ii) DUTY.—The Vice Chairperson 
shall act in place of the Chairperson in the 
absence of the Chairperson. 
(5) REMOVAL
OF
MEMBERS.—The President 
may remove a member of the Commission only for 
neglect of duty or malfeasance in office. 
(6) QUORUM.—A majority of members of the 
Commission appointed under paragraph (2)(B) shall 
constitute a quorum of the Commission, but a lesser 
number of members may hold hearings. 
(b) DUTIES OF THE COMMISSION.— 
(1) IN GENERAL.—The Commission shall— 
(A) monitor and report on the implementa-
tion of this Act; and 
(B) investigate, monitor, and report on 
progress towards health equity and the elimi-
nation of health disparities. 
(2) 
ANNUAL
REPORT.—The 
Commission 
shall— 
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1633 
(A) submit to the President and Congress 
at least one report annually on health equity 
and health disparities; and 
(B) include in such report— 
(i) a description of actions taken by 
the Department of Health and Human 
Services and any other Federal agency re-
lated to health equity or health disparities; 
and 
(ii) recommendations on ensuring eq-
uitable health care and eliminating health 
disparities. 
(c) POWERS.— 
(1) HEARINGS.— 
(A) IN GENERAL.—The Commission or, at 
the direction of the Commission, any sub-
committee or member of the Commission, may, 
for the purpose of carrying out this section, as 
the Commission or the subcommittee or mem-
ber considers advisable— 
(i) hold such hearings, meet and act 
at such times and places, take such testi-
mony, receive such evidence, and admin-
ister such oaths; and 
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1634 
(ii) require, by subpoena or otherwise, 
the attendance and testimony of such wit-
nesses and the production of such books, 
records, correspondence, memoranda, pa-
pers, documents, tapes, and materials. 
(B) 
LIMITATION
ON
HEARINGS.—The 
Commission may hold a hearing under subpara-
graph (A)(i) only if the hearing is approved— 
(i) by a majority of the members of 
the Commission appointed under sub-
section (a)(2)(B); or 
(ii) by a majority of such members 
present at a meeting when a quorum is 
present. 
(2) ISSUANCE
AND
ENFORCEMENT
OF
SUB-
POENAS.— 
(A) ISSUANCE.—A subpoena issued under 
paragraph (1) shall— 
(i) bear the signature of the Chair-
person of the Commission; and 
(ii) be served by any person or class 
of persons designated by the Chairperson 
for that purpose. 
(B) ENFORCEMENT.—In the case of contu-
macy or failure to obey a subpoena issued 
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1635 
under paragraph (1), the United States district 
court for the district in which the subpoenaed 
person resides, is served, or may be found may 
issue an order requiring the person to appear at 
any designated place to testify or to produce 
documentary or other evidence. 
(C) NONCOMPLIANCE.—Any failure to 
obey the order of the court may be punished by 
the court as a contempt of court. 
(3) WITNESS ALLOWANCES AND FEES.— 
(A) IN GENERAL.—Section 1821 of title 
28, United States Code, shall apply to a witness 
requested or subpoenaed to appear at a hearing 
of the Commission. 
(B) EXPENSES.—The per diem and mile-
age allowances for a witness shall be paid from 
funds available to pay the expenses of the Com-
mission. 
(4) POSTAL SERVICES.—The Commission may 
use the United States mails in the same manner and 
under the same conditions as other agencies of the 
Federal Government. 
(5) GIFTS.—The Commission may accept, use, 
and dispose of gifts or donations of services or prop-
erty. 
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1636 
(d) ADMINISTRATIVE PROVISIONS.— 
(1) STAFF.— 
(A) DIRECTOR.—There shall be a full-time 
staff director for the Commission who shall— 
(i) serve as the administrative head of 
the Commission; and 
(ii) be appointed by the Chairperson 
with the concurrence of the Vice Chair-
person. 
(B) OTHER
PERSONNEL.—The Commis-
sion may— 
(i) appoint such other personnel as it 
considers advisable, subject to the provi-
sions of title 5, United States Code, gov-
erning appointments in the competitive 
service, and the provisions of chapter 51 
and subchapter III of chapter 53 of that 
title relating to classification and General 
Schedule pay rates; and 
(ii) may procure temporary and inter-
mittent services under section 3109(b) of 
title 5, United States Code, at rates for in-
dividuals not in excess of the daily equiva-
lent paid for positions at the maximum 
rate for GS–15 of the General Schedule 
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1637 
under section 5332 of title 5, United 
States Code. 
(2) COMPENSATION OF MEMBERS.— 
(A) 
NON-FEDERAL
EMPLOYEES.—Each 
member of the Commission who is not an offi-
cer or employee of the Federal Government 
shall be compensated at a rate equal to the 
daily equivalent of the annual rate of basic pay 
prescribed for level IV of the Executive Sched-
ule under section 5315 of title 5, United States 
Code, for each day (including travel time) dur-
ing which the member is engaged in the per-
formance of the duties of the Commission. 
(B) FEDERAL EMPLOYEES.—Each member 
of the Commission who is an officer or em-
ployee of the Federal Government shall serve 
without compensation in addition to the com-
pensation received for the services of the mem-
ber as an office or employee of the Federal 
Government. 
(C) TRAVEL EXPENSES.—A member of the 
Commission shall be allowed travel expenses, in-
cluding per diem in lieu of subsistence, at rates 
authorized for an employee of an agency under 
subchapter I of chapter 57 of title 5, United 
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1638 
States Code, while away from the home or reg-
ular place of business of the member in the per-
formance of the duties of the Commission. 
(3) COOPERATION.—The Commission may se-
cure directly from any Federal department or agency 
such information as the Commission considers nec-
essary to carry out this Act. Upon request of the 
Chairman of the Commission, the head of such de-
partment or agency shall furnish such information to 
the Commission. 
(e) PERMANENT COMMISSION.—Section 14 of the 
Federal Advisory Committee Act (5 U.S.C. App.) shall not 
apply to the Commission. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated for fiscal year 2022 and 
each fiscal year thereafter such sums as may be necessary 
to carry out the duties of the Commission. 
TITLE X—ADDRESSING SOCIAL 
DETERMINANTS 
AND 
IM-
PROVING 
ENVIRONMENTAL 
JUSTICE 
Subtitle A—In General 
SEC. 10001. DEFINITIONS. 
In this title: 
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1639 
(1) ADMINISTRATOR.—The term ‘‘Adminis-
trator’’ means the Administrator of the Environ-
mental Protection Agency. 
(2) AGENCY.—The term ‘‘Agency’’ means the 
Environmental Protection Agency. 
(3) BUILT
ENVIRONMENT.—The term ‘‘built 
environment’’ means the components of the environ-
ment, and the location of these components in a geo-
graphically defined space, that are created or modi-
fied by individuals to form the physical and social 
characteristics of a community or enhance quality of 
human life, including— 
(A) homes, schools, and places of work and 
worship; 
(B) parks, recreation areas, and green-
ways; 
(C) transportation systems; 
(D) business, industry, and agriculture; 
and 
(E) land-use plans, projects, and policies 
that impact the physical or social characteris-
tics of a community, including access to services 
and amenities. 
(4) DETERMINANTS
OF
HEALTH.—The term 
‘‘determinants of health’’— 
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1640 
(A) means the range of nonclinical factors 
inclusive of personal, social, economic, and envi-
ronmental factors that directly influence health 
status; and 
(B) includes social determinants of health 
(which are sometimes referred to as ‘‘social and 
economic determinants of health’’, ‘‘socio-
economic determinants of health’’, ‘‘environ-
mental determinants of health’’, ‘‘social drivers 
of inequality’’, or ‘‘personal determinants of 
health’’). 
(5) ECONOMIC DETERMINANTS OF HEALTH.— 
The term ‘‘economic determinants of health’’ means 
income and social status. 
(6) 
ENVIRONMENTAL
DETERMINANTS
OF 
HEALTH.—The term ‘‘environmental determinants 
of health’’ means the broad physical (including man-
made and natural), psychological, social, spiritual, 
cultural, and aesthetic environment. 
(7) PERSONAL DETERMINANTS OF HEALTH.— 
The term ‘‘personal determinants of health’’ means 
an individual’s behavior, biology, and genetics. 
(8) SOCIAL DETERMINANTS OF HEALTH.—The 
term ‘‘social determinants of health’’ means a subset 
of determinants of the health of individuals and en-
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1641 
vironments (such as communities, neighborhoods, 
and societies) that describe an individual’s or group 
of people’s social identity, describe the social and 
economic resources to which such individual or 
group has access, and describe the conditions in 
which an individual or group of people works, lives, 
and plays. 
SEC. 10002. FINDINGS. 
Congress finds as follows: 
(1) Social determinants of health are the great-
est predictors of health outcomes. 
(2) Social determinants of health, including 
health-related behaviors, social and economic factors, 
and physical environment factors account for 80 per-
cent of health outcomes, whereas clinical care ac-
counts for 20 percent of improved health outcomes. 
Yet, in 2017, public health spending represented 
only 2.5 percent of all health spending in the United 
States. 
(3) There are more opportunities to improve 
health for everyone when we understand that health 
starts, first, not in a medical setting, but in our 
families, in our schools and workplaces, in our 
neighborhoods, in the air we breathe, and in the 
water we drink. 
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1642 
(4)(A) Healthy People 2030 identifies health 
and health care quality as a function of not only ac-
cess to health care, but also the social determinants 
of health, categorized into the following: neighbor-
hoods and the built environment; social and commu-
nity context; education; and economic stability. 
(B) The following examples illustrate the nexus 
between the unequal distribution of the social deter-
minants of health and health inequities: 
(i) The built environment influences resi-
dents’ level of physical activity. Neighborhoods 
with high levels of poverty are significantly less 
likely to have places where children can be 
physically active, such as parks, green spaces, 
and bike paths and lanes. Neighborhoods and 
communities can provide opportunities for phys-
ical activity and support active lifestyles 
through accessible and safe parks and open 
spaces and through land use policy, zoning, and 
healthy community design. 
(ii) Emotional and physical health and 
well-being are directly impacted by perceived 
levels of safety, such as unlit streets at night. 
Community members have expressed that safety 
is not only a barrier to accessing programs and 
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1643 
services that increase quality of life, but also a 
barrier to accessing physical activity in their 
community through the built environment. 
(iii) Historical and institutional racism in 
the United States has shaped the way in which 
social and economic resources and exposure to 
health promoting environments are distributed. 
Income, education, occupation, neighborhood 
conditions, schools, workplaces, the use of 
health and social services, and experiences with 
the criminal justice system are all highly pat-
terned by race, with people of color experiencing 
more that is health harming. Finding ways to 
uncouple the link between race and access to re-
sources and healthy environments is a principal 
means of reducing health inequities. Addition-
ally, the anticipation of racism itself causes 
higher psychological and cardiovascular stress 
levels that are linked to poor health outcomes. 
Remedying discriminatory practices at the indi-
vidual and systemic levels will likely reduce 
health inequities caused by this unequal dis-
tribution of stress. 
(iv) Poor health among Native Americans 
has largely been driven by post-colonial oppres-
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1644 
sion and historical trauma. The expropriation of 
native lands and territories to the American 
state had severe consequences on Native Amer-
ican health. This resulted in the deprivation of 
traditional food sources—and nutrients—for 
Native Americans and also the destruction of 
traditional economies and community organiza-
tion. Today, Native Americans have twice the 
rate of diabetes of non-Hispanic Whites. Rec-
ognition of the origins of diabetes as having a 
social and community context, rather than just 
individual responsibility and genetic predisposi-
tion, will shape better policy to provide food se-
curity. 
(v) In the context of prisons, overcrowding 
has led to the deterioration of the physical and 
mental health of individuals after they leave 
prison. In particular, the mass incarceration of 
African-American males as a result of inequities 
within and treatment in the criminal justice 
system has contributed to an overburdening of 
certain infectious diseases within the African- 
American community. As a social institution, 
incarceration amplifies existing adverse health 
conditions by concentrating diseases and harm-
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1645 
ful health behaviors such as tobacco use, drug 
use, and violence. 
(vi) Educational attainment is the strong-
est predictor of adult mortality. It is a basic 
component of socioeconomic status that shapes 
earning potential to access resources that pro-
mote health. People with more education are 
less likely to report that they are in poor health, 
and are also less likely to have diabetes and 
other chronic diseases. 
(vii) Individuals with lower levels of edu-
cational attainment are much more likely to re-
port to be current smokers. In 2017, smoking 
prevalence was 36.8 percent among adults with 
a GED diploma, 23.1 percent with less than a 
high school diploma, and 18.7 percent with a 
high school diploma, while dropping signifi-
cantly to 7.1 percent among adults with an un-
dergraduate college degree and 4.1 percent with 
a postgraduate college degree. 
(viii) Income inequality differences account 
for a large part of health inequities. For exam-
ple, children living in poverty experience poorer 
housing conditions, increased exposure to in-
door allergens and toxins (such as pesticides, 
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1646 
lead, mercury, radon, air pollution, and carcino-
gens), increased food insecurity, and more psy-
chological stress. These experiences culminate 
in worse adult health as compared with children 
with higher socioeconomic status. Specifically, 
children living in lower socioeconomic neighbor-
hoods have higher rates of asthma due to high-
er rates of psychological stress resulting from 
higher rates of violence. Food insecurity is asso-
ciated with obesity and racial and ethnic mi-
norities have higher rates of food insecurity. 
(ix) Lesbian, gay, bisexual, transgender, 
queer or questioning, intersex, and asexual or 
allied 
(referred 
to 
in 
this 
section 
as 
‘‘LGBTQIA+’’) individuals face health inequi-
ties linked to societal stigma, discrimination, 
and denial of their civil and human rights. Dis-
crimination against LGBTQIA+ individuals 
has been associated with high rates of psy-
chiatric disorders, substance abuse, and suicide. 
Experiences of violence and victimization are 
frequent for LGBTQIA+ individuals, and have 
long-lasting effects on the individual and the 
community. Personal, family, and social accept-
ance of sexual orientation and gender identity 
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1647 
affects the mental health and personal safety of 
LGBTQIA+ individuals. 
(x) Individuals in older and cheaper hous-
ing are at higher risks to be exposed to lead, 
particularly in housing built prior to 1960. The 
threat of lead poisoning disproportionally af-
fects vulnerable populations, with children living 
in poverty (5.6 percent) and Black children 
(5.6) experiencing the highest rates. According 
to the Department of Housing and Urban De-
velopment, about 3,600,000 homes nationwide 
that house young children have lead hazards 
such as contaminated drinking water, peeling 
paint, contaminated dust, or toxic soil. The 
combined cost of medical treatment and special 
education for lead poisoned children averages 
about $5,600 per child per year, and lead poi-
soning costs the United States an estimated 
$50,000,000,000 annually. 
(xi) According to the report Healthy Peo-
ple 2030, individuals with disabilities, as a 
group, experience health inequities in routine 
public health arenas such as health behaviors, 
clinical preventive services, and chronic condi-
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1648 
tions. Compared with individuals without dis-
abilities, individuals with disabilities are— 
(I) less likely to receive recommended 
preventive health care services, such as 
routine 
teeth 
cleanings 
and 
cancer 
screenings; 
(II) at a high risk for poor health out-
comes such as obesity, hypertension, falls- 
related injuries, and mood disorders such 
as depression; and 
(III) 
more 
likely 
to 
engage 
in 
unhealthy behaviors that put their health 
at risk, such as cigarette smoking and in-
adequate physical activity. 
(5) Laws and regulations that improve opportu-
nities to live in safe neighborhoods with more social 
cohesion, attain higher education, sustain stable em-
ployment, and bridge class differences help foster 
the health and safety of individuals. 
(6) The global public health community has 
reached consensus through the Rio Political Declara-
tion of Social Determinants of Health adopted by 
the World Health Organization in October 2011 that 
‘‘[c]ollaboration in coordinated and intersectoral pol-
icy actions has proven to be effective. Health in All 
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1649 
Policies, an initiative of the American Public Health 
Association, together with intersectoral cooperation 
and action, is one promising approach to enhance 
accountability in other sectors of health, as well as 
the promotion of health equity and more inclusive 
and productive societies.’’. 
SEC. 10003. HEALTH IMPACT ASSESSMENTS. 
(a) FINDINGS.—Congress makes the following find-
ings: 
(1) Health impact assessment is a tool to help 
planners, health officials, decision makers, and the 
public make more informed decisions about the po-
tential health effects of proposed plans, policies, pro-
grams, and projects in order to maximize health 
benefits and minimize harms. 
(2) Health impact assessments foster commu-
nity leadership, ownership, and participation in deci-
sion-making processes. 
(3) Health impact assessments can build com-
munity support and reduce opposition to a project or 
policy, thereby facilitating economic growth by aid-
ing the development of consensus regarding new de-
velopment proposals. 
(4) Health impact assessments facilitate col-
laboration across sectors. 
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1650 
(b) PURPOSES.—It is the purpose of this section to— 
(1) provide more information about the poten-
tial human health effects of policy decisions and the 
distribution of those effects; 
(2) improve how health is considered in plan-
ning and decision-making processes; and 
(3) 
build 
stronger, 
healthier 
communities 
through the use of health impact assessments. 
(c) HEALTH IMPACT ASSESSMENTS.—Part P of title 
III of the Public Health Service Act (42 U.S.C. 280g et 
seq.), as amended by section 7254 of this Act, is further 
amended by adding at the end the following: 
‘‘SEC. 399V–11. HEALTH IMPACT ASSESSMENTS. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) ADMINISTRATOR.—The term ‘Adminis-
trator’ means the Administrator of the Environ-
mental Protection Agency. 
‘‘(2) DIRECTOR.—The term ‘Director’ means 
the Director of the Centers for Disease Control and 
Prevention. 
‘‘(3) HEALTH IMPACT ASSESSMENT.—The term 
‘health impact assessment’ means a systematic proc-
ess that uses an array of data sources and analytic 
methods and considers input from stakeholders to 
determine the potential effects of a proposed policy, 
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1651 
plan, program, or project on the health of a popu-
lation and the distribution of those effects within the 
population. Such term includes identifying and rec-
ommending appropriate actions on monitoring and 
maximizing potential benefits and minimizing poten-
tial harms. 
‘‘(4) HEALTH INEQUITY.—The term ‘health in-
equity’ means a particular type of health difference 
that is closely linked with social, economic, or envi-
ronmental disadvantage and that adversely affects 
groups of people who have systematically experi-
enced greater obstacles to health based on their ra-
cial or ethnic group; religion; socioeconomic status; 
gender; age; mental health; cognitive, sensory, or 
physical disability; sexual orientation or gender iden-
tity; geographic location; citizenship status; or other 
characteristics historically linked to discrimination 
or exclusion. 
‘‘(b) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director and in collaboration with the Admin-
istrator, shall— 
‘‘(1) in consultation with the Director of the 
National Center for Chronic Disease Prevention and 
Health Promotion and relevant offices within the 
Department of Housing and Urban Development, 
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1652 
the Department of Transportation, and the Depart-
ment of Agriculture, establish a program at the Na-
tional Center for Environmental Health at the Cen-
ters for Disease Control and Prevention focused on 
advancing the field of health impact assessment that 
includes— 
‘‘(A) collecting and disseminating best 
practices; 
‘‘(B) 
administering 
capacity 
building 
grants to States, Indian Tribes, and Tribal or-
ganizations to support subgrantees in initiating 
health impact assessments, in accordance with 
subsection (d); 
‘‘(C) providing technical assistance; 
‘‘(D) developing training tools and pro-
viding training on conducting health impact as-
sessment and the implementation of built envi-
ronment and health indicators; 
‘‘(E) making information available, as ap-
propriate, regarding the existence of other com-
munity healthy living tools, checklists, and indi-
ces that help connect public health to other sec-
tors, and tools to help examine the effect of the 
indoor built environment and building codes on 
population health; 
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1653 
‘‘(F) conducting research and evaluations 
of health impact assessments; and 
‘‘(G) awarding competitive extramural re-
search grants; 
‘‘(2) develop guidance and guidelines to conduct 
health impact assessments in accordance with sub-
section (c); and 
‘‘(3) establish a grant program to allow States, 
Indian Tribes, and Tribal organizations to award 
subgrants to eligible entities to conduct health im-
pact assessments. 
‘‘(c) GUIDANCE.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of the Health Equity and Ac-
countability Act of 2022, the Secretary, acting 
through the Director, shall issue final guidance for 
conducting health impact assessments. In developing 
such guidance the Secretary shall— 
‘‘(A) consult with the Director of the Na-
tional Center for Environmental Health, the Di-
rector of the National Center for Chronic Dis-
ease Prevention and Health Promotion, and rel-
evant offices within the Department of Housing 
and Urban Development, the Department of 
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1654 
Transportation, and the Department of Agri-
culture; and 
‘‘(B) consider available international health 
impact assessment guidance, North American 
health impact assessment practice standards, 
and recommendations from the National Acad-
emy of Science. 
‘‘(2) CONTENT.—The guidance under this sub-
section shall include— 
‘‘(A) background on national and inter-
national efforts to bridge urban planning, cli-
mate forecasting, and public health institutions 
and disciplines, including a review of health im-
pact assessment best practices internationally; 
‘‘(B) evidence-based direct and indirect 
pathways that link land-use planning, transpor-
tation, and housing policy and objectives to 
human health outcomes; 
‘‘(C) data resources and quantitative and 
qualitative forecasting methods to evaluate both 
the status of health determinants and health ef-
fects, including identification of existing pro-
grams that can disseminate these resources; 
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1655 
‘‘(D) best practices for inclusive public in-
volvement in conducting health impact assess-
ments; and 
‘‘(E) technical assistance for other agen-
cies seeking to develop their own guidelines and 
procedures for health impact assessment. 
‘‘(d) GRANT PROGRAM.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director and in collaboration with the 
Administrator, shall— 
‘‘(A) award grants to States, Indian 
Tribes, and Tribal organizations to award sub-
grants to eligible entities for capacity building 
or to prepare health impact assessments; and 
‘‘(B) ensure that States, Indian Tribes, 
and Tribal organizations receiving a grant 
under this subsection further support training 
and technical assistance for subgrantees under 
subparagraph (A) by funding and overseeing 
appropriate experts on health impact assess-
ments from local, State, and Tribal govern-
ments, the Federal Government, institutions of 
higher education, and nonprofit organizations 
to provide such training and technical assist-
ance. 
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1656 
‘‘(2) APPLICATIONS FOR SUBGRANTS.— 
‘‘(A) IN GENERAL.—To be eligible to re-
ceive a subgrant under this section, an eligible 
entity shall— 
‘‘(i) be a community-based organiza-
tion serving individuals or populations the 
health of which are, or will be, affected by 
an activity or a proposed activity; and 
‘‘(ii) submit to the grantee an applica-
tion in accordance with this subsection, at 
such time, in such manner, and containing 
such additional information as the Sec-
retary (acting through the Director and in 
collaboration with the Administrator) and 
the grantee may require. 
‘‘(B) INCLUSION.—An application for a 
subgrant under this subsection shall include— 
‘‘(i) a list of proposed activities that 
require or would benefit from conducting a 
health 
impact 
assessment 
within 
six 
months of receiving the subgrant; 
‘‘(ii) supporting documentation, in-
cluding letters of support, from potential 
conductors of health impact assessments 
for the listed proposed activities; 
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1657 
‘‘(iii) an assessment by the applicant 
of the health of the population to be served 
through the subgrant; and 
‘‘(iv) a description of potential adverse 
or positive effects on health that the pro-
posed activities may create. 
‘‘(C) PREFERENCE.—In awarding sub-
grants under this subsection, States may give 
preference to eligible entities that demonstrate 
the potential to significantly improve population 
health or lower health care costs as a result of 
potential health impact assessment work. 
‘‘(3) USE OF FUNDS.— 
‘‘(A) IN GENERAL.—A State, Indian Tribe, 
or Tribal organization receiving a grant under 
this subsection shall use such grant to conduct 
health impact assessment capacity building in 
support of a subgrantee conducting a health im-
pact assessment for a proposed activity in ac-
cordance with this subsection. 
‘‘(B) PURPOSES.—The purposes of a 
health impact assessment under this subsection 
are— 
‘‘(i) to facilitate the involvement of 
Tribal, State, and local public health offi-
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1658 
cials in community planning, transpor-
tation, housing, and land use decisions and 
other decisions affecting the built environ-
ment to identify any potential health con-
cern or health benefit relating to an activ-
ity or proposed activity; 
‘‘(ii) to provide for an investigation of 
any health-related issue of concern raised 
in a planning process, an environmental 
impact assessment process, or policy ap-
praisal relating to a proposed activity; 
‘‘(iii) to describe and compare alter-
natives (including no-action alternatives) to 
a proposed activity to provide clarification 
with respect to the potential health out-
comes associated with the proposed activity 
and, where appropriate, to the related ben-
efit-cost or cost-effectiveness of the pro-
posed activity and alternatives; 
‘‘(iv) to contribute, when applicable, 
to the findings of a planning process, pol-
icy appraisal, or an environmental impact 
statement with respect to the terms and 
conditions of implementing a proposed ac-
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1659 
tivity or related mitigation recommenda-
tions, as necessary; 
‘‘(v) to ensure that the dispropor-
tionate distribution of negative impacts 
among vulnerable populations is minimized 
as much as possible; 
‘‘(vi) to engage affected community 
members and ensure adequate opportunity 
for public comment on all stages of the 
health impact assessment; 
‘‘(vii) where appropriate, to consult 
with local and county health departments 
and appropriate organizations, including 
planning, transportation, and housing or-
ganizations, and provide them information 
and tools regarding how to conduct and in-
tegrate health impact assessment into their 
work; and 
‘‘(viii) to inspect homes, water sys-
tems, and other elements that pose risks to 
lead exposure, with an emphasis on areas 
that pose a higher risk to children. 
‘‘(4) ASSESSMENTS.—Health impact assess-
ments carried out using funds under this section 
shall— 
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‘‘(A) take appropriate health factors into 
consideration as early as practicable during the 
planning, review, or decision-making processes; 
‘‘(B) assess the effect on the health of in-
dividuals and populations of proposed policies, 
projects, or plans that result in modifications to 
the built environment; and 
‘‘(C) assess the distribution of health ef-
fects across various factors, such as race, in-
come, ethnicity, age, disability status, gender, 
and geography. 
‘‘(5) ELIGIBLE ACTIVITIES.— 
‘‘(A) IN GENERAL.—A State, Indian Tribe, 
or Tribal organization receiving a grant under 
this section shall conduct an evaluation of any 
activity proposed to be funded through the 
grant, including through a subgrant, to deter-
mine whether such activity will have a signifi-
cant adverse or positive effect on the health of 
the affected population to be served, based on 
the criteria described in subparagraph (B). 
‘‘(B) CRITERIA.—The criteria described in 
this subparagraph include, as applicable to the 
proposed activity, the following: 
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1661 
‘‘(i) Any substantial adverse effect or 
significant health benefit on health out-
comes or factors known to influence health, 
including the following: 
‘‘(I) Physical activity. 
‘‘(II) Injury. 
‘‘(III) Mental health. 
‘‘(IV) Accessibility to health-pro-
moting goods and services. 
‘‘(V) Respiratory health. 
‘‘(VI) Chronic disease. 
‘‘(VII) Nutrition. 
‘‘(VIII) Land use changes that 
promote 
local, 
sustainable 
food 
sources. 
‘‘(IX) Infectious disease. 
‘‘(X) Health inequities. 
‘‘(XI) 
Existing 
air 
quality, 
ground or surface water quality or 
quantity, or noise levels. 
‘‘(XII) Lead exposure. 
‘‘(XIII) Drinking water quality 
and accessibility. 
‘‘(ii) Other factors that may be con-
sidered, including— 
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1662 
‘‘(I) the potential for a proposed 
activity to result in systems failure 
that leads to a public health emer-
gency; 
‘‘(II) the probability that the pro-
posed activity will result in a signifi-
cant increase in tourism, economic de-
velopment, or employment in the pop-
ulation to be served; 
‘‘(III) any other significant po-
tential hazard or enhancement to 
human health, as determined by the 
grantee; or 
‘‘(IV) whether the evaluation of a 
proposed activity would duplicate an-
other analysis or study being under-
taken in conjunction with the pro-
posed activity. 
‘‘(C) FACTORS FOR CONSIDERATION.—In 
evaluating a proposed activity under subpara-
graph (A), a grantee may take into consider-
ation any reasonable, direct, indirect, or cumu-
lative effect that can be clearly related to poten-
tial health effects and that is related to the pro-
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1663 
posed activity, including the effect of any action 
that is— 
‘‘(i) included in the long-range plan 
relating to the proposed activity; 
‘‘(ii) likely to be carried out in coordi-
nation with the proposed activity; 
‘‘(iii) dependent on the occurrence of 
the proposed activity; or 
‘‘(iv) likely to have a disproportionate 
impact on high-risk or vulnerable popu-
lations. 
‘‘(6) REQUIREMENTS.—A health impact assess-
ment prepared with funds awarded under this sub-
section shall incorporate the following, after con-
ducting the screening phase (identifying projects or 
policies for which a health impact assessment would 
be valuable and feasible) through the application 
process: 
‘‘(A) SCOPING.—Identifying which health 
effects to consider and the research methods to 
be utilized. 
‘‘(B) ASSESSING RISKS AND BENEFITS.— 
Assessing the baseline health status and factors 
known to influence the health status in the af-
fected community, which may include aggre-
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1664 
gating and synthesizing existing health assess-
ment evidence and data from the community. 
‘‘(C) DEVELOPING RECOMMENDATIONS.— 
Suggesting changes to proposals to promote 
positive or mitigate adverse health effects. 
‘‘(D) REPORTING.—Synthesizing the as-
sessment and recommendations and commu-
nicating the results to decision makers. 
‘‘(E) MONITORING
AND
EVALUATING.— 
Tracking the decision and implementation effect 
on health determinants and health status. 
‘‘(7) PLAN.—A subgrantee under this section 
shall develop and implement a plan, to be approved 
by the Secretary (acting through the Director and in 
collaboration with the Administrator) and the grant-
ee, for meaningful and inclusive stakeholder involve-
ment in all phases of the health impact assessment. 
Stakeholders may include community leaders, com-
munity-based organizations, youth-serving organiza-
tions, planners, public health experts, State and 
local public health departments and officials, health 
care experts or officials, housing experts or officials, 
and transportation experts or officials. 
‘‘(8) SUBMISSION
OF
FINDINGS.—A grantee 
under this section shall submit the findings of any 
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1665 
funded health impact assessment activities to the 
Secretary and make these findings publicly available. 
‘‘(9) ASSESSMENT OF IMPACTS.—A subgrantee 
under this section shall ensure the assessment of the 
distribution of health impacts (related to the pro-
posed activity) across race, ethnicity, income, age, 
gender, disability status, and geography. 
‘‘(10) CONDUCT
OF
ASSESSMENT.—To the 
greatest extent feasible, a health impact assessment 
shall be conducted under this section in a manner 
that respects the needs and timing of the decision- 
making process it evaluates. 
‘‘(11) METHODOLOGY.—In preparing a health 
impact assessment funded under this subsection, a 
subgrantee under this section shall follow the guid-
ance published under subsection (c). 
‘‘(e) HEALTH IMPACT ASSESSMENT DATABASE.— 
The Secretary, acting through the Director and in collabo-
ration with the Administrator, shall establish, maintain, 
and make publicly available a health impact assessment 
database, including— 
‘‘(1) a catalog of health impact assessments re-
ceived under this section; 
‘‘(2) an inventory of tools used by subgrantees 
to conduct health impact assessments; and 
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1666 
‘‘(3) guidance for subgrantees with respect to 
the selection of appropriate tools described in para-
graph (2). 
‘‘(f) EVALUATION OF GRANTEE ACTIVITIES.—The 
Secretary shall award competitive grants to Prevention 
Research Centers, or nonprofit organizations or academic 
institutions with expertise in health impact assessments 
to— 
‘‘(1) assist grantees and subgrantees with the 
provision of training and technical assistance in the 
conducting of health impact assessments; 
‘‘(2) evaluate the activities carried out with 
grants and subgrants under subsection (d); and 
‘‘(3) assist the Secretary in disseminating evi-
dence, best practices, and lessons learned from 
grantees and subgrantees. 
‘‘(g) REPORT TO CONGRESS.—Not later than 1 year 
after the date of enactment of the Health Equity and Ac-
countability Act of 2022, the Secretary shall submit to 
Congress a report concerning the evaluation of the pro-
grams under this section, including recommendations as 
to how lessons learned from such programs can be incor-
porated into future guidance documents developed and 
provided by the Secretary and other Federal agencies, as 
appropriate. 
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1667 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary. 
‘‘SEC. 399V–12. IMPLEMENTATION OF RESEARCH FINDINGS 
TO IMPROVE HEALTH OUTCOMES THROUGH 
THE BUILT ENVIRONMENT. 
‘‘(a) RESEARCH GRANT PROGRAM.—The Secretary, 
in collaboration with the Administrator of the Environ-
mental Protection Agency (referred to in this section as 
the ‘Administrator’), shall award grants to public agencies 
or private nonprofit institutions to implement evidence- 
based programming to improve human health through im-
provements to the built environment and subsequently 
human health, by addressing— 
‘‘(1) levels of physical activity; 
‘‘(2) consumption of nutritional foods; 
‘‘(3) rates of crime; 
‘‘(4) air, water, and soil quality; 
‘‘(5) risk or rate of injury; 
‘‘(6) accessibility to health-promoting goods and 
services; 
‘‘(7) chronic disease rates; 
‘‘(8) community design; 
‘‘(9) housing; 
‘‘(10) transportation options; and 
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1668 
‘‘(11) other factors, as the Secretary determines 
appropriate. 
‘‘(b) APPLICATIONS.—A public agency or private 
nonprofit institution desiring a grant under this section 
shall submit to the Secretary an application at such time, 
in such manner, and containing such agreements, assur-
ances, and information as the Secretary, in consultation 
with the Administrator, may require. 
‘‘(c) RESEARCH.—The Secretary, in consultation 
with the Administrator, shall support, through grants 
awarded under this section, research that— 
‘‘(1) uses evidence-based research to improve 
the built environment and human health; 
‘‘(2) examines— 
‘‘(A) the scope and intensity of the impacts 
that the built environment (including the var-
ious characteristics of the built environment) 
has on human health; or 
‘‘(B) the distribution of such impacts by— 
‘‘(i) location; and 
‘‘(ii) population subgroup; 
‘‘(3) is used to develop— 
‘‘(A) measures and indicators to address 
health impacts and the connection of health to 
the built environment; 
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1669 
‘‘(B) efforts to link the measures to trans-
portation, land use, and health databases; and 
‘‘(C) efforts to enhance the collection of 
built environment surveillance data; 
‘‘(4) distinguishes carefully between personal 
attitudes and choices and external influences on be-
havior to determine how much the association be-
tween the built environment and the health of resi-
dents, versus the lifestyle preferences of the people 
that choose to live in the neighborhood, reflects the 
physical characteristics of the neighborhood; and 
‘‘(5)(A) identifies or develops effective interven-
tion strategies focusing on enhancements to the built 
environment that promote increased use physical ac-
tivity, access to nutritious foods, or other health-pro-
moting activities by residents; and 
‘‘(B) in developing the intervention strategies 
under subparagraph (A), ensures that the interven-
tion strategies will reach out to high-risk or vulner-
able populations, including low-income urban and 
rural communities and aging populations, in addi-
tion to the general population. 
‘‘(d) SURVEYS.—The Secretary may allow recipients 
of grants under this section to use such grant funds to 
support the expansion of national surveys and data track-
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1670 
ing systems to provide more detailed information about 
the connection between the built environment and health. 
‘‘(e) PRIORITY.—In awarding grants under this sec-
tion, the Secretary and the Administrator shall give pri-
ority to entities with programming that incorporates— 
‘‘(1) interdisciplinary approaches; or 
‘‘(2) the expertise of the public health, physical 
activity, urban planning, land use, and transpor-
tation research communities in the United States 
and abroad. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. The Secretary may al-
locate not more than 20 percent of the amount so appro-
priated for a fiscal year for purposes of conducting re-
search under subsection (c).’’. 
SEC. 10004. GRANT PROGRAM TO CONDUCT ENVIRON-
MENTAL HEALTH IMPROVEMENT ACTIVITIES 
AND TO IMPROVE SOCIAL DETERMINANTS OF 
HEALTH. 
(a) DEFINITIONS.—In this section: 
(1) DIRECTOR.—The term ‘‘Director’’ means 
the Director of the Centers for Disease Control and 
Prevention, acting in collaboration with the Adminis-
trator of the Environmental Protection Agency and 
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1671 
the Director of the National Institute of Environ-
mental Health Sciences. 
(2) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means a State, Indian Tribe, Tribal organiza-
tion, or local community that— 
(A) bears a disproportionate burden of ex-
posure to environmental health hazards; 
(B) bears a disproportionate burden of ex-
posure to unhealthy living conditions, low 
standard housing conditions, low socioeconomic 
status, poor nutrition, less opportunity for edu-
cational attainment, disproportionately high un-
employment rates, or lower literacy levels and 
access to information; 
(C) has established a coalition— 
(i) with not less than 1 community- 
based organization or demonstration pro-
gram; and 
(ii) with not less than 1— 
(I) public health entity; 
(II) health care provider organi-
zation; 
(III) academic institution, includ-
ing any minority-serving institution 
(including a Hispanic-serving institu-
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1672 
tion, a historically Black college or 
university, or a Tribal College or Uni-
versity); 
(IV) child-serving institution; or 
(V) landlord or housing provider 
working on lead remediation; 
(D) ensures planned activities and funding 
streams are coordinated to improve community 
health; and 
(E) submits an application in accordance 
with subsection (c). 
(b) ESTABLISHMENT.—The Director shall establish a 
grant program under which eligible entities shall receive 
grants to conduct environmental health improvement ac-
tivities and to improve social determinants of health. 
(c) APPLICATION.—To receive a grant under this sec-
tion, an eligible entity shall submit an application to the 
Director at such time, in such manner, and accompanied 
by such information as the Director may require. 
(d) USE OF GRANT FUNDS.—An eligible entity may 
use a grant under this section— 
(1) to promote environmental health; 
(2) to address environmental health inequities 
among all populations, including children; and 
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(3) to address racial and ethnic inequities in so-
cial determinants of health. 
(e) AMOUNT OF COOPERATIVE AGREEMENT.—The 
Director shall award grants to eligible entities at the fol-
lowing 3 funding levels: 
(1) LEVEL 1 COOPERATIVE AGREEMENTS.— 
(A) IN
GENERAL.—An eligible entity 
awarded a grant under this paragraph shall use 
the funds to identify environmental health prob-
lems and solutions by— 
(i) 
establishing 
a 
planning 
and 
prioritizing council in accordance with sub-
paragraph (B); and 
(ii) 
conducting 
an 
environmental 
health assessment in accordance with sub-
paragraph (C). 
(B) PLANNING AND PRIORITIZING COUN-
CIL.— 
(i) IN
GENERAL.—A planning and 
prioritizing council established under sub-
paragraph (A)(i) (referred to in this para-
graph as a ‘‘PPC’’) shall assist the envi-
ronmental health assessment process and 
environmental health promotion activities 
of the eligible entity. 
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1674 
(ii) MEMBERSHIP.—Membership of a 
PPC shall consist of representatives from 
various organizations within public health, 
planning, development, and environmental 
services and shall include stakeholders 
from vulnerable groups such as children, 
the elderly, disabled, and minority ethnic 
groups that are often not actively involved 
in democratic or decision-making proc-
esses. 
(iii) DUTIES.—A PPC shall— 
(I) identify key stakeholders and 
engage and coordinate potential part-
ners in the planning process; 
(II) establish a formal advisory 
group to plan for the establishment of 
services; 
(III) conduct an in-depth review 
of the nature and extent of the need 
for an environmental health assess-
ment, including a local epidemiological 
profile, an evaluation of the service 
provider capacity of the community, 
and a profile of any target popu-
lations; and 
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(IV) define the components of 
care and form essential programmatic 
linkages with related providers in the 
community. 
(C) ENVIRONMENTAL
HEALTH
ASSESS-
MENT.— 
(i) IN GENERAL.—A PPC shall carry 
out an environmental health assessment to 
identify environmental health concerns. 
(ii) 
ASSESSMENT
PROCESS.—The 
PPC shall— 
(I) define the goals of the assess-
ment; 
(II) generate the environmental 
health issue list; 
(III) analyze issues with a sys-
tems framework; 
(IV) develop appropriate commu-
nity environmental health indicators; 
(V) 
rank 
the 
environmental 
health issues; 
(VI) set priorities for action; 
(VII) develop an action plan; 
(VIII) implement the plan; and 
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1676 
(IX) evaluate progress and plan-
ning for the future. 
(D) EVALUATION.—Each eligible entity 
that receives a grant under this paragraph shall 
evaluate, report, and disseminate program find-
ings and outcomes. 
(E) TECHNICAL ASSISTANCE.—The Direc-
tor may provide such technical and other non- 
financial assistance to eligible entities as the 
Director determines to be necessary. 
(2) LEVEL 2 COOPERATIVE AGREEMENTS.— 
(A) ELIGIBILITY.— 
(i) IN GENERAL.—The Director shall 
award grants under this paragraph to eli-
gible entities that have already— 
(I) established broad-based col-
laborative partnerships; and 
(II) completed environmental as-
sessments. 
(ii) NO LEVEL 1 REQUIREMENT.—To 
be eligible to receive a grant under this 
paragraph, an eligible entity is not re-
quired to have successfully completed a 
Level 1 Cooperative Agreement (as de-
scribed in paragraph (1)). 
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1678 
(XVI) injuries; 
(ii) building partnerships between 
planning, public health, and other sectors, 
including child-serving institutions, to ad-
dress how the built environment impacts 
food availability and access and physical 
activity to promote healthy behaviors and 
lifestyles and reduce overweight and obe-
sity, musculoskeletal diseases, respiratory 
conditions, infectious diseases, dental, oral, 
and mental health conditions, poverty, and 
related co-morbidities; 
(iii) establishing programs to ad-
dress— 
(I) how environmental and social 
conditions of work and living choices 
influence physical activity and dietary 
intake; or 
(II) how the conditions described 
in subclause (I) influence the concerns 
and needs of people who have im-
paired mobility and use assistance de-
vices, including wheelchairs, lower 
limb prostheses, and hip, knee, and 
other joint replacements; and 
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1679 
(iv) convening intervention and dem-
onstration programs that examine the role 
of the social environment in connection 
with the physical and chemical environ-
ment in— 
(I) determining access to nutri-
tional food; 
(II) improving physical activity to 
reduce overweight, obesity, and co- 
morbidities and increase quality of 
life; and 
(III) location and access to med-
ical facilities. 
(3) LEVEL 3 COOPERATIVE AGREEMENTS.— 
(A) IN
GENERAL.—An eligible entity 
awarded a grant under this paragraph shall use 
the funds to identify and address racial and 
ethnic inequities in social determinants of 
health by creating demonstration programs that 
assess the feasibility of establishing a federally 
funded comprehensive program and describe 
key outcomes that address racial and ethnic in-
equities in social determinants of health. 
(B) PROGRAM DESIGN.— 
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(i) EVALUATION.—No later than 1 
year after enactment of this Act, the Di-
rector shall evaluate the best practices of 
existing programs from the private, public, 
community based, and academically sup-
ported initiatives focused on reducing in-
equities in the social determinants of 
health for racial and ethnic populations. 
(ii) 
DEMONSTRATION
PROJECTS.— 
Not later than two years after the date of 
enactment of this Act, the Director shall 
implement at least 12 demonstration 
projects, including at least one project for 
each major racial and ethnic minority 
group, each of which is unique to the cul-
tural and linguistic needs of each of the 
following groups: 
(I) Native Americans and Alaska 
Natives. 
(II) Asian Americans. 
(III) African Americans/Blacks. 
(IV) Hispanic/Latino-Americans. 
(V) Native Hawaiians and Pacific 
Islanders. 
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1681 
(VI) Middle Eastern and North-
ern African communities. 
(iii) REPORT TO CONGRESS.—No later 
than 2 years after the implementation of 
the initial demonstration projects under 
this paragraph, the Director shall submit 
to Congress a report which includes— 
(I) a description of each dem-
onstration project and design; 
(II) an evaluation of the cost-ef-
fectiveness of each project’s preven-
tion and treatment efforts; 
(III) an evaluation of the cultural 
and linguistic appropriateness of each 
project by racial and ethnic group; 
and 
(IV) an evaluation of the bene-
ficiary’s health status improvement 
under the demonstration project. 
(iv) 
ANY
OTHER
INFORMATION 
DEEMED
APPROPRIATE
BY
THE
DIREC-
TOR.—The Director shall require eligible 
entities awarded a grant under this para-
graph to report any other information the 
Director determines appropriate to be 
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1682 
shared by or developed by such entity, in-
cluding the following: 
(I) Developing models and evalu-
ating methods that improve the cul-
tural and linguistically appropriate 
services provided through the Centers 
for Disease Control and Prevention to 
target individuals impacted by health 
inequities based on their race, eth-
nicity, gender, and sexual orientation. 
(II) Promoting the collaboration 
between primary and specialty care 
health care providers and patients, to 
ensure patients impacted by health in-
equities based on race, ethnicity, gen-
der, or sexual orientation are receiving 
comprehensive and organized treat-
ment and care. 
(III) Educating health care pro-
fessionals on the causes and effects of 
inequities in the social determinants 
of health in relation to minority and 
racial and ethnic communities and the 
need for culturally and linguistically 
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1683 
appropriate care in the prevention and 
treatment of high-impact diseases. 
(IV) Encouraging collaboration 
among community- and patient-based 
organizations which work to address 
inequities in the social determinants 
of health in relation to high-impact 
diseases in minority and racial and 
ethnic populations. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this sec-
tion— 
(1) $25,000,000 for fiscal year 2023; and 
(2) such sums as may be necessary for fiscal 
years 2024 through 2026. 
SEC. 10005. ADDITIONAL RESEARCH ON THE RELATION-
SHIP BETWEEN THE BUILT ENVIRONMENT 
AND THE HEALTH OF COMMUNITY RESI-
DENTS. 
(a) DEFINITION OF ELIGIBLE INSTITUTION.—In this 
section, the term ‘‘eligible institution’’ means a public or 
private nonprofit institution that submits to the Secretary 
of Health and Human Services (in this section referred 
to as the ‘‘Secretary’’) and the Administrator of the Envi-
ronmental Protection Agency (in this section referred to 
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1684 
as the ‘‘Administrator’’) an application for a grant under 
the grant program authorized under subsection (b)(2) at 
such time, in such manner, and containing such agree-
ments, assurances, and information as the Secretary and 
Administrator may require. 
(b) RESEARCH GRANT PROGRAM.— 
(1) DEFINITION OF HEALTH.—In this section, 
the term ‘‘health’’ includes— 
(A) levels of physical activity; 
(B) degree of mobility due to factors such 
as musculoskeletal diseases, arthritis, and obe-
sity; 
(C) consumption of nutritional foods; 
(D) rates of crime; 
(E) air, water, and soil quality; 
(F) risk of injury; 
(G) accessibility to health care services; 
(H) levels of educational attainment; and 
(I) other indicators as determined appro-
priate by the Secretary. 
(2) GRANTS.—The Secretary, in collaboration 
with the Administrator, shall provide grants to eligi-
ble institutions to conduct and coordinate research 
on the built environment and its influence on indi-
vidual and population-based health. 
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1685 
(3) RESEARCH.—The Secretary shall support 
research that— 
(A) investigates and defines the causal 
links between all aspects of the built environ-
ment and the health of residents; 
(B) examines— 
(i) the extent of the impact of the 
built environment (including the various 
characteristics of the built environment) on 
the health of residents; 
(ii) the variation in the health of resi-
dents by— 
(I) location (such as inner cities, 
inner suburbs, outer suburbs, reserva-
tions, and rural areas); and 
(II) population subgroup (includ-
ing children, young adults, the elderly, 
the disadvantaged); or 
(iii) the importance of the built envi-
ronment to the total health of residents, 
which is the primary variable of interest 
from a public health perspective; 
(C) is used to develop— 
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1686 
(i) measures to address health and the 
connection of health to the built environ-
ment; and 
(ii) efforts to link the measures to 
travel and health databases; 
(D) distinguishes carefully between per-
sonal attitudes and choices and external influ-
ences on observed behavior to determine how 
much an observed association between the built 
environment and the health of residents, versus 
the lifestyle preferences of the people that 
choose to live in the neighborhood, reflects the 
physical characteristics of the neighborhood; 
and 
(E)(i) identifies or develops effective inter-
vention strategies to promote better health 
among residents with a focus on behavioral 
interventions and enhancements of the built en-
vironment that promote increased use by resi-
dents; and 
(ii) in developing the intervention strate-
gies under clause (i), ensures that the interven-
tion strategies will reach out to high-risk popu-
lations, including racial and ethnic minorities, 
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1687 
low-income urban and rural communities, and 
children. 
(4) PRIORITY.—In providing assistance under 
the grant program authorized under paragraph (2), 
the Secretary and the Administrator shall give pri-
ority to research that incorporates— 
(A) minority-serving institutions as grant-
ees; 
(B) interdisciplinary approaches; or 
(C) the expertise of the public health, 
physical activity, nutrition and health care (in-
cluding child health), urban planning, and 
transportation research communities in the 
United States and abroad. 
SEC. 10006. ENVIRONMENT AND PUBLIC HEALTH RESTORA-
TION. 
(a) FINDINGS.—Congress finds that— 
(1) humans share an environment with a wide 
variety of habitats and ecosystems that nurture and 
sustain a diversity of species; 
(2) the abundance of natural resources in the 
environment forms the basis for the economy and 
has greatly contributed to human development 
throughout history; 
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1688 
(3) the accelerated pace of human development 
over the last several hundred years has significantly 
impacted— 
(A) the natural environment and its re-
sources; 
(B) the health and diversity of plant and 
animal life; 
(C) the availability of critical habitats; 
(D) the quality of the air and water; and 
(E) the global climate; 
(4) the intervention of the Federal Government 
is necessary to minimize and mitigate human impact 
on the environment— 
(A) for the benefit of public health; 
(B) to maintain air quality and water qual-
ity; 
(C) to sustain the diversity of plants and 
animals; 
(D) to combat global climate change; and 
(E) to protect the environment; 
(5) laws and regulations in the United States 
have been enacted and promulgated to minimize and 
mitigate human impact on the environment for the 
benefit of public health, to maintain air quality and 
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1689 
water quality, to sustain wildlife, and to protect the 
environment; and 
(6) attempts to repeal or weaken key environ-
mental safeguards pose dangers to the public health, 
air quality, water quality, wildlife, and the environ-
ment. 
(b) STATEMENT OF POLICY.—It is the policy of the 
Federal Government to work in conjunction with States, 
territories, Tribal governments, international organiza-
tions, and foreign governments as a steward of the envi-
ronment for the benefit of public health, to maintain air 
quality and water quality, to sustain the diversity of plant 
and animal species, to combat global climate change, and 
to protect the environment for future generations. 
(c) STUDY AND REPORT ON PUBLIC HEALTH OR EN-
VIRONMENTAL IMPACT
OF REVISED RULES, REGULA-
TIONS, LAWS, OR OTHER AGENCY DECISIONS.— 
(1) STUDY.—Not later than 30 days after the 
date of enactment of this Act, the President shall 
seek to enter into an arrangement under which the 
National Academy of Sciences shall conduct a study 
to determine the effects on public health, air quality, 
water quality, wildlife, and the environment of the 
following regulations, laws, and other agency deci-
sions: 
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1692 
the United States’ ’’ and published in the 
Federal Register on April 21, 2020 (85 
Fed. Reg. 22250). 
(B) FORESTS AND LAND MANAGEMENT.— 
(i) The Healthy Forests Restoration 
Act of 2003 (16 U.S.C. 6501 et seq.). 
(ii) The application of section 553(e) 
of title 5, United States Code, such that a 
State may petition for a special rule for 
the National Forest System inventoried 
roadless areas within the State. 
(iii) The final rules entitled ‘‘National 
Forest System Land Management Plan-
ning’’ (77 Fed. Reg. 21162) and ‘‘National 
Forest System Land Management Plan-
ning’’ (81 Fed. Reg. 90723), published on 
April 19, 2013, and December 15, 2016, 
respectively. 
(iv) The final rule entitled ‘‘Oil Shale 
Management—General’’ and published on 
January 15, 2009 (73 Fed. Reg. 69414). 
(v) The record of decision described in 
the notice of availability entitled ‘‘Notice of 
Availability of Approved Land Use Plan 
Amendments/Record of Decision for Allo-
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1693 
cation of Oil Shale and Tar Sands Re-
sources on Lands Administered by the Bu-
reau of Land Management in Colorado, 
Utah, and Wyoming and Final Pro-
grammatic Environmental Impact State-
ment’’ and published on April 1, 2013 (78 
Fed. Reg. 19518). 
(C) SCIENTIFIC REVIEW.—The final rule 
entitled ‘‘Interagency Cooperation Under the 
Endangered Species Act’’ (December 16, 2008) 
(73 Fed. Reg. 76272), as amended by the final 
rule entitled ‘‘Endangered and Threatened 
Wildlife and Plants; Regulations for Inter-
agency Cooperation’’ (August 27, 2019) (84 
Fed. Reg. 44976). 
(2) METHOD.—In conducting the study under 
paragraph (1), the National Academy of Sciences 
may use and compare existing scientific studies re-
garding the regulations, laws, and other agency deci-
sions described in paragraph (1). 
(3) REPORT.—Not later than 270 days after 
the date on which the President enters into the ar-
rangement under paragraph (1), the National Acad-
emy of Sciences shall make publicly available and 
shall submit to Congress and to the head of each de-
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1694 
partment and agency of the Federal Government 
that issued, implements, or would implement a regu-
lation, law, or other agency decision described in 
paragraph (1), a report that includes— 
(A) a description of the effects of each reg-
ulation, law, or other agency decision described 
in paragraph (1) on public health, air quality, 
water quality, wildlife, and the environment, 
compared to the impact of preexisting regula-
tions, laws, or other agency decisions in effect, 
as applicable, including— 
(i) any negative impacts to air quality 
or water quality; 
(ii) any negative impacts to wildlife; 
(iii) any delays in hazardous waste 
cleanup that are projected to be hazardous 
to public health; and 
(iv) any other negative impact on pub-
lic health or the environment; and 
(B) any recommendations that the Na-
tional Academy of Sciences considers appro-
priate to maintain, restore, or improve in whole 
or in part protections for public health, air 
quality, water quality, wildlife, and the environ-
ment for each of the regulations, laws, and 
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1695 
other agency decisions described in paragraph 
(1), which may include recommendations for 
the adoption of any regulation or law in place 
or proposed prior to January 1, 2001. 
(d) DEPARTMENT AND AGENCY REVISION OF EXIST-
ING RULES, REGULATIONS, OR LAWS.—Not later than 
180 days after the date on which the report is submitted 
pursuant to subsection (c)(3), the head of each depart-
ment or agency that has issued or implemented a regula-
tion, law, or other agency decision described in subsection 
(c)(1) shall submit to Congress a plan describing the steps 
the department or agency will take, or has taken, to re-
store or improve protections for public health and the envi-
ronment in whole or in part that were in existence prior 
to the issuance of the applicable regulation, law, or other 
agency decision. 
SEC. 10007. GAO REPORT ON HEALTH EFFECTS OF DEEP-
WATER HORIZON OIL RIG EXPLOSION IN THE 
GULF COAST. 
(a) STUDY.—The Comptroller General of the United 
States shall conduct a study on the type and scope of 
health care services administered through the Department 
of Health and Human Services addressing the provision 
of health care to racial and ethnic minorities, including 
residents, cleanup workers, and volunteers, affected by the 
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blowout and explosion of the mobile offshore drilling unit 
Deepwater Horizon that occurred on April 20, 2010, and 
resulting hydrocarbon releases into the environment. 
(b) SPECIFIC COMPONENTS.—In carrying out sub-
section (a), the Comptroller General of the United States 
shall— 
(1) assess the type, size, and scope of programs 
administered by the Secretary of Health and Human 
Services that focus on the provision of health care 
to communities on the Gulf Coast; 
(2) identify the merits and disadvantages asso-
ciated with each of the programs; 
(3) perform an analysis of the costs and bene-
fits of the programs; and 
(4) determine whether there is any duplication 
of programs. 
(c) REPORT.—Not later than 180 days after the date 
of enactment of this Act, the Comptroller General of the 
United States shall submit to Congress a report that in-
cludes— 
(1) the findings of the study conducted under 
subsection (a); and 
(2) recommendations for improving access to 
health care for racial and ethnic minorities. 
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1697 
SEC. 10008. ESTABLISH AN INTERAGENCY COUNSEL AND 
GRANT 
PROGRAMS 
ON 
SOCIAL 
DETER-
MINANTS OF HEALTH. 
(a) FINDINGS; PURPOSES.— 
(1) FINDINGS.—Congress finds the following: 
(A) There is a significant body of evidence 
showing that economic and social conditions 
have a powerful impact on individual and popu-
lation health outcomes and well-being, as well 
as medical costs. 
(B) State, local, and Tribal governments 
and the service delivery partners of such gov-
ernments face significant challenges in coordi-
nating benefits and services delivered through 
the Medicaid program and other social services 
programs because of the fragmented and com-
plex nature of Federal and State funding and 
administrative requirements. 
(C) 
The 
Federal 
Government 
should 
prioritize and proactively assist State and local 
governments to strengthen the capacity of State 
and local governments to improve health and 
social outcomes for individuals, thereby improv-
ing cost-effectiveness and return on investment. 
(2) PURPOSES.—The purposes of this section 
are as follows: 
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(A) To establish effective, coordinated Fed-
eral technical assistance to help State and local 
governments to improve outcomes and cost-ef-
fectiveness of, and return on investment from, 
health and social services programs. 
(B) To build a pipeline of State and locally 
designed, cross-sector interventions and strate-
gies that generate rigorous evidence about how 
to improve health and social outcomes, and in-
crease the cost-effectiveness of, and return on 
investment from, Federal, State, local, and 
Tribal health and social services programs. 
(C) To enlist State and local governments 
and the service providers of such governments 
as partners in identifying Federal statutory, 
regulatory, and administrative challenges in im-
proving the health and social outcomes of, cost- 
effectiveness of, and return on investment from, 
Federal spending on individuals enrolled in 
Medicaid. 
(D) To develop strategies to improve 
health and social outcomes without denying 
services to, or restricting the eligibility of, vul-
nerable populations. 
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(b) SOCIAL DETERMINANTS ACCELERATOR COUN-
CIL.— 
(1) ESTABLISHMENT.—The Secretary of Health 
and Human Services (referred to in this section as 
the ‘‘Secretary’’), in coordination with the Adminis-
trator of the Centers for Medicare & Medicaid Serv-
ices (referred to in this section as the ‘‘Adminis-
trator’’), shall establish an interagency council, to be 
known as the Social Determinants Accelerator Inter-
agency Council (referred to in this section as the 
‘‘Council’’) to achieve the purposes listed in sub-
section (b)(2). 
(2) MEMBERSHIP.— 
(A) FEDERAL COMPOSITION.—The Council 
shall be composed of at least one designee from 
each of the following Federal agencies: 
(i) The Office of Management and 
Budget. 
(ii) The Department of Agriculture. 
(iii) The Department of Education. 
(iv) The Indian Health Service. 
(v) The Department of Housing and 
Urban Development. 
(vi) The Department of Labor. 
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(vii) The Department of Transpor-
tation. 
(viii) Any other Federal agency the 
Chair of the Council determines necessary. 
(B) DESIGNATION.— 
(i) IN GENERAL.—The head of each 
agency specified in subparagraph (A) shall 
designate at least one employee described 
in clause (ii) to serve as a member of the 
Council. 
(ii) RESPONSIBILITIES.—An employee 
described in this clause shall be a senior 
employee of the agency— 
(I) whose responsibilities relate 
to authorities, policies, and procedures 
with respect to the health and well- 
being of individuals receiving medical 
assistance under a State plan (or a 
waiver of such plan) under title XIX 
of the Social Security Act (42 U.S.C. 
1396 et seq.); or 
(II) who has authority to imple-
ment and evaluate transformative ini-
tiatives that harness data or conduct 
rigorous evaluation to improve the im-
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1701 
pact and cost-effectiveness of federally 
funded services and benefits. 
(C) HHS REPRESENTATION.—In addition 
to the designees under subparagraph (A), the 
Council shall include designees from at least 3 
agencies within the Department of Health and 
Human Services, including the Centers for 
Medicare & Medicaid Services, at least one of 
whom shall meet the criteria under subpara-
graph (B)(ii). 
(D) OMB ROLE.—The Director of the Of-
fice of Management and Budget shall facilitate 
the timely resolution of Federal Government- 
wide and multiagency issues to help the Council 
achieve consensus recommendations described 
under this section. 
(E) NON-FEDERAL
COMPOSITION.—The 
Comptroller General of the United States may 
designate up to 6 Council designees— 
(i) who have relevant subject matter 
expertise, including expertise implementing 
and evaluating transformative initiatives 
that harness data and conduct evaluations 
to improve the impact and cost-effective-
ness of Federal Government services; and 
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1702 
(ii) that each represent— 
(I) State, local, and Tribal health 
and human services agencies; 
(II) public housing authorities or 
State housing finance agencies; 
(III) State and local government 
budget offices; 
(IV) State Medicaid agencies; or 
(V) national consumer advocacy 
organizations. 
(F) CHAIR.— 
(i) IN GENERAL.—The Secretary shall 
select the Chair of the Council from among 
the members of the Council. 
(ii) 
INITIATING
GUIDANCE.—The 
Chair, on behalf of the Council, shall iden-
tify and invite individuals from diverse en-
tities to provide the Council with advice 
and information pertaining to addressing 
social determinants of health, including— 
(I) individuals from State and 
local government health and human 
services agencies; 
(II) individuals from State Med-
icaid agencies; 
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1703 
(III) individuals from State and 
local government budget offices; 
(IV) 
individuals 
from 
public 
housing authorities or State housing 
finance agencies; 
(V) individuals from nonprofit or-
ganizations, small businesses, and 
philanthropic organizations; 
(VI) advocates; 
(VII) researchers; and 
(VIII) any other individuals the 
Chair determines to be appropriate. 
(3) DUTIES.—The duties of the Council are— 
(A) to make recommendations to the Sec-
retary and the Administrator regarding the cri-
teria for making awards under this section; 
(B) to identify Federal authorities and op-
portunities for use by States or local govern-
ments to improve coordination of funding and 
administration of Federal programs, the bene-
ficiaries of whom include individuals, and which 
may be unknown or underutilized, and to make 
information on such authorities and opportuni-
ties publicly available; 
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1704 
(C) to provide targeted technical assistance 
to States developing a social determinants ac-
celerator plan under this section, including 
identifying potential statutory or regulatory 
pathways for implementation of the plan and 
assisting in identifying potential sources of 
funding to implement the plan; 
(D) to report to Congress annually on the 
subjects set forth in this section; 
(E) to develop and disseminate evaluation 
guidelines and standards that can be used to 
reliably assess the impact of an intervention or 
approach that may be implemented pursuant to 
this section on outcomes, cost-effectiveness of, 
and return on investment from Federal, State, 
local, and Tribal governments, and to facilitate 
technical assistance, where needed, to help to 
improve State and local evaluation designs and 
implementation; 
(F) to seek feedback from State, local, and 
Tribal governments, including through an an-
nual survey by an independent third party, on 
how to improve the technical assistance the 
Council provides to better equip State, local, 
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1705 
and Tribal governments to coordinate health 
and social service programs; 
(G) to solicit applications for grants under 
this section; and 
(H) to coordinate with other cross-agency 
initiatives focused on improving the health and 
well-being of low-income and at-risk populations 
in order to prevent unnecessary duplication be-
tween agency initiatives. 
(4) SCHEDULE.—Not later than 60 days after 
the date of the enactment of this Act, the Council 
shall convene to develop a schedule and plan for car-
rying out the duties described in this section, includ-
ing solicitation of applications for the grants under 
this section. 
(5) REPORT TO CONGRESS.—The Council shall 
submit an annual report to Congress, which shall in-
clude— 
(A) a list of the Council members; 
(B) activities and expenditures of the 
Council; 
(C) summaries of the interventions and ap-
proaches that will be supported by State, local, 
and Tribal governments that received a grant 
under this section, including— 
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1706 
(i) the best practices and evidence- 
based approaches such governments plan 
to employ to achieve the purposes listed in 
this section; and 
(ii) a description of how the practices 
and approaches will impact the outcomes, 
cost-effectiveness of, and return on invest-
ment from, Federal, State, local, and Trib-
al governments with respect to such pur-
poses; 
(D) the feedback received from State and 
local governments on ways to improve the tech-
nical assistance of the Council, including find-
ings from a third-party survey and actions the 
Council plans to take in response to such feed-
back; and 
(E) the major statutory, regulatory, and 
administrative challenges identified by State, 
local, and Tribal governments that received a 
grant under subsection (d), and the actions that 
Federal agencies are taking to address such 
challenges. 
(6) FACA APPLICABILITY.—The Federal Advi-
sory Committee Act (5 U.S.C. App.) shall not apply 
to the Council. 
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1707 
(7) COUNCIL PROCEDURES.—The Secretary, in 
consultation with the Comptroller General of the 
United States and the Director of the Office of Man-
agement and Budget, shall establish procedures for 
the Council to— 
(A) ensure that adequate resources are 
available to effectively execute the responsibil-
ities of the Council; 
(B) effectively coordinate with other rel-
evant advisory bodies and working groups to 
avoid unnecessary duplication; 
(C) create transparency to the public and 
Congress with regard to Council membership, 
costs, and activities, including through use of 
modern technology and social media to dissemi-
nate information; and 
(D) avoid conflicts of interest that would 
jeopardize the ability of the Council to make de-
cisions and provide recommendations. 
(c) SOCIAL DETERMINANTS ACCELERATOR GRANTS 
TO STATES OR LOCAL GOVERNMENTS.— 
(1) GRANTS TO STATES, LOCAL GOVERNMENTS, 
AND TRIBES.—Not later than 180 days after the 
date of the enactment of this Act, the Administrator, 
in consultation with the Secretary and the Council, 
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1708 
shall award on a competitive basis not more than 25 
grants to eligible applicants described in this sub-
section, for the development of social determinants 
accelerator plans, as described in this subsection. 
(2) ELIGIBLE
APPLICANT.—An eligible appli-
cant described in this subsection is a State, local, or 
Tribal health or human services agency that— 
(A) demonstrates the support of relevant 
parties across relevant State, local, or Tribal ju-
risdictions; and 
(B) in the case of an applicant that is a 
local government agency, provides to the Sec-
retary a letter of support from the lead State 
health or human services agency for the State 
in which the local government is located. 
(3) AMOUNT OF GRANT.—The Administrator, 
in coordination with the Council, shall determine the 
total amount that the Administrator will make avail-
able to each grantee under this subsection. 
(4) APPLICATION.—An eligible applicant seek-
ing a grant under this subsection shall include in the 
application the following information: 
(A) The target population (or populations) 
that would benefit from implementation of the 
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1709 
social determinants accelerator plan proposed to 
be developed by the applicant. 
(B) A description of the objective or objec-
tives and outcome goals of such proposed plan, 
which shall include at least one health outcome 
and at least one other important social out-
come. 
(C) The sources and scope of inefficiencies 
that, if addressed by the plan, could result in 
improved cost-effectiveness of or return on in-
vestment from Federal, State, local, and Tribal 
governments. 
(D) A description of potential interventions 
that could be designed or enabled using such 
proposed plan. 
(E) The State, local, and Tribal govern-
ments, academic institutions, nonprofit organi-
zations, community-based organizations, and 
other public and private sector partners that 
would participate in the development of the pro-
posed plan and subsequent implementation of 
programs or initiatives included in such pro-
posed plan. 
(F) Such other information as the Admin-
istrator, in consultation with the Secretary and 
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1710 
the Council, determines necessary to achieve the 
purposes of this section. 
(5) USE OF FUNDS.—A recipient of a grant 
under this subsection may use funds received 
through the grant for the following purposes: 
(A) To convene and coordinate with rel-
evant government entities and other stake-
holders across sectors to assist in the develop-
ment of a social determinant accelerator plan. 
(B) To identify populations of individuals 
receiving medical assistance under a State plan 
(or a waiver of such plan) under title XIX of 
the Social Security Act (42 U.S.C. 1396 et 
seq.) who may benefit from the proposed ap-
proaches to improving the health and well-being 
of such individuals through the implementation 
of the proposed social determinants accelerator 
plan. 
(C) To engage qualified research experts to 
advise on relevant research and to design a pro-
posed evaluation plan, in accordance with the 
standards and guidelines issued by the Admin-
istrator. 
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1713 
(I) A description of potential consider-
ations 
that 
would 
enhance 
the 
impact, 
scalability, or sustainability of the proposed 
interventions or approaches and the actions the 
grant awardee would take to address such con-
siderations. 
(J) A proposed evaluation plan, to be car-
ried out by an independent evaluator, to meas-
ure the impact of the proposed interventions or 
approaches on the outcomes of, cost-effective-
ness of, and return on investment from, Fed-
eral, State, local, and Tribal governments. 
(K) Precautions for ensuring that vulner-
able populations will not be denied access to 
Medicaid or other essential services as a result 
of implementing the proposed plan. 
(d) FUNDING.— 
(1) IN GENERAL.—Out of any money in the 
Treasury not otherwise appropriated, there is appro-
priated to carry out this section $25,000,000 to re-
main available for obligation until the date that is 
5 years after the date of enactment of this section. 
(2) RESERVATION OF FUNDS.— 
(A) IN
GENERAL.—Of the funds made 
available under paragraph (1), the Secretary 
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1714 
shall reserve not less than 20 percent to award 
grants to eligible applicants for the development 
of social determinants accelerator plans under 
this section intended to serve rural populations. 
(B) EXCEPTION.—In the case of a fiscal 
year for which the Secretary determines that 
there are not sufficient eligible applicants to 
award up to 25 grants under subsection (d) 
that are intended to serve rural populations and 
the Secretary cannot satisfy the 20-percent re-
quirement, the Secretary may reserve an 
amount that is less than 20 percent of amounts 
made available under paragraph (1) to award 
grants for such purpose. 
(3) RULE OF CONSTRUCTION.—Nothing in this 
section shall prevent Federal agencies represented 
on the Council from contributing additional funding 
from other sources to support activities to improve 
the effectiveness of the Council. 
SEC. 10009. CORRECTING HURTFUL AND ALIENATING 
NAMES 
IN 
GOVERNMENT 
EXPRESSION 
(CHANGE). 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Correcting Hurtful and Alienating Names in Government 
Expression (CHANGE) Act’’. 
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1715 
(b) DEFINITIONS.—In this section: 
(1) EMPLOYEE.—The term ‘‘employee’’ has the 
meaning given the term in section 2105 of title 5, 
United States Code. 
(2) EXECUTIVE AGENCY.—The term ‘‘Executive 
agency’’ has the meaning given the term in section 
105 of title 5, United States Code. 
(3) OFFICER.—The term ‘‘officer’’ has the 
meaning given the term in section 2104 of title 5, 
United States Code. 
(4) PROHIBITED TERM.—The term ‘‘prohibited 
term’’ means— 
(A) the term ‘‘alien’’, when used to refer to 
an individual who is not a citizen or national of 
the United States; and 
(B) the term ‘‘illegal alien’’, when used to 
refer to an individual who— 
(i) is unlawfully present in the United 
States; or 
(ii) lacks a lawful immigration status 
in the United States. 
(c) MODERNIZATION OF LANGUAGE REFERRING TO 
INDIVIDUALS WHO ARE NOT CITIZENS OR NATIONALS OF 
THE UNITED STATES.— 
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1716 
(1) IN GENERAL.—Except as provided in para-
graph (2), on and after the date of enactment of this 
Act, an Executive agency may not use a prohibited 
term in any proposed or final rule, regulation, inter-
pretation, publication, other document, display, or 
sign issued by the Executive agency. 
(2) EXCEPTION.—An Executive agency may use 
a prohibited term under paragraph (1) if the Execu-
tive agency uses the prohibited term while quoting 
or reproducing text written by a source that is not 
an officer or employee of the Executive agency. 
(d) UNIFORM DEFINITION.— 
(1) IN GENERAL.—Chapter 1 of title 1, United 
States Code, is amended by adding at the end the 
following: 
‘‘§ 9. Definition of ‘foreign national’ 
‘‘In determining the meaning of any Act of Congress 
or any ruling, regulation, or interpretation of an adminis-
trative bureau or agency of the United States, the term 
‘foreign national’ means any individual that is not an indi-
vidual who— 
‘‘(1) is a citizen of the United States; or 
‘‘(2) though not a citizen of the United States, 
owes permanent allegiance to the United States.’’. 
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1717 
(2) TECHNICAL
AMENDMENT.—The table of 
sections for chapter 1 of title 1, United States Code, 
is amended by adding at the end the following: 
‘‘9. Definition of ‘foreign national’.’’. 
(e) REFERENCES.—Any reference in any Federal 
statute, rule, regulation, Executive order, publication, or 
other document of the United States— 
(1) to the term ‘‘alien’’, when used to refer to 
an individual who is not a citizen or national of the 
United States, is deemed to refer to the term ‘‘for-
eign national’’; and 
(2) to the term ‘‘illegal alien’’ is deemed to 
refer to the term ‘‘undocumented foreign national’’, 
when used to refer to an individual who— 
(A) is unlawfully present in the United 
States; or 
(B) lacks a lawful immigration status in 
the United States. 
SEC. 10010. ANDREW KEARSE ACCOUNTABILITY FOR DE-
NIAL OF MEDICAL CARE. 
(a) IN GENERAL.—Chapter 13 of title 18, United 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘§ 250. Medical attention for individuals in Federal 
custody displaying medical distress 
‘‘(a) DEFINITIONS.—In this section— 
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1718 
‘‘(1) the term ‘appropriate Inspector General’, 
with respect to a covered official, means— 
‘‘(A) the Inspector General of the Federal 
agency that employs the covered official; or 
‘‘(B) in the case of a covered official em-
ployed by a Federal agency that does not have 
an Inspector General, the Inspector General of 
the Department of Justice; 
‘‘(2) the term ‘covered official’ means— 
‘‘(A) a Federal law enforcement officer (as 
defined in section 115); 
‘‘(B) an officer or employee of the Bureau 
of Prisons; or 
‘‘(C) an officer or employee of the United 
States Marshals Service; and 
‘‘(3) the term ‘medical distress’ includes breath-
ing difficulties. 
‘‘(b) REQUIREMENT.— 
‘‘(1) OFFENSE.—It shall be unlawful for a cov-
ered official to negligently fail to obtain or provide 
immediate medical attention to an individual in Fed-
eral custody who displays medical distress in the 
presence of the covered official, if the individual suf-
fers unnecessary pain, injury, or death as a result of 
that failure. 
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1719 
‘‘(2) PENALTY.—A covered official who violates 
paragraph (1) shall be fined under this title, impris-
oned for not more than 1 year, or both. 
‘‘(3) STATE CIVIL ENFORCEMENT.—Whenever 
an attorney general of a State has reasonable cause 
to believe that a resident of the State has been ag-
grieved by a violation of paragraph (1) by a covered 
official, the attorney general, or another official, 
agency, or entity designated by the State, may bring 
a civil action in any appropriate district court of the 
United States to obtain appropriate equitable and 
declaratory relief. 
‘‘(c) INSPECTOR GENERAL INVESTIGATION.— 
‘‘(1) IN GENERAL.—The appropriate Inspector 
General shall investigate any instance in which— 
‘‘(A) a covered official fails to obtain or 
provide immediate medical attention to an indi-
vidual in Federal custody who displays medical 
distress in the presence of the covered official; 
and 
‘‘(B) the individual suffers unnecessary 
pain, injury, or death as a result of the failure 
to obtain or provide immediate medical atten-
tion. 
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1720 
‘‘(2) REFERRAL FOR PROSECUTION.—If an In-
spector General, in conducting an investigation 
under paragraph (1), concludes that the covered offi-
cial acted negligently in failing to obtain or provide 
immediate medical attention to the individual in 
Federal custody, the Inspector General shall refer 
the case to the Attorney General for prosecution 
under this section. 
‘‘(3) CONFIDENTIAL
COMPLAINT
PROCESS.— 
The Inspector General of a Federal agency that em-
ploys covered officials shall establish a process under 
which an individual may confidentially submit a 
complaint to the Inspector General regarding an in-
cident described in paragraph (1) involving a covered 
official employed by the Federal agency (or, in the 
case of the Inspector General of the Department of 
Justice, involving a covered official employed by a 
Federal agency that does not have an Inspector Gen-
eral). 
‘‘(d) TRAINING.—The head of an agency that em-
ploys covered officials shall provide training to each such 
covered official on obtaining or providing medical assist-
ance to individuals in medical distress.’’. 
(b) TECHNICAL AND CONFORMING AMENDMENT.— 
The table of sections for chapter 13 of title 18, United 
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1721 
States Code, is amended by adding at the end the fol-
lowing: 
‘‘250. Medical attention for individuals in Federal custody displaying medical 
distress.’’. 
SEC. 10011. INVESTING IN COMMUNITY HEALING. 
(a) FINDINGS.—Congress finds the following: 
(1) According to the Bureau of Justice Statis-
tics, African Americans are more likely to have face- 
to-face contact with law enforcement and are 2.5 
times more likely to experience a threat or use of 
nonfatal force by police. 
(2) Research shows that young men who have 
experienced these law enforcement practices display 
higher levels of stress, anxiety, and trauma associ-
ated with the interaction. 
(3) Witnessing or experiencing invasive encoun-
ters with law enforcement can also be an everyday 
stressor for racial and ethnic minorities, leading to 
physiological and psychological strain. 
(4) Racial and ethnic minorities face inequities 
in accessing mental health services. 
(5) Addressing the stigma in some communities 
of color associated with receiving mental health serv-
ices and informing individuals about available treat-
ment can encourage better utilization of these serv-
ices. 
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1722 
(b) SENSE OF CONGRESS.—It is the sense of the 
Congress that it is imperative that a comprehensive public 
health approach to addressing trauma and mental health 
care be focused on care delivery that is culturally sensitive 
and competent. 
(c) RESEARCH ON ADVERSE HEALTH EFFECTS AS-
SOCIATED WITH INTERACTIONS WITH LAW ENFORCE-
MENT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the 
‘‘Secretary’’), acting through the Director of the Of-
fice of Minority Health of the Centers for Disease 
Control and Prevention (established pursuant to sec-
tion 1707A of the Public Health Service Act (42 
U.S.C. 300u–6a)), shall conduct research on the ad-
verse health effects associated with interactions with 
law enforcement. 
(2) EFFECTS AMONG RACIAL AND ETHNIC MI-
NORITIES.—The research under paragraph (1) shall 
include research on— 
(A) the health consequences, both indi-
vidual and community-wide, of trauma related 
to violence committed by law enforcement 
among racial and ethnic minorities; and 
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1723 
(B) the disproportionate burden of mor-
bidity and mortality associated with such trau-
ma. 
(3) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Secretary shall— 
(A) complete the research under this sub-
section; and 
(B) submit to the Congress a report on the 
findings, conclusions, and recommendations re-
sulting from such research. 
(d) GRANTS FOR INCREASING RACIAL AND ETHNIC 
MINORITY ACCESS TO HIGH-QUALITY TRAUMA SUPPORT 
SERVICES AND MENTAL HEALTH CARE.— 
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Assistant Secretary for Mental Health 
and Substance Use, shall award grants to eligible 
entities to establish or expand programs for the pur-
pose of increasing racial and ethnic minority access 
to high-quality trauma support services and mental 
health care. 
(2) ELIGIBLE
ENTITIES.—To seek a grant 
under this subsection, an entity shall be a commu-
nity-based program or organization that— 
(A) provides culturally competent pro-
grams and resources that are aligned with evi-
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1724 
dence-based practices for trauma-informed care; 
and 
(B) has demonstrated expertise in serving 
communities of color or can partner with a pro-
gram that has such demonstrated expertise. 
(3) USE OF FUNDS.—As a condition on receipt 
of a grant under this subsection, a grantee shall 
agree to use the grant to increase racial and ethnic 
minority access to high-quality trauma support serv-
ices and mental health care, such as by— 
(A) establishing and maintaining commu-
nity-based programs providing evidence-based 
services in trauma-informed care and culturally 
specific services and other resources; 
(B) developing innovative culturally spe-
cific strategies and projects to enhance access 
to trauma-informed care and resources for ra-
cial and ethnic minorities who face obstacles to 
using more traditional services and resources 
(such as obstacles in geographic access to pro-
viders, insurance coverage, and access to audio 
and video technologies); 
(C) working with State and local govern-
ments and social service agencies to develop and 
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1725 
enhance effective strategies to provide culturally 
specific services to racial and ethnic minorities; 
(D) increasing communities’ capacity to 
provide culturally specific resources and support 
for communities of color; 
(E) working in cooperation with the com-
munity to develop education and prevention 
strategies highlighting culturally specific issues 
and resources regarding racial and ethnic mi-
norities; 
(F) providing culturally specific programs 
for racial and ethnic minorities exposed to law 
enforcement violence; and 
(G) examining the dynamics of culture and 
its impact on victimization and healing. 
(4) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to eligi-
ble entities proposing to serve communities that have 
faced high rates of community trauma, including 
from exposure to law enforcement violence, intergen-
erational poverty, civil unrest, discrimination, or op-
pression. 
(5) GRANT
PERIOD.—The period of a grant 
under this subsection shall be 4 years. 
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1726 
(6) EVALUATION.—Not later than 6 months 
after the end of the period of all grants under this 
subsection, the Secretary shall— 
(A) conduct an evaluation of the programs 
funded by a grant under this subsection; 
(B) include in such evaluation an assess-
ment of the outcomes of each such program; 
and 
(C) submit a report on the results of such 
evaluation to the Congress. 
(7) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this subsection, there is authorized to be 
appropriated $20,000,000 for each of fiscal years 
2023 through 2027. 
(e) BEHAVIORAL AND MENTAL HEALTH OUTREACH 
EDUCATION STRATEGY.— 
(1) IN GENERAL.—The Secretary shall, in co-
ordination with advocacy and behavioral and mental 
health organizations serving racial and ethnic minor-
ity groups, develop and implement an outreach and 
education strategy to promote behavioral and mental 
health, and reduce stigma associated with mental 
health conditions, among racial and ethnic minori-
ties. 
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1727 
(2) DESIGN.—The strategy under this sub-
section shall be designed to— 
(A) meet the diverse cultural and language 
needs of racial and ethnic minority groups; 
(B) provide information on evidence-based, 
culturally and linguistically appropriate and 
adapted interventions and treatments; 
(C) increase awareness of symptoms of 
mental illness among racial and ethnic minority 
groups; and 
(D) ensure full participation of, and en-
gage, both consumers and community members 
in the development and implementation of ma-
terials. 
(3) REPORT.—Not later than 1 year after the 
date of enactment of this Act, the Secretary shall 
submit to the Congress, and make publicly available, 
a report detailing the outreach and education strat-
egy that is developed and implemented under this 
subsection and the results of such implementation. 
SEC. 10012. ENVIRONMENTAL JUSTICE MAPPING AND DATA 
COLLECTION. 
(a) FINDINGS.—Congress finds that— 
(1) environmental hazards causing adverse 
health outcomes have disproportionately affected en-
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vironmental justice communities as a result of sys-
temic injustices relating to factors that include race 
and income; 
(2) environmental justice communities have in-
creased vulnerability to the adverse effects of climate 
change and need significant investment to face cur-
rent and future environmental hazards; 
(3) the Federal Government has lacked a cohe-
sive and consistent strategy to carry out the respon-
sibilities of Federal agencies described in Executive 
Order 12898 (42 U.S.C. 4321 note; relating to Fed-
eral actions to address environmental justice in mi-
nority populations and low-income populations); 
(4) it is necessary that the Federal Government 
meaningfully engage environmental justice commu-
nities in the process of developing a robust strategy 
to address environmental justice, including high lev-
els of review, input, and consent; 
(5) there is a lack of nationwide high-quality 
data relating to environmental justice concerns, such 
as socioeconomic factors, air pollution, water pollu-
tion, soil pollution, and public health, and a failure 
to update the existing data with adequate frequency; 
(6) there is no nationally consistent method to 
identify environmental justice communities based on 
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1729 
the cumulative effects of socioeconomic factors, pol-
lution burden, and public health; 
(7) a method described in paragraph (6) is 
needed to correct for racist and unjust practices 
leading to historical and current environmental in-
justices through the targeted investment in environ-
mental justice communities of at least 40 percent of 
the funds provided for a clean energy transition and 
other related investments, including transportation 
infrastructure, housing infrastructure, and water 
quality infrastructure; 
(8) funds targeted for environmental justice 
communities should include set-asides for technical 
assistance and capacity building for environmental 
justice communities to access the funds; 
(9) particular oversight and care are necessary 
when investing in environmental justice communities 
to ensure that existing issues are not exacerbated 
and new issues are not created, particularly issues 
relating to pollution burden and the displacement of 
residents; 
(10) several States, academic institutions, and 
nonprofit organizations have engaged in cumulative 
impact environmental justice mapping efforts that 
can serve as references for a Federal mapping effort; 
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1730 
(11) many environmental justice communities, 
such as communities in ‘‘Cancer Alley’’ in the State 
of Louisiana, have been clearly affected by extreme 
environmental hazards such that the communities— 
(A) are identifiable before the establish-
ment of the tool under paragraph (2) of sub-
section (d) and the completion of the data gap 
audit under paragraph (4) of that subsection; 
and 
(B) should be eligible for programs tar-
geted toward environmental justice communities 
that have faced extreme environmental hazards 
before the establishment of that tool and the 
completion of that audit; 
(12) in addition to investment in environmental 
justice communities, pollution reduction is essential 
to achieving equitable access to a healthy and clean 
environment and an equitable energy system; and 
(13) specific policy and permitting decisions 
and investments may rely on different combinations 
of data sets and indicators relating to environmental 
justice, and race alone may be considered a criterion 
when assessing the susceptibility of a community to 
environmental injustice. 
(b) DEFINITIONS.—In this section: 
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1731 
(1) ADMINISTRATOR.—The term ‘‘Adminis-
trator’’ means the Administrator of the Environ-
mental Protection Agency. 
(2) ADVISORY COUNCIL.—The term ‘‘advisory 
council’’ means the advisory council established 
under subsection (c)(4)(B)(i). 
(3) 
COMMITTEE.—The 
term 
‘‘Committee’’ 
means the Environmental Justice Mapping Com-
mittee established by subsection (c)(1). 
(4) ENVIRONMENTAL JUSTICE.—The term ‘‘en-
vironmental justice’’ means the fair treatment and 
meaningful involvement of all people regardless of 
race, color, culture, national origin, or income, with 
respect to the development, implementation, and en-
forcement of environmental laws, regulations, and 
policies to ensure that each person enjoys— 
(A) the same degree of protection from en-
vironmental and health hazards; and 
(B) equal access to any Federal agency ac-
tion relating to the development, implementa-
tion, and enforcement of environmental laws, 
regulations, and policies for the purpose of hav-
ing a healthy environment in which to live, 
learn, work, and recreate. 
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1732 
(5) ENVIRONMENTAL
JUSTICE
COMMUNITY.— 
The term ‘‘environmental justice community’’ means 
a community with significant representation of com-
munities of color, low-income communities, or Tribal 
and indigenous communities, that experiences, or is 
at risk of experiencing, higher or more adverse 
human health or environmental effects, as compared 
to other communities. 
(6) GROUND-TRUTHING.—The term ‘‘ground- 
truthing’’ means a community fact-finding process 
by which residents of a community supplement tech-
nical information with local knowledge for the pur-
pose of better informing policy and project decisions. 
(7) RELEVANT STAKEHOLDER.—The term ‘‘rel-
evant stakeholder’’ means— 
(A) a representative of a regional, State, 
Tribal, or local government agency; 
(B) a representative of a nongovernmental 
organization with experience in areas that may 
include Tribal relations, environmental con-
servation, city and regional planning, and public 
health; 
(C) a representative of a labor union; 
(D) a representative or member of— 
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1733 
(i) an environmental justice commu-
nity; or 
(ii) a community-based organization 
for an environmental justice community; 
(E) an individual with expertise in cumu-
lative impacts, geospatial data, and environ-
mental justice, particularly such an individual 
from an academic or research institution; and 
(F) an advocate with experience in envi-
ronmental justice who represents an environ-
mental justice community. 
(c) ESTABLISHMENT OF COMMITTEE.— 
(1) IN GENERAL.—There is established a com-
mittee, to be known as the ‘‘Environmental Justice 
Mapping Committee’’. 
(2) MEMBERSHIP.— 
(A) IN GENERAL.—The Committee shall be 
composed of not fewer than 1 representative of 
each of the following: 
(i) Of the Environmental Protection 
Agency— 
(I) the Office of Air and Radi-
ation; 
(II) the Office of Chemical Safety 
and Pollution Prevention; 
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1734 
(III) the Office of International 
and Tribal Affairs; 
(IV) the Office of Land and 
Emergency Management; 
(V) the Office of Water; 
(VI) the Office of Environmental 
Justice; 
(VII) the Office of Research and 
Development; and 
(VIII) the Office of Public En-
gagement and Environmental Edu-
cation. 
(ii) The Council on Environmental 
Quality. 
(iii) Of the Department of Com-
merce— 
(I) the Office of Oceanic and At-
mospheric Research, including not 
fewer than 1 representative of the Cli-
mate Program Office; 
(II) the Economics and Statistics 
Administration, including not fewer 
than 1 representative of the Bureau 
of Economic Analysis; and 
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1735 
(III) the National Institute of 
Standards and Technology. 
(iv) Of the Department of Health and 
Human Services— 
(I) the Centers for Disease Con-
trol and Prevention, not including the 
Agency for Toxic Substances and Dis-
ease Registry; 
(II) the Agency for Toxic Sub-
stances and Disease Registry; 
(III) the Administration for Chil-
dren and Families; 
(IV) of the National Institutes of 
Health— 
(aa) the National Institute 
of 
Environmental 
Health 
Sciences; 
(bb) the National Institute 
of Mental Health; and 
(cc) the National Institute 
on Minority Health and Health 
Disparities; and 
(V) the Office for Civil Rights. 
(v) Of the Department of the Inte-
rior— 
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1736 
(I) the Bureau of Indian Affairs; 
(II) the Office of Civil Rights; 
and 
(III) the United States Geologi-
cal Survey. 
(vi) The Forest Service. 
(vii) The Department of Housing and 
Urban Development. 
(viii) The Department of Energy. 
(ix) The Department of Transpor-
tation. 
(x) The Department of Justice. 
(xi) The Federal Energy Regulatory 
Commission. 
(xii) The Department of the Treasury. 
(xiii) Such other Federal departments, 
agencies, and offices as the Administrator 
determines to be appropriate, particularly 
offices relating to public engagement. 
(B) SELECTION OF REPRESENTATIVES.— 
The head of a department or agency described 
in subparagraph (A) shall, in appointing to the 
Committee a representative of the department 
or agency, select a representative— 
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1737 
(i) of a component of the department 
or agency that is among the components 
that are the most relevant to the respon-
sibilities of the Committee; or 
(ii) who has expertise in areas rel-
evant to those responsibilities, such as de-
mographic indicators relating to socio-
economic hardship, environmental justice, 
public engagement, public health, exposure 
to pollution, future climate and extreme 
weather mapping, affordable energy, sus-
tainable transportation, and access to 
water, food, and green space. 
(C) CO-CHAIRS.— 
(i) IN
GENERAL.—The members of 
the Committee shall select 3 members to 
serve as co-chairs of the Committee— 
(I) 1 of whom shall be a rep-
resentative of the Environmental Pro-
tection Agency; 
(II) 1 of whom shall be a rep-
resentative of the Council on Environ-
mental Quality; and 
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1738 
(III) 1 of whom shall have sub-
stantial experience in public engage-
ment. 
(ii) 
TERMS.—Each 
co-chair 
shall 
serve for a term of not more than 3 years. 
(iii) 
RESPONSIBILITIES
OF
CO- 
CHAIRS.—The co-chairs of the Committee 
shall— 
(I) determine the agenda of the 
Committee, in consultation with other 
members of the Committee; 
(II) direct the work of the Com-
mittee, including the oversight of a 
meaningful public engagement proc-
ess; and 
(III) convene meetings of the 
Committee not less frequently than 
once each fiscal quarter. 
(3) ADMINISTRATIVE SUPPORT.— 
(A) IN
GENERAL.—The Administrator 
shall provide technical and administrative sup-
port to the Committee. 
(B) FUNDING.—The Administrator may 
carry out subparagraph (A) using, in addition 
to any amounts made available under sub-
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1739 
section (f), amounts authorized to be appro-
priated to the Administrator before the date of 
enactment of this Act and available for obliga-
tion as of that date of enactment. 
(4) CONSULTATION.— 
(A) IN GENERAL.—In carrying out the du-
ties of the Committee, the Committee shall con-
sult with relevant stakeholders. 
(B) ADVISORY COUNCIL.— 
(i) IN
GENERAL.—The Committee 
shall establish an advisory council com-
posed of a balanced proportion of relevant 
stakeholders, at least 1⁄2 of whom shall 
represent environmental justice commu-
nities. 
(ii) CHAIR.—The advisory council 
shall be chaired by an environmental jus-
tice advocate or other relevant stakeholder 
with substantial experience in environ-
mental justice. 
(iii) 
REQUIREMENTS.—Consultation 
described in subparagraph (A) shall in-
clude— 
(I) early and regular engagement 
with the advisory council, including in 
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1740 
carrying out public engagement under 
subparagraph (C); and 
(II) consideration of the rec-
ommendations of the advisory council. 
(iv) RECOMMENDATIONS NOT USED.— 
If the Committee does not use a rec-
ommendation of the advisory council, not 
later than 60 days after the date on which 
the Committee receives notice of the rec-
ommendation, the Committee shall— 
(I) make available to the public 
on an internet website of the Environ-
mental Protection Agency a written 
report describing the rationale of the 
Committee for not using the rec-
ommendation; and 
(II) submit the report described 
in subclause (I) to the Committee on 
Environment and Public Works of the 
Senate and the Committee on Energy 
and Commerce of the House of Rep-
resentatives. 
(v) OUTREACH.—The advisory council 
may carry out public outreach activities 
using amounts made available under sub-
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1745 
determined by the Administrator, in con-
sultation with the advisory council. 
(d) DUTIES OF COMMITTEE.— 
(1) IN GENERAL.—The Committee shall— 
(A) establish a tool described in paragraph 
(2) to identify environmental justice commu-
nities, including the identification of— 
(i) criteria to be used in the tool; and 
(ii) a methodology to determine the 
cumulative impacts of those criteria; 
(B) assess and address data gaps in ac-
cordance with paragraph (4); and 
(C) collect data for the environmental jus-
tice data repository established under sub-
section (e). 
(2) ESTABLISHMENT OF TOOL.— 
(A) IN GENERAL.—The Committee, in con-
sultation with relevant stakeholders and the ad-
visory council, shall establish an interactive, 
transparent, integrated, and Federal Govern-
ment-wide tool for assessing and mapping envi-
ronmental justice communities based on the cu-
mulative impacts of all indicators selected by 
the Committee to be integrated into the tool. 
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1746 
(B) REQUIREMENTS.—In establishing the 
tool under subparagraph (A), the Committee 
shall— 
(i) integrate into the tool multiple 
data layers of indicators that fall into cat-
egories including— 
(I) demographics, particularly re-
lating to socioeconomic hardship and 
social stressors, such as— 
(aa) race and ethnicity; 
(bb) low income; 
(cc) high unemployment; 
(dd) low levels of home own-
ership; 
(ee) high rent burden; 
(ff) high transportation bur-
den; 
(gg) low levels of educational 
attainment; 
(hh) linguistic isolation; 
(ii) energy insecurity or high 
utility rate burden; 
(jj) food insecurity; 
(kk) health insurance status 
and access to healthcare; and 
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1750 
(IV) indoor air quality in multi-
unit dwellings; 
(V) mental health; 
(VI) labor market categories, 
particularly relating to essential work-
ers; and 
(VII) each type of utility expense; 
(iv) consider the implementation of 
specific regional indicators, with the poten-
tial— 
(I) to create regionally and lo-
cally downscaled maps in addition to a 
national map; 
(II) to provide incentives for 
States to collect data and conduct ad-
ditional analyses to capture conditions 
specific to their localities; 
(III) to provide resources for and 
engage in ground-truthing to identify 
and verify important data with com-
munity members; and 
(IV) to develop companion re-
sources for, and provide technical sup-
port to, regional, State, local, or Trib-
al governments to create their own 
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