126
strategies that inform healthcare professionals and the 
public about the existence of and methods to reduce racial 
and ethnic disparities in health and healthcare. 
‘‘(b) ACTIVITIES.—The Secretary, through the edu-
cation program established under subsection (a) shall, 
through the use of public awareness and outreach cam-
paigns targeting the general public and the medical com-
munity at large—
‘‘(1) disseminate scientific evidence for the ex-
istence and extent of racial and ethnic disparities in 
healthcare, including disparities that are not other-
wise attributable to known factors such as access to 
care, patient preferences, or appropriateness of 
intervention, as described in the 2002 Institute of 
Medicine Report, Unequal Treatment; 
‘‘(2) disseminate new research findings to 
healthcare providers and patients to assist them in 
understanding, reducing, and eliminating health and 
healthcare disparities; 
‘‘(3) disseminate information about the impact 
of linguistic and cultural barriers on healthcare qual-
ity and the obligation of health providers who receive 
Federal financial assistance to ensure that people 
with limited English proficiency have access to lan-
guage access services;
127
‘‘(4) disseminate information about the impor-
tance and legality of racial, ethnic, and primary lan-
guage data collection, analysis, and reporting; 
‘‘(5) design and implement specific educational 
initiatives to health care providers relating to health 
and health care disparities; 
‘‘(6) assess the impact of the programs estab-
lished under this section in raising awareness of 
health and healthcare disparities and providing in-
formation on available resources. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2920A. CULTURAL COMPETENCE TRAINING FOR 
HEALTHCARE PROFESSIONALS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, the Director of the Office of Minority 
Health, and the Director of the National Center for Mi-
nority Health and Health Disparities, shall award grants 
to eligible entities to test, implement, and evaluate models 
of cultural competence training for healthcare providers 
in coordination with the initiative under section 2920A(a).
128
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall—
‘‘(1) be an academic medical center, a health 
center or clinic, a hospital, a health plan, or a health 
system; 
‘‘(2) partner with a minority serving institution, 
minority professional association, or community-
based organization representing minority popu-
lations, in addition to a research institution to carry 
out activities under this grant; and 
‘‘(3) prepare and submit to the Secretary an 
application at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010.’’. 
SEC. 302. HEALTH CAREERS OPPORTUNITY PROGRAM. 
(a) PURPOSE.—It is the purpose of this section to 
diversify the healthcare workforce by increasing the num-
ber of individuals from disadvantaged backgrounds in the 
health and allied health professions by enhancing the aca-
demic skills of students from disadvantaged backgrounds 
and supporting them in successfully competing, entering,
129
and graduating from health professions training pro-
grams. 
(b) AUTHORIZATION OF APPROPRIATIONS.—Section 
740(c) of the Public Health Service Act (42 U.S.C. 
293d(c)) is amended by striking ‘‘$29,400,000’’ and all 
that follows through ‘‘2002’’ and inserting ‘‘$50,000,000 
for fiscal year 2005, and such sums as may be necessary 
for each of fiscal years 2006 through 2010’’. 
SEC. 303. PROGRAM OF EXCELLENCE IN HEALTH PROFES-
SIONS 
EDUCATION 
FOR 
UNDERREP-
RESENTED MINORITIES. 
(a) PURPOSE.—It is the purpose of this section to 
diversify the healthcare workforce by supporting programs 
of excellence in designated health professions schools that 
demonstrate a commitment to underrepresented minority 
populations with a focus on minority health issues, cul-
tural and linguistic competence, and eliminating health 
disparities. 
(b) AUTHORIZATION
OF APPROPRIATION.—Section 
737(h)(1) of the Public Health Service Act (42 U.S.C. 
293(h)(1)) is amended to read as follows: 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.—
For the purpose of making grants under subsection 
(a), there are authorized to be appropriated 
$50,000,000 for fiscal year 2005, and such sums as
130
may be necessary for each of the fiscal years 2006 
through 2010.’’. 
SEC. 
304. 
HISPANIC-SERVING 
HEALTH 
PROFESSIONS 
SCHOOLS. 
Part B of title VII of the Public Health Service Act 
(42 U.S.C. 293 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 
742. 
HISPANIC-SERVING 
HEALTH 
PROFESSIONS 
SCHOOLS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration, shall award grants to Hispanic-serving 
health professions schools for the purpose of carrying out 
programs to recruit Hispanic individuals to enroll in and 
graduate from such schools, which may include providing 
scholarships and other financial assistance as appropriate. 
‘‘(b) ELIGIBILITY.—In subsection (a), the term ‘His-
panic-serving health professions school’ means an entity 
that—
‘‘(1) is a school or program under section 
799B; 
‘‘(2) has an enrollment of full-time equivalent 
students that is made up of at least 9 percent His-
panic students;
131
‘‘(3) has been effective in carrying out pro-
grams to recruit Hispanic individuals to enroll in 
and graduate from the school; 
‘‘(4) has been effective in recruiting and retain-
ing Hispanic faculty members; and 
‘‘(5) has a significant number of graduates who 
are providing health services to medically under-
served populations or to individuals in health profes-
sional shortage areas.’’. 
SEC. 305. HEALTH PROFESSIONS STUDENT LOAN FUND; AU-
THORIZATIONS 
OF 
APPROPRIATIONS 
RE-
GARDING STUDENTS FROM DISADVANTAGED 
BACKGROUNDS. 
Section 724(f)(1) of the Public Health Service Act 
(42 
U.S.C. 
292t(f)(1)) 
is 
amended 
by 
striking 
‘‘$8,000,000’’ and all that follows and inserting 
‘‘$35,000,000 for fiscal year 2005, and such sums as may 
be necessary for each of the fiscal years 2006 through 
2010.’’. 
SEC. 306. NATIONAL HEALTH SERVICE CORPS; RECRUIT-
MENT AND FELLOWSHIPS FOR INDIVIDUALS 
FROM DISADVANTAGED BACKGROUNDS. 
(a) IN GENERAL.—Section 331(b) of the Public 
Health Service Act (42 U.S.C. 254d(b)) is amended by 
adding at the end the following:
132
‘‘(3) The Secretary shall ensure that the individuals 
with respect to whom activities under paragraphs (1) and 
(2) are carried out include individuals from disadvantaged 
backgrounds, including activities carried out to provide 
health professions students with information on the Schol-
arship and Repayment Programs.’’. 
(b) ASSIGNMENT OF CORPS PERSONNEL.—Section 
333(a) of the Public Health Service Act (42 U.S.C. 
254f(a)) is amended by adding at the end the following: 
‘‘(4) In assigning Corps personnel under this section, 
the Secretary shall give preference to applicants who re-
quest assignment to a federally qualified health center (as 
defined in section 1905(l)(2)(B) of the Social Security 
Act) or to a provider organization that has a majority of 
patients who are minorities or individuals from low-income 
families (families with a family income that is less than 
200 percent of the Official Poverty Line).’’. 
SEC. 307. LOAN REPAYMENT PROGRAM OF CENTERS FOR 
DISEASE CONTROL AND PREVENTION. 
Section 317F(c) of the Public Health Service Act (42 
U.S.C. 247b–7(c)) is amended—
(1) by striking ‘‘and’’ after ‘‘1994,’’; and 
(2) by inserting before the period the following: 
‘‘$750,000 for fiscal year 2005, and such sums as
133
may be necessary for each of the fiscal years 2006 
through 2010.’’. 
SEC. 308. COOPERATIVE AGREEMENTS FOR ONLINE DE-
GREE PROGRAMS AT SCHOOLS OF PUBLIC 
HEALTH AND SCHOOLS OF ALLIED HEALTH. 
Part B of title VII of the Public Health Service Act 
(42 U.S.C. 293 et seq.), as amended by section 304, is 
further amended by adding at the end the following: 
‘‘SEC. 743. COOPERATIVE AGREEMENTS FOR ONLINE DE-
GREE PROGRAMS. 
‘‘(a) COOPERATIVE AGREEMENTS.—The Secretary, 
acting through the Administrator of the Health Resources 
and Services Administration, in consultation with the Di-
rector of the Centers for Disease Control and Prevention, 
the Director of the Agency for Healthcare Research and 
Quality, and the Director of the Office of Minority Health, 
shall award cooperative agreements to schools of public 
health and schools of allied health to design and imple-
ment online degree programs. 
‘‘(b) PRIORITY.—In awarding cooperative agreements 
under this section, the Secretary shall give priority to any 
school of public health or school of allied health that is 
located in a medically underserved community.
134
‘‘(c) REQUIREMENTS.—Awardees must design and 
implement an online degree program, that meet the fol-
lowing restrictions: 
‘‘(1) Enrollment of individuals who have ob-
tained a secondary school diploma or its recognized 
equivalent. 
‘‘(2) Maintaining a significant enrollment of 
underrepresented minority or disadvantaged stu-
dents. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010.’’. 
SEC. 309. MID-CAREER HEALTH PROFESSIONS SCHOLAR-
SHIP PROGRAM. 
Part B of title VII of the Public Health Service Act 
(as amended by section 308) is further amended by adding 
at the end the following: 
‘‘SEC. 744. MID-CAREER HEALTH PROFESSIONS SCHOLAR-
SHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary may make grants 
to eligible schools for awarding scholarships to eligible in-
dividuals to attend the school involved, for the purpose of 
enabling the individuals to make a career change from a 
non-health profession to a health profession.
135
‘‘(b) EXPENSES.—Amounts awarded as a scholarship 
under this section may be expended only for tuition ex-
penses, other reasonable educational expenses, and reason-
able living expenses incurred in the attendance of the 
school involved. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE
SCHOOL.—The term ‘eligible 
school’ means a school of medicine, osteopathic med-
icine, dentistry, nursing (as defined in section 801), 
pharmacy, podiatric medicine, optometry, veterinary 
medicine, public health, chiropractic, or allied health, 
a school offering a graduate program in behavioral 
and mental health practice, or an entity providing 
programs for the training of physician assistants. 
‘‘(2) ELIGIBLE INDIVIDUAL.—The term ‘eligible 
individual’ means an individual who has obtained a 
secondary school diploma or its recognized equiva-
lent. 
‘‘(d) PRIORITY.—In providing scholarships to eligible 
individuals, eligible schools shall give to individuals from 
disadvantaged backgrounds. 
‘‘(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 
2005 through 2010.’’.
136
SEC. 310. NATIONAL REPORT ON THE PREPAREDNESS OF 
HEALTH PROFESSIONALS TO CARE FOR DI-
VERSE POPULATIONS. 
The Secretary of Health and Human Services shall 
include in the report prepared under section 1707(c) of 
the Public Health Service Act (as added by section 603 
of this Act), information relating to the preparedness of 
health professionals to care for racially and ethnically di-
verse populations. Such information, which shall be col-
lected by the Bureau of Health Professions, shall in-
clude—
(1) with respect to health professions education, 
the number and percentage of hours of classroom 
discussion relating to minority health issues, includ-
ing cultural competence; 
(2) a description of the coursework involved in 
such education; 
(3) a description of the results of an evaluation 
of the preparedness of students in such education; 
(4) a description of the types of exposure that 
students have during their education to minority pa-
tient populations; and 
(5) a description of model programs and prac-
tices.
137
SEC. 311. SCHOLARSHIP AND FELLOWSHIP PROGRAMS. 
Subtitle B of title XXIX of the Public Health Service 
Act, as amended by section 301, is further amended by 
adding at the end the following: 
‘‘SEC. 
2920B. 
DAVID 
SATCHER 
PUBLIC 
HEALTH 
AND 
HEALTH SERVICES CORPS. 
‘‘(a) IN GENERAL.—The Administrator of the Health 
Resources and Services Administration and Director of 
the Centers for Disease Control and Prevention, in col-
laboration with the Director of the Office of Minority 
Health, shall award grants to eligible entities to increase 
awareness among post-primary and post-secondary stu-
dents of career opportunities in the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall—
‘‘(1) be a clinical, public health or health serv-
ices organization, community-based or non-profit en-
tity, or other entity determined appropriate by the 
Director of the Centers for Disease Control and Pre-
vention; 
‘‘(2) serve a health professional shortage area, 
as determined by the Secretary; 
‘‘(3) work with students, including those from 
racial and ethnic minority backgrounds, that have 
expressed an interest in the health professions; and
138
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE
OF FUNDS.—Grant awards under sub-
section (a) shall be used to support internships that will 
increase awareness among students of non-research based 
and career opportunities in the following health profes-
sions: 
‘‘(1) Medicine. 
‘‘(2) Nursing. 
‘‘(3) Public Health. 
‘‘(4) Pharmacy. 
‘‘(5) Health Administration and Management. 
‘‘(6) Health Policy. 
‘‘(7) Psychology. 
‘‘(8) Dentistry. 
‘‘(9) International Health. 
‘‘(10) Social Work. 
‘‘(11) Allied Health. 
‘‘(12) Other professions deemed appropriate by 
the Director of the Centers for Disease Control and 
Prevention. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
139
trol and Prevention shall give priority to those entities 
that—
‘‘(1) serve a high proportion of individuals from 
disadvantaged backgrounds; 
‘‘(2) have experience in health disparity elimi-
nation programs; 
‘‘(3) facilitate the entry of disadvantaged indi-
viduals into institutions of higher education; and 
‘‘(4) provide counseling or other services de-
signed to assist disadvantaged individuals in success-
fully completing their education at the post-sec-
ondary level. 
‘‘(f) STIPENDS.—The Secretary may approve sti-
pends under this section for individuals for any period of 
education in student-enhancement programs (other than 
regular courses) at health professions schools, programs, 
or entities, except that such a stipend may not be provided 
to an individual for more than 6 months, and such a sti-
pend may not exceed $20 per day (notwithstanding any 
other provision of law regarding the amount of stipends). 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010.
140
‘‘SEC. 2920C. LOUIS STOKES PUBLIC HEALTH SCHOLARS 
PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Director of the Office of Minority Health, shall award 
scholarships to postsecondary students who seek a career 
in public health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a schol-
arship under subsection (a) an individual shall—
‘‘(1) have experience in public health research 
or public health practice, or other health professions 
as determined appropriate by the Director of the 
Centers for Disease Control and Prevention; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) have expressed an interest in public health; 
‘‘(4) demonstrate promise for becoming a leader 
in public health; 
‘‘(5) secure admission to a 4-year institution of 
higher education; 
‘‘(6) comply with subsection (f); and 
‘‘(7) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require.
141
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become public health professionals. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those stu-
dents that—
‘‘(1) are from disadvantaged backgrounds; 
‘‘(2) have secured admissions to a minority 
serving institution; and 
‘‘(3) have identified a health professional as a 
mentor at their school or institution and an aca-
demic advisor to assist in the completion of their 
baccalaureate degree. 
‘‘(e) SCHOLARSHIPS.—The Secretary may approve 
payment of scholarships under this section for such indi-
viduals for any period of education in student under-
graduate tenure, except that such a scholarship may not 
be provided to an individual for more than 4 years, and 
such scholarships may not exceed $10,000 per academic 
year (notwithstanding any other provision of law regard-
ing the amount of scholarship). 
‘‘(f) REQUIREMENTS.—To be eligible to receive as-
sistance under this section an individual shall—
‘‘(1) have at minimum a grade point average of 
2.75 at the time of entry to an entity described in
142
subsection (d)(2) and maintain such 2.75 average or 
above throughout their tenure at such institutions; 
‘‘(2) receive academic instruction that prepares 
the individual to enter the field of public health; 
‘‘(3) gain experience in public health through 
working at non-profit, community-based health fa-
cilities or at Federal, State, or local governmental 
healthcare institutions; and 
‘‘(4) meet at minimum twice a month with the 
identified health professions mentor. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2920D. PATSY MINK HEALTH AND GENDER RESEARCH 
FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention, in collaboration with the 
Director of the Office of Minority Health, the Adminis-
trator of the Substance Abuse and Mental Health Services 
Administration, and the Director of the Indian Health 
Services, shall award research fellowships to post-bacca-
laureate students to conduct research that will examine 
gender and health disparities and to pursue a career in 
the health professions.
143
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall—
‘‘(1) have experience in health research or pub-
lic health practice; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) have expressed an interest in the health 
professions; 
‘‘(4) demonstrate promise for becoming a leader 
in the field of women’s health; 
‘‘(5) secure admission to a health professions 
school or graduate program with an emphasis in 
gender studies; 
‘‘(6) comply with subsection (f); and 
‘‘(7) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become researchers and advance 
the research base on the intersection between gender and 
health. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Centers for Disease Con-
144
trol and Prevention shall give priority to those applicants 
that—
‘‘(1) are from disadvantaged backgrounds; and 
‘‘(2) have identified a mentor and academic ad-
visor who will assist in the completion of their grad-
uate or professional degree and have secured a re-
search assistant position with a researcher working 
in the area of gender and health. 
‘‘(e) FELLOWSHIPS.—The Director of the Centers for 
Disease Control and Prevention may approve fellowships 
for individuals under this section for any period of edu-
cation in the student’s graduate or health profession ten-
ure, except that such a fellowship may not be provided 
to an individual for more than 3 years, and such a fellow-
ship may not exceed $18,000 per academic year (notwith-
standing any other provision of law regarding the amount 
of fellowship). 
‘‘(f) REQUIREMENTS.—To be eligible to receive as-
sistance under this section, an individual shall—
‘‘(1) maintain a minimum a grade point aver-
age of 2.75 at the time of entry to an entity de-
scribed in subsection (b)(5) and maintain a grade 
point average of 3.25 or above throughout their ten-
ure at such institution;
145
‘‘(2) undergo academic instruction to assist in 
completion of the health professions or graduate de-
gree; and 
‘‘(3) attend twice-monthly meetings with an 
academic advisor throughout the tenure of the fel-
lowship. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2920E. PAUL DAVID WELLSTONE INTERNATIONAL 
HEALTH FELLOWSHIP PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
the Director of the Office of Minority Health, shall award 
research fellowships to college students or recent grad-
uates to advance their understanding of international 
health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a fellow-
ship under subsection (a) an individual shall—
‘‘(1) have educational experience in the field of 
international health; 
‘‘(2) reside in a health professional shortage 
area as determined by the Secretary;
146
‘‘(3) demonstrate promise for becoming a leader 
in the field of international health; 
‘‘(4) be a college senior or recent graduate of 
a four year higher education institution; 
‘‘(5) comply with subsection (f); and 
‘‘(6) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under an 
award under subsection (a) shall be used to support oppor-
tunities for students to become health professionals and 
to advance their knowledge about international issues re-
lating to healthcare access and quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give priority to those appli-
cants that—
‘‘(1) are from a disadvantaged background; and 
‘‘(2) have identified a mentor at a health pro-
fessions school or institution, an academic advisor to 
assist in the completion of their graduate or profes-
sional degree, and an advisor from an international 
health Non-Governmental Organization, Private Vol-
unteer Organization, or other international institu-
tion or program that focuses on increasing
147
healthcare access and quality for residents in devel-
oping countries. 
‘‘(e) FELLOWSHIPS.—The Secretary shall approve 
fellowships for college seniors or recent graduates, except 
that such a fellowship may not be provided to an indi-
vidual for more than 6 months, may not be awarded to 
a graduate that has not been enrolled in school for more 
than 1 year, and may not exceed $4,000 per academic year 
(notwithstanding any other provision of law regarding the 
amount of fellowship). 
‘‘(f) REQUIREMENTS.—To be eligible to receive as-
sistance under this section, an individual shall—
‘‘(1) maintain a minimum grade point average 
of 2.75 at the time of application; and 
‘‘(2) undergo academic instruction in global 
health, and issues relating to access and quality of 
healthcare; 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 through 2010. 
‘‘SEC. 2920F. EDWARD R. ROYBAL HEALTHCARE SCHOLAR 
PROGRAM. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, the Director of the Cen-
148
ters for Medicaid and Medicare, and the Administrator for 
Health Resources and Services Administration, in collabo-
ration with the Director of the Office of Minority Health, 
shall award grants to eligible entities to expose entering 
graduate students to the health professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a) an entity shall—
‘‘(1) be a clinical, public health or health serv-
ices organization, community-based or non-profit en-
tity, or other entity determined appropriate by the 
Director of the Agency for Healthcare Research and 
Quality; 
‘‘(2) serve in a health professional shortage 
area as determined by the Secretary; 
‘‘(3) work with students obtaining a degree in 
the health professions; and 
‘‘(4) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
‘‘(c) USE OF FUNDS.—Amounts received under a 
grant awarded under subsection (a) shall be used to sup-
port opportunities that expose students to non-research 
based health professions, including—
‘‘(1) public health policy; 
‘‘(2) healthcare and pharmaceutical policy;
149
‘‘(3) healthcare administration and manage-
ment; 
‘‘(4) health economics; and 
‘‘(5) other professions determined appropriate 
by the Director of the Agency for Healthcare Re-
search and Quality. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director of the Agency for Healthcare Re-
search and Quality shall give priority to those entities 
that—
‘‘(1) have experience with health disparity elimi-
nation programs; 
‘‘(2) facilitate training in the fields described in 
subsection (c); and 
‘‘(3) provide counseling or other services de-
signed to assist such individuals in successfully com-
pleting their education at the post-secondary level. 
‘‘(e) STIPENDS.—The Secretary may approve the 
payment of stipends for individuals under this section for 
any period of education in student-enhancement programs 
(other than regular courses) at health professions schools 
or entities, except that such a stipend may not be provided 
to an individual for more than 2 months, and such a sti-
pend may not exceed $100 per day (notwithstanding any 
other provision of law regarding the amount of stipends).
150
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2005 through 2010.’’. 
TITLE IV—REDUCING DISEASE 
AND DISEASE-RELATED COM-
PLICATIONS 
Subtitle A—Eliminating Disparities 
in Prevention, Detection, and 
Treatment of Disease 
CHAPTER 1—GENERAL PROVISIONS 
SEC. 401. GUIDELINES FOR DISEASE SCREENING FOR MI-
NORITY PATIENTS. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity, shall convene a series of meetings to develop guidelines 
for disease screening for minority patient populations 
which have a higher than average risk for many chronic 
diseases and cancers. 
(b) PARTICIPANTS.—In convening meetings under 
subsection (a), the Secretary shall ensure that meeting 
participants include representatives of—
(1) professional societies and associations; 
(2) minority health organizations;
151
(3) healthcare researchers and providers, in-
cluding those with expertise in minority health; 
(4) Federal health agencies, including the Of-
fice of Minority Health and the National Institutes 
of Health; and 
(5) other experts determined appropriate by the 
Secretary. 
(c) DISEASES.—Screening guidelines for minority 
populations shall be developed under subsection (a) for—
(1) hypertension; 
(2) hypercholesterolemia; 
(3) diabetes; 
(4) cardiovascular disease; 
(5) prostate cancer; 
(6) breast cancer; 
(7) colon cancer; 
(8) kidney disease; 
(9) glaucoma; and 
(10) other diseases determined appropriate by 
the Secretary. 
(d) DISSEMINATION.—Not later than 24 months 
after the date of enactment of this title, the Secretary 
shall publish and disseminate to healthcare provider orga-
nizations the guidelines developed under subsection (a).
152
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
sums as may be necessary for each of fiscal years 2005 
through 2010. 
SEC. 402. PREVENTIVE HEALTH SERVICES BLOCK GRANTS, 
USE OF ALLOTMENTS. 
Section 1904(a)(1) of the Public Health Service Act 
(42 U.S.C. 300w–3(a)(1)) is amended—
(1) in subparagraph (G)—
(A) by striking ‘‘through (F)’’ and insert-
ing ‘‘through (G)’’; and 
(B) by redesignating such subparagraph as 
subparagraph (H); and 
(2) by inserting after subparagraph (F), the fol-
lowing: 
‘‘(G) Community outreach and education pro-
grams and other activities designed to address and 
prevent minority health conditions (as defined in 
section 485E(c)(2)).’’. 
SEC. 403. PROGRAM FOR INCREASING IMMUNIZATION 
RATES FOR ADULTS AND ADOLESCENTS; COL-
LECTION 
OF 
ADDITIONAL 
IMMUNIZATION 
DATA. 
(a) ACTIVITIES OF CENTERS FOR DISEASE CONTROL 
AND PREVENTION.—Section 317(j) of the Public Health
153
Service Act (42 U.S.C. 247b(j)) is amended by adding at 
the end the following paragraphs: 
‘‘(3)(A) For the purpose of carrying out activities to-
ward increasing immunization rates for adults and adoles-
cents through the immunization program under this sub-
section, and for the purpose of carrying out subsection 
(k)(2), there are authorized to be appropriated such sums 
as may be necessary for each of the fiscal years 2004 
through 2010. Such authorization is in addition to 
amounts available under paragraphs (1) and (2) for such 
purposes. 
‘‘(B) In expending amounts appropriated under sub-
paragraph (A), the Secretary shall give priority to adults 
and adolescents who are medically underserved and are 
at risk for vaccine-preventable diseases, including as ap-
propriate populations identified through projects under 
subsection (k)(2)(E). 
‘‘(C) The purposes for which amounts appropriated 
under subparagraph (A) are available include (with re-
spect to immunizations for adults and adolescents) pay-
ment of the costs of storing vaccines, outreach activities 
to inform individuals of the availability of the immuniza-
tions, and other program expenses necessary for the estab-
lishment or operation of immunization programs carried
154
out or supported by States or other public entities pursu-
ant to this subsection. 
‘‘(4) The Secretary shall annually submit to the Con-
gress a report that—
‘‘(A) evaluates the extent to which the immuni-
zation system in the United States has been effective 
in providing for adequate immunization rates for 
adults and adolescents, taking into account the ap-
plicable year 2010 health objectives established by 
the Secretary regarding the health status of the peo-
ple of the United States; and 
‘‘(B) describes any issues identified by the Sec-
retary that may affect such rates. 
‘‘(5) In carrying out this subsection and paragraphs 
(1) and (2) of subsection (k), the Secretary shall consider 
recommendations regarding immunizations that are made 
in reports issued by the Institute of Medicine.’’. 
(b) RESEARCH, DEMONSTRATIONS, 
AND
EDU-
CATION.—Section 317(k) of the Public Health Service Act 
(42 U.S.C. 247b(k)) is amended—
(1) by redesignating paragraphs (2) through 
(4) as paragraphs (3) through (5), respectively; and 
(2) by inserting after paragraph (1) the fol-
lowing paragraph:
155
‘‘(2) The Secretary, directly and through grants 
under paragraph (1), shall provide for a program of 
research, demonstration projects, and education in 
accordance with the following: 
‘‘(A) The Secretary shall coordinate with 
public and private entities (including nonprofit 
private entities), and develop and disseminate 
guidelines, toward the goal of ensuring that im-
munizations are routinely offered to adults and 
adolescents by public and private health care 
providers. 
‘‘(B) The Secretary shall cooperate with 
public and private entities to obtain information 
for the annual evaluations required in sub-
section (j)(4)(A). 
‘‘(C) The Secretary shall (relative to fiscal 
year 2001) increase the extent to which the 
Secretary collects data on the incidence, preva-
lence, and circumstances of diseases and ad-
verse events that are experienced by adults and 
adolescents and may be associated with immu-
nizations, including collecting data in coopera-
tion with commercial laboratories. 
‘‘(D) The Secretary shall ensure that the 
entities with which the Secretary cooperates for
156
purposes of subparagraphs (A) through (C) in-
clude managed care organizations, community 
based organizations that provide health serv-
ices, and other health care providers. 
‘‘(E) The Secretary shall provide for 
projects to identify racial and ethnic minority 
groups and other health disparity populations 
for which immunization rates for adults and 
adolescents are below such rates for the general 
population, and to determine the factors under-
lying such disparities.’’. 
SEC. 404. INNOVATIVE CHRONIC DISEASE MANAGEMENT 
PROGRAMS. 
(a) IN GENERAL.—The Secretary, acting in coordina-
tion with the Administrator of the Centers for Medicare 
and Medicaid Services, the Administrator of the Health 
Resources and Services Administration, the Director of 
the National Institutes of Health, the Director of the Cen-
ters for Disease Control and Prevention, and the Director 
of the Office of Minority Health, shall award grants to 
eligible entities for the identification, implementation, and 
evaluation of programs for patients with chronic disease. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall—
157
(1) be a health center or clinic, public health 
department, health plan, hospital, health system, 
community-based or non-profit organization, or 
other health entity determined appropriate by the 
Secretary; and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
taining such information as the Secretary may re-
quire. 
(c) USE OF FUNDS.—An entity shall use amounts re-
ceived under a grant under subsection (a) to identify, im-
plement, and evaluate chronic disease management pro-
grams that are tailored for racially and ethnically diverse 
populations. In carrying out such activities, an entity shall 
focus on—
(1) self-management training; 
(2) patient empowerment; 
(3) group visits; 
(4) community health workers; 
(5) case management; 
(6) work- and school-based interventions; 
(7) home visitation; or 
(8) other activities determined appropriate by 
the Secretary.
158
(d) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2004 through 2010. 
SEC. 405. GRANTS FOR RACIAL AND ETHNIC APPROACHES 
TO COMMUNITY HEALTH. 
(a) PURPOSE.—It is the purpose of this section to 
provide for the awarding of grants to assist communities 
in mobilizing and organizing resources in support of effec-
tive and sustainable programs that will reduce or eliminate 
disparities in health and healthcare experienced by racial 
and ethnic minority individuals. 
(b) AUTHORITY TO AWARD GRANTS.—The Sec-
retary, acting through the Centers for Disease Control and 
Prevention and the Office of Minority Health, shall award 
planning, implementation, and evaluation grants to eligi-
ble entities to assist in designing, implementing, and eval-
uating culturally and linguistically appropriate, science-
based, and community-driven strategies to eliminate racial 
and ethnic health and healthcare disparities. 
(c) ELIGIBLE ENTITIES.—To be eligible to receive a 
grant under this section, an entity shall—
(1) represent a coalition—
(A) whose principal purpose is to develop 
and implement interventions to reduce or elimi-
159
nate a health or healthcare disparity in a tar-
geted racial or ethnic minority group in the 
community served by the coalition; and 
(B) that includes—
(i) at least 3 members selected from 
among—
(I) public health departments; 
(II) community-based organiza-
tions; 
(III) university and/or research 
organizations; 
(IV) Indian tribal organizations 
or national Indian organizations; 
(V) Papa Ola Lokahi; and 
(VI) interested public or private 
sector healthcare providers or organi-
zations; 
(ii) at least 1 member that is from a 
community-based organization that rep-
resents the targeted racial or ethnic minor-
ity group; and 
(iii) at least 1 member that is a Na-
tional Center for Minority Health and 
Health Disparities Center of Excellence 
(unless such a Center does not exist within
160
the community involved, declines or refuses 
to participate, or the coalition dem-
onstrates to the Secretary that such par-
ticipation would not further the goals of 
the program or would be unduly burden-
some); and 
(2) submit to the Secretary an application, at 
such time, in such manner, and containing such in-
formation as the Secretary may require, including—
(A) a description of the targeted racial or 
ethnic population in the community to be served 
under the grant; 
(B) a description of at least 1 health dis-
parity that exists in the racial or ethnic tar-
geted population; and 
(C) a demonstration of the proven record 
of accomplishment of the coalition members in 
serving and working with the targeted commu-
nity. 
(d) PLANNING GRANTS.—
(1) IN GENERAL.—The Secretary shall award 
grants to eligible entities described in subsection (c) 
to support the planning and development of cul-
turally and linguistically appropriate programs that 
utilize science-based and community-driven strate-
161
gies to reduce or eliminate a health or healthcare 
disparity in the targeted population. Such grants 
may be used to—
(A) expand the coalition that is rep-
resented by the entity through the identification 
of additional partners, particularly among the 
targeted community, and establish linkages with 
national and State public and private partners; 
(B) establish community working groups; 
(C) conduct a needs assessment for the 
targeted population in the area of the health 
disparity using input from the targeted commu-
nity; 
(D) participate in workshops sponsored by 
the Office of Minority Health or the Centers for 
Disease Control and Prevention for technical 
assistance, planning, evaluation, and other pro-
grammatic issues; 
(E) identify promising intervention strate-
gies; and 
(F) develop a plan with the input of the 
targeted community that includes strategies 
for—
(i) implementing intervention strate-
gies that have the most promising potential
162
for reducing the health disparity in the 
target population; 
(ii) identifying other sources of rev-
enue and integrating current and proposed 
funding sources to ensure long-term sus-
tainability of the program; and 
(iii) evaluating the program, including 
collecting data and measuring progress to-
ward reducing or eliminating the health 
disparity in the targeted population that 
takes into account the evaluation model de-
veloped by the Centers for Disease Control 
and Prevention in collaboration with the 
Office of Minority Health. 
(2) DURATION.—The period during which pay-
ments may be made under a grant under paragraph 
(1) shall not exceed 1 year, except where the Sec-
retary determines that extraordinary circumstances 
exist as described in section 340(c)(3) of the Public 
Health Service Act. 
(e) IMPLEMENTATION GRANTS.—
(1) IN GENERAL.—The Secretary shall award 
grants to eligible entities that have received a plan-
ning grant under subsection (d) to enable such enti-
ty to—
163
(A) implement a plan to address the se-
lected health disparity for the target population, 
in an effective and timely manner; 
(B) collect data appropriate for monitoring 
and evaluating the program carried out under 
the grant; 
(C) analyze and interpret data, or collabo-
rate with academic or other appropriate institu-
tions, for such analysis and collection; 
(D) participate in conferences and work-
shops for the purpose of informing and edu-
cating others regarding the experiences and les-
sons learned from the project; 
(E) collaborate with appropriate partners 
to publish the results of the project for the ben-
efit of the public health community; 
(F) establish mechanisms with other public 
or private groups to maintain financial support 
for the program after the grant terminates; and 
(G) maintain relationships with local part-
ners and continue to develop new relationships 
with State and national partners. 
(2) DURATION.—The period during which pay-
ments may be made under a grant under paragraph 
(1) shall not exceed 4 years. Such payments shall be
164
subject to annual approval by the Secretary and to 
the availability of appropriations for the fiscal year 
involved. 
(f) EVALUATION GRANTS.—
(1) IN GENERAL.—The Secretary shall award 
grants to eligible entities that have received an im-
plementation grant under subsection (e) that require 
additional assistance for the purpose of rigorous 
data analysis, program evaluation (including process 
and outcome measures), or dissemination of find-
ings. 
(2) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to—
(A) entities that in previous funding cy-
cles—
(i) have received a planning grant 
under subsection (d); and 
(ii) implemented activities of the type 
described in subsection (e)(1); 
(B) entities that fulfilled the goals of their 
planning grant under subsection (d) in an espe-
cially timely manner; 
(C) entities that incorporate best practices 
or build on successful models in their action
165
plan, including the use of community health 
workers; and 
(D) entities that would enable the Sec-
retary to provide for an equitable distribution of 
such grants among the 5 categories for race 
and ethnicity described in the 1997 Office of 
Management and Budget Standards for Main-
taining, Collecting, and Presenting Federal 
Data on Race and Ethnicity. 
(g) MAINTENANCE OF EFFORT.—The Secretary may 
not award a grant to an eligible entity under this section 
unless the entity agrees that, with respect to the costs to 
be incurred by the entity in carrying out the activities for 
which the grant was awarded, the entity (and each of the 
participating partners in the coalition represented by the 
entity) will maintain its expenditures of non-Federal funds 
for such activities at a level that is not less than the level 
of such expenditures during the fiscal year immediately 
preceding the first fiscal year for which the grant is 
awarded. 
(h) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide any entity 
that receives a grant under this section with technical and 
other nonfinancial assistance necessary to meet the re-
quirements of this section.
166
(i) ADMINISTRATIVE BURDENS.—The Secretary shall 
make every effort to minimize duplicative or unnecessary 
administrative burdens on grantees in the process of ap-
plying for grants under subsection (d), (e), or (f). 
(j) REPORT.—Not later than September 30, 2007, 
the Secretary shall publish a report that describes the ex-
tent to which the activities funded under this section have 
been successful in reducing and eliminating disparities in 
health and healthcare in targeted populations, and pro-
vides examples of best practices or model programs funded 
under this section. 
(k) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated such sums as may be nec-
essary to carry out this section for each of fiscal years 
2005 through 2010. 
SEC. 406. IOM STUDY REQUEST. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall request that the Institute of Medi-
cine conduct, or contract with another entity to conduct, 
a study to investigate promising strategies for improving 
minority health and reducing and eliminating racial and 
ethnic disparities in health and healthcare. 
(b) CONTENT.—The study under subsection (a) 
shall—
167
(1) identify key stakeholders for intervention in 
the public and private sector; 
(2) identify the barriers to eliminating racial 
and ethnic disparities in health and healthcare; 
(3) explore approaches for addressing dispari-
ties in health and healthcare using a quality im-
provement framework; 
(4) suggest an evaluation and research agenda 
that will advance effective strategies for reducing 
and eliminating racial and ethnic disparities in 
health and healthcare; and 
(5) assess the capacity of the Department of 
Health and Human Services, as currently struc-
tured, to implement and evaluate promising strate-
gies to improve minority health and reduce and 
eliminate racial and ethnic disparities in health and 
healthcare. 
(c) AGENDA.—The agenda described in subsection 
(b)(4) shall include a focus on the following: 
(1) Observational studies of race-discordant and 
race-concordant physician-patient clinical encoun-
ters. 
(2) Studies of the behaviors and expressed atti-
tudes toward race and ethnicity during education 
and training of health professionals.
168
(3) Expansion of prospective studies of dispari-
ties in care, combining clinical data with qualitative 
interviews with patients and providers. 
(4) Studies of the natural history of social cat-
egorization in medical education and practice. 
(5) Studies of the effectiveness of standard clin-
ical guidelines in reducing disparities across disease 
categories. 
(6) Exploration of health system characteristics 
that may contribute to or mitigate disparities in 
health care. 
(7) Evaluation of cultural competency programs 
and their impact on the attitudes, knowledge, skills, 
and behaviors of healthcare providers. 
(8) Expansion of community-participatory re-
search with a focus on such topics as increasing 
trust and patient empowerment. 
(9) Studies on appropriate indicators of socio-
economic status, and methods for incorporating such 
indicators in patient records. 
(10) Interventional studies designed to elimi-
nate disparities. 
(d) REPORT.—Not later than 24 months after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall submit to the appropriate commit-
169
tees of Congress a report containing the results of the 
study conducted under subsection (a). 
(e) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
such sums as may be necessary for each of fiscal years 
2005 and 2006. 
SEC. 407. STRATEGIC PLAN. 
(a) IN GENERAL.—The Secretary, acting through the 
Administrator of the Substance Abuse and Mental Health 
Services Administration, shall formulate a strategic plan 
for implementing the 2001 report by the Surgeon General 
of the Public Health Service entitled ‘Mental Health: Cul-
ture, Race, and Ethnicity—A Supplement to Mental 
Health: A Report of the Surgeon General’ and the 2003 
report by the President’s New Freedom Commission on 
Mental Health entitled ‘Achieving the Promise: Trans-
forming Mental Health Care in America’. 
(b) SUBMISSION.—Not later than 6 months after the 
date of the enactment of this title, the Secretary shall sub-
mit to the Congress the strategic plan formulated under 
this section. 
CHAPTER 2—ENVIRONMENTAL JUSTICE 
SEC. 410. SHORT TITLE; PURPOSES. 
(a) SHORT TITLE.—This chapter may be cited as the 
‘‘Environmental Justice Act of 2003’’.
170
(b) PURPOSES.—The purposes of this chapter are—
(1) to ensure that all Federal health agencies 
develop practices that promote environmental jus-
tice; 
(2) to provide minority, low-income, and Native 
American communities greater access to public in-
formation and opportunity for participation in deci-
sionmaking affecting human health and the environ-
ment; and 
(3) to mitigate the inequitable distribution of 
the burdens and benefits of Federal programs hav-
ing significant impact on human health and the en-
vironment. 
SEC. 411. DEFINITIONS. 
For purposes of this chapter: 
(1) ENVIRONMENTAL JUSTICE.—
(A) IN
GENERAL.—The term ‘‘environ-
mental justice’’ means the fair treatment of 
people of all races, cultures, and socioeconomic 
groups with respect to the development, adop-
tion, implementation, and enforcement of laws, 
regulations, and policies affecting the environ-
ment. 
(B) FAIR
TREATMENT.—The term ‘‘fair 
treatment’’ means policies and practices that
171
will minimize the likelihood that a minority, 
low-income, or Native American community will 
bear a disproportionate share of the adverse en-
vironmental consequences, or be denied reason-
able access to the environmental benefits, re-
sulting from implementation of a Federal pro-
gram or policy. 
(2) FEDERAL
AGENCY.—The term ‘‘Federal 
agency’’ means—
(A) each Federal entity represented on the 
Working Group; 
(B) any other entity that conducts any 
Federal program or activity that substantially 
affects human health or the environment; and 
(C) each Federal agency that implements 
any program, policy, or activity applicable to 
Native Americans. 
(3) WORKING
GROUP.—The term ‘‘Working 
Group’’ means the interagency working group estab-
lished by section 413. 
(4) ADVISORY COMMITTEE.—The term ‘‘the Ad-
visory Committee’’ means the advisory committee es-
tablished by section 415.
172
SEC. 412. ENVIRONMENTAL JUSTICE RESPONSIBILITIES OF 
FEDERAL AGENCIES. 
(a) ENVIRONMENTAL JUSTICE MISSION.—To the 
greatest extent practicable, the head of each Federal agen-
cy shall make achieving environmental justice part of its 
mission by identifying and addressing, as appropriate, dis-
proportionately high and adverse human health or envi-
ronmental effects of its programs, policies, and activities 
on minority and low-income populations in the United 
States and its territories and possessions, including the 
District of Columbia, the Commonwealth of Puerto Rico, 
Virgin Islands, Guam, and the Commonwealth of the Mar-
iana Islands. 
(b) NONDISCRIMINATION.—Each Federal agency 
shall conduct its programs, policies, and activities in a 
manner that ensures that such programs, policies, and ac-
tivities do not have the effect of excluding any person or 
group from participation in, denying any person or group 
the benefits of, or subjecting any person or group to dis-
crimination under, such programs, policies, and activities, 
because of race, color, national origin, or income. 
SEC. 413. INTERAGENCY ENVIRONMENTAL JUSTICE WORK-
ING GROUP. 
(a) CREATION AND COMPOSITION.—There is hereby 
established the Interagency Working Group on Environ-
173
mental Justice, comprising the heads of the following exec-
utive agencies and offices, or their designees: 
(1) The Department of Defense. 
(2) The Department of Health and Human 
Services. 
(3) The Department of Housing and Urban De-
velopment. 
(4) The Department of Homeland Security. 
(5) The Department of Labor. 
(6) The Department of Agriculture. 
(7) The Department of Transportation. 
(8) The Department of Justice; 
(9) The Department of the Interior. 
(10) The Department of Commerce. 
(11) The Department of Energy. 
(12) The Environmental Protection Agency. 
(13) The Office of Management and Budget. 
(14) Any other official of the United States 
that the President may designate. 
(b) FUNCTIONS.—The Working Group shall—
(1) provide guidance to Federal agencies on cri-
teria for identifying disproportionately high and ad-
verse human health or environmental effects on mi-
nority, low-income, and Native American popu-
lations;
174
(2) coordinate with, provide guidance to, and 
serve as a clearinghouse for, each Federal agency as 
it develops or revises an environmental justice strat-
egy as required by this chapter, in order to ensure 
that the administration, interpretation and enforce-
ment of programs, activities, and policies are under-
taken in a consistent manner; 
(3) assist in coordinating research by, and stim-
ulating cooperation among, the Environmental Pro-
tection Agency, the Department of Health and 
Human Services, the Department of Housing and 
Urban Development, and other Federal agencies 
conducting research or other activities in accordance 
with section 7; 
(4) assist in coordinating data collection, main-
tenance, and analysis required by this chapter; 
(5) examine existing data and studies on envi-
ronmental justice; 
(6) hold public meetings and otherwise solicit 
public participation and consider complaints as re-
quired under subsection (c); 
(7) develop interagency model projects on envi-
ronmental justice that evidence cooperation among 
Federal agencies; and
175
(8) in coordination with the Department of the 
Interior and after consultation with tribal leaders, 
coordinate steps to be taken pursuant to this chap-
ter that affect or involve federally-recognized Indian 
Tribes. 
(c) PUBLIC PARTICIPATION.—The Working Group 
shall—
(1) hold public meetings and otherwise solicit 
public participation, as appropriate, for the purpose 
of fact-finding with regard to implementation of this 
chapter, and prepare for public review a summary of 
the comments and recommendations provided; and 
(2) receive, consider, and in appropriate in-
stances conduct inquiries concerning complaints re-
garding environmental justice and the implementa-
tion of this chapter by Federal agencies. 
(d) ANNUAL REPORTS.—
(1) IN GENERAL.—Each fiscal year following 
enactment of this Act, the Working Group shall sub-
mit to the President, through the Office of the Dep-
uty Assistant to the President for Environmental 
Policy and the Office of the Assistant to the Presi-
dent for Domestic Policy, a report that describes the 
implementation of this chapter, including, but not 
limited to, a report of the final environmental justice
176
strategies described in section 6 of this chapter and 
annual progress made in implementing those strate-
gies. 
(2) COPY
OF
REPORT.—The President shall 
transmit to the Speaker of the House of Representa-
tives and the President of the Senate a copy of each 
report submitted to the President pursuant to para-
graph (1). 
(e) CONFORMING CHANGE.—The Interagency Work-
ing Group on Environmental Justice established under 
Executive Order No. 12898, dated February 11, 1994, is 
abolished. 
SEC. 414. FEDERAL AGENCY STRATEGIES. 
(a) AGENCY-WIDE
STRATEGIES.—Each Federal 
agency shall develop an agency-wide environmental justice 
strategy that identifies and addresses disproportionally 
high and adverse human health or environmental effects 
or disproportionally low benefits of its programs, policies, 
and activities with respect to minority, low-income, and 
Native American populations. 
(b) REVISIONS.—Each strategy developed pursuant 
to subsection (a) shall identify programs, policies, plan-
ning, and public participation processes, rulemaking, and 
enforcement activities related to human health or the envi-
ronment that should be revised to—
177
(1) promote enforcement of all health and envi-
ronmental statutes in areas with minority, low-in-
come, or Native American populations; 
(2) ensure greater public participation; 
(3) improve research and data collection relat-
ing to the health of and environment of minority, 
low-income, and Native American populations; and 
(4) identify differential patterns of use of nat-
ural resources among minority, low-income, and Na-
tive American populations. 
(c) TIMETABLES.—Each strategy developed pursuant 
to subsection (a) shall include, where appropriate, a time-
table for undertaking revisions identified pursuant to sub-
section (b). 
SEC. 415. FEDERAL ENVIRONMENTAL JUSTICE ADVISORY 
COMMITTEE. 
(a) ESTABLISHMENT.—There is established a com-
mittee to be known as the ‘‘Federal Environmental Justice 
Advisory Committee’’. 
(b) DUTIES.—The Advisory Committee shall provide 
independent advice and recommendations to the Environ-
mental Protection Agency and the Working Group on 
areas relating to environmental justice, which may include 
any of the following:
178
(1) Advice on Federal agencies’ framework de-
velopment for integrating socioeconomic programs 
into strategic planning, annual planning, and man-
agement accountability for achieving environmental 
justice results agency-wide. 
(2) Advice on measuring and evaluating agen-
cies’ progress, quality, and adequacy in planning, de-
veloping, and implementing environmental justice 
strategies, projects, and programs. 
(3) Advice on agencies’ existing and future in-
formation management systems, technologies, and 
data collection, and the conduct of analyses that 
support and strengthen environmental justice pro-
grams in administrative and scientific areas. 
(4) Advice to help develop, facilitate, and con-
duct reviews of the direction, criteria, scope, and 
adequacy of the Federal agencies’ scientific research 
and demonstration projects relating to environ-
mental justice. 
(5) Advice for improving how the Environ-
mental Protection Agency and others participate, co-
operate, and communicate within that agency and 
between other Federal agencies, State or local gov-
ernments, federally recognized Tribes, environmental 
justice leaders, interest groups, and the public.
179
(6) Advice regarding the Environmental Protec-
tion Agency’s administration of grant programs re-
lating to environmental justice assistance (not to in-
clude the review or recommendations of individual 
grant proposals or awards). 
(7) Advice regarding agencies’ awareness, edu-
cation, training, and other outreach activities involv-
ing environmental justice. 
(c) ADVISORY COMMITTEE.—The Advisory Com-
mittee shall be considered an advisory committee within 
the meaning of the Federal Advisory Committee Act (5 
U.S.C. App.). 
(d) MEMBERSHIP.—
(1) IN
GENERAL.—The Advisory Committee 
shall be composed of 21 members to be appointed in 
accordance with paragraph (2). Members shall in-
clude representatives of—
(A) community-based groups; 
(B) industry and business; 
(C) academic and educational institutions; 
(D) minority health organizations; 
(E) State and local governments, federally 
recognized tribes, and indigenous groups; and 
(F) nongovernmental and environmental 
groups.
180
(2) APPOINTMENTS.—Of the members of the 
Advisory Committee—
(A) five members shall be appointed by the 
majority leader of the Senate; 
(B) five members shall be appointed by the 
minority leader of the Senate; 
(C) five members shall be appointed by the 
Speaker of the House of Representatives; 
(D) five members shall be appointed by the 
minority leader of the House of Representa-
tives; and 
(E) one member to be appointed by the 
President. 
(e) MEETINGS.—The Advisory Committee shall meet 
at least twice annually. Meetings shall occur as needed and 
approved by the Director of the Office of Environmental 
Justice of the Environmental Protection Agency, who shall 
serve as the officer required to be appointed under section 
10(e) of the Federal Advisory Committee Act (5 U.S.C. 
App.) with respect to the Committee (in this subsection 
referred to as the ‘‘Designated Federal Officer’’). The Ad-
ministrator of the Environmental Protection Agency may 
pay travel and per diem expenses of members of the Advi-
sory Committee when determined necessary and appro-
priate. The Designated Federal Officer or a designee of
181
such Officer shall be present at all meetings, and each 
meeting will be conducted in accordance with an agenda 
approved in advance by such Officer. The Designated Fed-
eral Officer may adjourn any meeting when the Des-
ignated Federal Officer determines it is in the public inter-
est to do so. As required by the Federal Advisory Com-
mittee Act, meetings of the Advisory Committee shall be 
open to the public unless the President determines that 
a meeting or a portion of a meeting may be closed to the 
public in accordance with subsection (c) of section 552b 
of title 5, United States Code. Unless a meeting or portion 
thereof is closed to the public, the Designated Federal Of-
ficer shall provide an opportunity for interested persons 
to file comments before or after such meeting or to make 
statements to the extent that time permits. 
(f) DURATION.—The Advisory Committee shall re-
main in existence until otherwise provided by law. 
SEC. 416. HUMAN HEALTH AND ENVIRONMENTAL RE-
SEARCH, DATA COLLECTION AND ANALYSIS. 
(a) DISPROPORTIONATE IMPACT.—To the extent per-
mitted by other applicable law, including section 552a of 
title 5, United States Code, popularly known as the Pri-
vacy Act of 1974, the Administrator of the Environmental 
Protection Agency, or the head of such other Federal 
agency as the President may direct, shall collect, maintain,
182
and analyze information assessing and comparing environ-
mental and human health risks borne by populations iden-
tified by race, national origin, or income. To the extent 
practical and appropriate, Federal agencies shall use this 
information to determine whether their programs, policies, 
and activities have disproportionally high and adverse 
human 
health 
or 
environmental 
effects 
on, 
or 
disproportionally low benefits for, minority, low-income, 
and Native American populations. 
(b) INFORMATION RELATED TO NON-FEDERAL FA-
CILITIES.—In connection with the development and imple-
mentation of agency strategies in section 4, the Adminis-
trator of the Environmental Protection Agency, or the 
head of such other Federal agency as the President may 
direct, shall collect, maintain, and analyze information on 
the race, national origin, and income level, and other read-
ily accessible and appropriate information, for areas sur-
rounding facilities or sites expected to have a substantial 
environmental, human health, or economic effect on the 
surrounding populations, if such facilities or sites become 
the subject of a substantial Federal environmental admin-
istrative or judicial action. 
(c) IMPACT FROM FEDERAL FACILITIES.—The Ad-
ministrator of the Environmental Protection Agency, or 
the head of such other Federal agency as the President
183
may direct, shall collect, maintain, and analyze informa-
tion on the race, national origin, and income level, and 
other readily accessible and appropriate information, for 
areas surrounding Federal facilities that are—
(1) subject to the reporting requirements under 
the Emergency Planning and Community Right-to-
Know Act (42 U.S.C. 11001 et seq.) as mandated 
in Executive Order No. 12856; and 
(2) expected to have a substantial environ-
mental, human health, or economic effect on sur-
rounding populations. 
(d) INFORMATION SHARING.—
(1) IN GENERAL.—In carrying out the respon-
sibilities in this section, each Federal agency, to the 
extent practicable and appropriate, shall share infor-
mation and eliminate unnecessary duplication of ef-
forts through the use of existing data systems and 
cooperative agreements among Federal agencies and 
with State, local, and tribal governments. 
(2) PUBLIC AVAILABILITY.—Except as prohib-
ited by other applicable law, information collected or 
maintained pursuant to this section shall be made 
available to the public. 
(e) PUBLIC COMMENT.—Federal agencies shall pro-
vide minority, low-income, and Native American popu-
184
lations the opportunity to participate in the development, 
design, and conduct of activities undertaken pursuant to 
this section. 
CHAPTER 3—BORDER HEALTH 
SEC. 421. SHORT TITLE. 
This chapter may be cited as the ‘‘Border Health Se-
curity Act of 2003’’. 
SEC. 422. DEFINITIONS. 
In this chapter: 
(1) BORDER AREA.—The term ‘‘border area’’ 
has the meaning given the term ‘‘United States-
Mexico Border Area’’ in section 8 of the United 
States-Mexico Border Health Commission Act (22 
U.S.C. 290n–6). 
(2) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
SEC. 423. BORDER HEALTH GRANTS. 
(a) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State, public institution 
of higher education, local government, tribal government, 
nonprofit health organization, community health center, or 
community clinic receiving assistance under section 330 
of the Public Health Service Act (42 U.S.C. 254b), that 
is located in the border area.
185
(b) AUTHORIZATION.—From funds appropriated 
under subsection (f), the Secretary, acting through the 
United States members of the United States-Mexico Bor-
der Health Commission, shall award grants to eligible en-
tities to address priorities and recommendations to im-
prove the health of border area residents that are estab-
lished by—
(1) the United States members of the United 
States-Mexico Border Health Commission; 
(2) the State border health offices; and 
(3) the Secretary. 
(c) APPLICATION.—An eligible entity that desires a 
grant under subsection (b) shall submit an application to 
the Secretary at such time, in such manner, and con-
taining such information as the Secretary may require. 
(d) USE OF FUNDS.—An eligible entity that receives 
a grant under subsection (b) shall use the grant funds 
for—
(1) programs relating to—
(A) maternal and child health; 
(B) primary care and preventative health; 
(C) public health and public health infra-
structure; 
(D) health education and promotion; 
(E) oral health;
186
(F) behavioral and mental health; 
(G) substance abuse; 
(H) health conditions that have a high 
prevalence in the border area; 
(I) medical and health services research; 
(J) workforce training and development; 
(K) 
community 
health 
workers 
or 
promotoras; 
(L) health care infrastructure problems in 
the border area (including planning and con-
struction grants); 
(M) health disparities in the border area; 
(N) environmental health; and 
(O) outreach and enrollment services with 
respect to Federal programs (including pro-
grams authorized under titles XIX and XXI of 
the Social Security Act (42 U.S.C. 1396 and 
1397aa)); and 
(2) other programs determined appropriate by 
the Secretary. 
(e) SUPPLEMENT, NOT SUPPLANT.—Amounts pro-
vided to an eligible entity awarded a grant under sub-
section (b) shall be used to supplement and not supplant 
other funds available to the eligible entity to carry out the 
activities described in subsection (d).
187
(f) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, 
$200,000,000 for fiscal year 2005, and such sums as may 
be necessary for each succeeding fiscal year. 
SEC. 424. UNITED STATES-MEXICO BORDER HEALTH COM-
MISSION ACT AMENDMENTS. 
The United States-Mexico Border Health Commis-
sion Act (22 U.S.C. 290n et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 9. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated to carry out 
this Act $10,000,000 for fiscal year 2005 and such sums 
as may be necessary for each succeeding fiscal year.’’. 
CHAPTER 4—PATIENT NAVIGATOR, OUT-
REACH, AND CHRONIC DISEASE PRE-
VENTION 
SEC. 425. SHORT TITLE. 
This chapter may be cited as the ‘‘Patient Navigator, 
Outreach, and Chronic Disease Prevention Act of 2003’’.
188
SEC. 426. HRSA GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; HRSA GRANTS FOR PATIENT NAVIGA-
TORS. 
Subpart I of part D of title III of the Public Health 
Service Act (42 U.S.C. 254b et seq.) is amended by adding 
at the end the following: 
‘‘SEC. 330I. MODEL COMMUNITY CANCER AND CHRONIC 
DISEASE CARE AND PREVENTION; PATIENT 
NAVIGATORS. 
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC 
DISEASE CARE AND PREVENTION.—
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, may make grants to 
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, clinics serving 
Asian Americans and Pacific Islanders and Alaska 
Natives, and rural health clinics and qualified non-
profit entities that partner with one or more centers 
providing healthcare to provide navigation services, 
which demonstrate the ability to perform all of the 
functions outlined in this subsection and subsections
189
(b) and (c)) for the development and operation of 
model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection, 
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases; 
‘‘(B) ensure that the health services are 
provided to such individuals in a culturally com-
petent manner; 
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
‘‘(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
‘‘(ii) facilitate access to appropriate 
healthcare services within the healthcare 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements,
190
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
‘‘(D) require training for patient naviga-
tors employed through such model programs to 
ensure the ability of navigators to perform all 
of the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
‘‘(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pro-
gram is serving, about the services of the model pro-
gram under the grant. Such activities shall include 
facilitating access to appropriate healthcare services 
and patient navigators within the healthcare system
191
to ensure optimal patient utilization of these serv-
ices. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective program evaluation, the 
grantee shall collect specific patient data recording 
services provided to each patient served by the pro-
gram and shall establish and implement procedures 
and protocols, consistent with applicable Federal and 
State laws (including 45 C.F.R. 160 and 164) to en-
sure the confidentiality of all information shared by 
a participant in the program, or their personal rep-
resentative and their healthcare providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers.
192
‘‘(4) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section. 
‘‘(5) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide 
for evaluations to determine which outreach ac-
tivities under paragraph (2) were most effective 
in informing the public and the specific commu-
nity that the program is serving, about the 
model program services and to determine the 
extent to which such programs were effective in 
providing culturally competent services to the 
health disparity population served by the pro-
grams. 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A).
193
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (b), with the program under section 
417D, and to the extent practicable, with programs 
for prevention centers that are carried out by the 
Director of the Centers for Disease Control and Pre-
vention. 
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Administrator of the Health Resources 
and Services Administration, may make grants to 
public and nonprofit private health centers (includ-
ing health centers under section 330, Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, clinics serving 
Asian Americans and Pacific Islanders and Alaska 
Natives, and rural health clinics and qualified non-
profit entities that partner with one or more centers 
providing healthcare to provide navigation services, 
which demonstrate the ability to perform all of the 
functions outlined in this subsection and subsections 
(a) and (c)) for the development and operation of 
programs to pay the costs of such health centers 
in—
194
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for managing the care of individuals of 
health disparity populations for the duration of 
receiving health services from the health cen-
ters, including aid in coordinating and sched-
uling appointments and referrals, community 
outreach, assistance with transportation ar-
rangements, and assistance with insurance 
issues and other barriers to care and providing 
information about clinical trials; 
‘‘(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
‘‘(C) ensuring that patient navigators with 
direct knowledge of the communities they serve 
provide services to such individuals in a cul-
turally competent manner; 
‘‘(D) developing model practices for patient 
navigators, including with respect to—
‘‘(i) coordination of health services, 
including 
psychosocial 
assessment 
and 
care;
195
‘‘(ii) appropriate follow-up care, in-
cluding psychosocial assessment and care; 
‘‘(iii) 
determining 
coverage 
under 
health insurance and health plans for all 
services; 
‘‘(iv) ensuring the initiation, continu-
ation and/or sustained access to care pre-
scribed by the patients’ healthcare pro-
viders; and 
‘‘(v) aiding patients with health insur-
ance coverage issues; 
‘‘(E) requiring training for patient naviga-
tors to ensure the ability of navigators to per-
form all of the duties required in this sub-
section and in subsection (a), including training 
to ensure that navigators are informed about 
health insurance systems and are able to aid 
patients in resolving access issues; and 
‘‘(F) ensuring that consumers have direct 
access to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
196
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pa-
tient navigator is serving of the services of the model 
program under the grant. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective patient navigator pro-
gram evaluation, the grantee shall collect specific pa-
tient data recording navigation services provided to 
each patient served by the program and shall estab-
lish and implement procedures and protocols, con-
sistent with applicable Federal and State laws (in-
cluding 45 C.F.R. 160 and 164) to ensure the con-
fidentiality of all information shared by a participant 
in the program, or their personal representative and 
their healthcare providers, group health plans, or 
health insurance insurers with the program. The pa-
tient navigator program may, consistent with appli-
cable Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
197
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Secretary and the 
application is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section. 
‘‘(5) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Administrator of the Health Re-
sources and Services Administration, shall, di-
rectly or through grants or contracts, provide 
for evaluations to determine the effects of the 
services of patient navigators on the individuals 
of health disparity populations for whom the 
services were provided, taking into account the 
matters referred to in paragraph (1)(C). 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A).
198
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (a) and with the program under section 
417D. 
‘‘(c) REQUIREMENTS REGARDING FEES.—
‘‘(1) IN GENERAL.—A condition for the receipt 
of a grant under subsection (a)(1) or (b)(1) is that 
the program for which the grant is made have in ef-
fect—
‘‘(A) a schedule of fees or payments for 
the provision of its healthcare services related 
to the prevention and treatment of disease that 
is consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and 
‘‘(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or 
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to require payment 
for navigation services or to require payment for 
healthcare services in cases where care is provided 
free of charge, including the case of services pro-
199
vided through programs of the Indian Health Serv-
ice. 
‘‘(d) MODEL.—Not later than five years after the 
date of the enactment of this section, the Secretary shall 
develop a peer-reviewed model of systems for the services 
provided by this section. The Secretary shall update such 
model as may be necessary to ensure that the best prac-
tices are being utilized. 
‘‘(e) DURATION
OF GRANT.—The period during 
which payments are made to an entity from a grant under 
subsection (a)(1) or (b)(1) may not exceed five years. The 
provision of such payments are subject to annual approval 
by the Secretary of the payments and subject to the avail-
ability of appropriations for the fiscal year involved to 
make the payments. This subsection may not be construed 
as establishing a limitation on the number of grants under 
such subsection that may be made to an entity. 
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients.
200
‘‘(2) The term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care. 
‘‘(3) The term ‘health disparity population’ 
means a population in which there exists a signifi-
cant disparity in the overall rate of disease inci-
dence, morbidity, mortality, or survival rates in the 
population as compared to the health status of the 
general population. Such term includes—
‘‘(A) racial and ethnic minority groups as 
defined in section 1707; and 
‘‘(B) medically underserved groups, such 
as rural and low-income individuals and individ-
uals with low levels of literacy. 
‘‘(4)(A) The term ‘patient navigator’ means an 
individual whose functions include—
‘‘(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the 
healthcare system to accomplish the follow-up 
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease including pro-
viding information about clinical trials; and 
‘‘(ii) identifying, anticipating, and helping 
patients overcome barriers within the healthcare
201
system to ensure prompt diagnostic and treat-
ment resolution of an abnormal finding of can-
cer or other chronic disease. 
‘‘(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) IN GENERAL.—
‘‘(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) (other than the 
purpose described in paragraph (2)(A)), there 
are authorized to be appropriated such sums as 
may be necessary for each of the fiscal years 
2005 through 2010. 
‘‘(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) (other than 
the purpose described in paragraph (2)(B)), 
there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal 
years 2005 through 2010. 
‘‘(C) 
BUREAU
OF
PRIMARY 
HEALTHCARE.—Amounts appropriated under 
subparagraph (A) or (B) shall be administered 
through the Bureau of Primary Health Care.
202
‘‘(2) PROGRAMS IN RURAL AREAS.—
‘‘(A) MODEL PROGRAMS.—For the purpose 
of carrying out subsection (a) by making grants 
under such subsection for model programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2005 through 2010. 
‘‘(B) PATIENT NAVIGATORS.—For the pur-
pose of carrying out subsection (b) by making 
grants under such subsection for programs in 
rural areas, there are authorized to be appro-
priated such sums as may be necessary for each 
of the fiscal years 2005 through 2010. 
‘‘(C) OFFICE
OF
RURAL
HEALTH
POL-
ICY.—Amounts appropriated under subpara-
graph (A) or (B) shall be administered through 
the Office of Rural Health Policy. 
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs 
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs.’’.
203
SEC. 427. NCI GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; NCI GRANTS FOR PATIENT NAVIGA-
TORS. 
Subpart 1 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285 et seq.) is amended by adding 
at the end the following section: 
‘‘SEC. 417D. MODEL COMMUNITY CANCER AND CHRONIC 
DISEASE CARE AND PREVENTION; PATIENT 
NAVIGATORS. 
‘‘(a) MODEL COMMUNITY CANCER
AND CHRONIC 
DISEASE CARE AND PREVENTION.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of model programs that—
‘‘(A) provide to individuals of health dis-
parity populations prevention, early detection, 
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases; 
‘‘(B) ensure that the health services are 
provided to such individuals in a culturally com-
petent manner; 
‘‘(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
204
‘‘(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
‘‘(ii) facilitate access to appropriate 
healthcare services within the healthcare 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
‘‘(D) require training for patient naviga-
tors employed through such model programs to 
ensure the ability of navigators to perform all 
of the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and
205
‘‘(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) ELIGIBLE ENTITIES.—For purposes of this 
section, an eligible entity is a designated cancer cen-
ter of the Institute, an academic institution, Indian 
Health Service Clinics, tribal governments, urban In-
dian organizations, tribal organizations, a hospital, a 
qualified nonprofit entity that partners with one or 
more centers providing healthcare to provide naviga-
tion services, which demonstrates the ability to per-
form all of the functions outlined in this subsection 
and subsections (b) and (c), or any other public or 
private entity determined to be appropriate by the 
Director of the Institute, that provides services de-
scribed in paragraph (1)(A) for cancer and chronic 
diseases. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective program evaluation, the 
grantee shall collect specific patient data recording 
services provided to each patient served by the pro-
gram and shall establish and implement procedures 
and protocols, consistent with applicable Federal and 
State laws (including 45 C.F.R. 160 and 164) to en-
sure the confidentiality of all information shared by
206
a participant in the program, or their personal rep-
resentative and their healthcare providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pro-
gram is serving of the services of the model program 
under the grant. Such activities shall include facili-
tating access to appropriate healthcare services and
207
patient navigators within the healthcare system to 
ensure optimal patient utilization of these services. 
‘‘(5) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section. 
‘‘(6) EVALUATIONS.—
‘‘(A) IN GENERAL.—The Director of the 
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine which outreach activities under paragraph 
(3) were most effective in informing the public 
and the specific community that the program is 
serving of the model program services and to 
determine the extent to which such programs 
were effective in providing culturally competent 
services to the health disparity population 
served by the programs. 
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Director of the Institute shall as appropriate 
disseminate to public and private entities the
208
findings made in evaluations under subpara-
graph (A). 
‘‘(7) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (b), with the program under section 330I, 
and to the extent practicable, with programs for pre-
vention centers that are carried out by the Director 
of the Centers for Disease Control and Prevention. 
‘‘(b) PROGRAM FOR PATIENT NAVIGATORS.—
‘‘(1) IN GENERAL.—The Director of the Insti-
tute may make grants to eligible entities for the de-
velopment and operation of programs to pay the 
costs of such entities in—
‘‘(A) assigning patient navigators, in ac-
cordance with applicable criteria of the Sec-
retary, for managing the care of individuals of 
health disparity populations for the duration of 
receiving health services from the health cen-
ters, including aid in coordinating and sched-
uling appointments and referrals, community 
outreach, assistance with transportation ar-
rangements, and assistance with insurance 
issues and other barriers to care and providing 
information about clinical trials;
209
‘‘(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
‘‘(C) ensuring that the patient navigators 
with direct knowledge of the communities they 
serve provide services to such individuals in a 
culturally competent manner; 
‘‘(D) developing model practices for patient 
navigators, including with respect to—
‘‘(i) coordination of health services, 
including 
psychosocial 
assessment 
and 
care; 
‘‘(ii) follow-up services, including psy-
chosocial assessment and care; 
‘‘(iii) 
determining 
coverage 
under 
health insurance and health plans for all 
services; 
‘‘(iv) ensuring the initiation, continu-
ation and/or sustained access to care pre-
scribed by the patients’ healthcare pro-
viders; and 
‘‘(v) aiding patients with health insur-
ance coverage issues;
210
‘‘(E) requiring training for patient naviga-
tors to ensure the ability of navigators to per-
form all of the duties required in this sub-
section and in subsection (a), including training 
to ensure that navigators are informed about 
health insurance systems and are able to aid 
patients in resolving access issues; and 
‘‘(F) ensuring that consumers have direct 
access to patient navigators during regularly 
scheduled hours of business operation. 
‘‘(2) OUTREACH
SERVICES.—A condition for 
the receipt of a grant under paragraph (1) is that 
the applicant involved agree to provide ongoing out-
reach activities while receiving the grant, in a man-
ner that is culturally competent for the health dis-
parity population served by the program, to inform 
the public and the specific community that the pa-
tient navigator is serving of the services of the model 
program under the grant. 
‘‘(3) DATA
COLLECTION
AND
REPORT.—In 
order to allow for effective patient navigator pro-
gram evaluation, the grantee shall collect specific pa-
tient data recording navigation services provided to 
each patient served by the program and shall estab-
lish and implement procedures and protocols, con-
211
sistent with applicable Federal and State laws (in-
cluding 45 C.F.R. 160 and 164) to ensure the con-
fidentiality of all information shared by a participant 
in the program, or their personal representative and 
their healthcare providers, group health plans, or 
health insurance insurers with the program. The pa-
tient navigator program may, consistent with appli-
cable Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers. 
‘‘(4) APPLICATION FOR GRANT.—A grant may 
be made under paragraph (1) only if an application 
for the grant is submitted to the Director of the In-
stitute and the application is in such form, is made 
in such manner, and contains such agreements, as-
surances, and information as the Director deter-
mines to be necessary to carry out this section. 
‘‘(5) EVALUATIONS.—
212
‘‘(A) IN GENERAL.—The Director of the 
Institute, directly or through grants or con-
tracts, shall provide for evaluations to deter-
mine the effects of the services of patient navi-
gators on the health disparity population for 
whom the services were provided, taking into 
account the matters referred to in paragraph 
(1)(C).
‘‘(B) DISSEMINATION OF FINDINGS.—The 
Director of the Institute shall as appropriate 
disseminate to public and private entities the 
findings made in evaluations under subpara-
graph (A). 
‘‘(6) 
COORDINATION
WITH
OTHER
PRO-
GRAMS.—The Secretary shall coordinate the pro-
gram under this subsection with the program under 
subsection (a) and with the program under section 
330I. 
‘‘(c) REQUIREMENTS REGARDING FEES.—
‘‘(1) IN GENERAL.—A condition for the receipt 
of a grant under subsection (a)(1) or (b)(1) is that 
the program for which the grant is made have in ef-
fect—
‘‘(A) a schedule of fees or payments for 
the provision of its healthcare services related
213
to the prevention and treatment of disease that 
is consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and
‘‘(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or 
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to require payment 
for navigation services or to require payment for 
healthcare services in cases where care is provided 
free of charge, including the case of services pro-
vided through programs of the Indian Health Serv-
ice. 
‘‘(d) MODEL.—Not later than five years after the 
date of the enactment of this section, the Director of the 
Institute shall develop a peer-reviewed model of systems 
for the services provided by this section. The Director shall 
update such model as may be necessary to ensure that 
the best practices are being utilized. 
‘‘(e) DURATION
OF GRANT.—The period during 
which payments are made to an entity from a grant under 
subsection (a)(1) or (b)(1) may not exceed five years. The 
provision of such payments are subject to annual approval
214
by the Director of the Institute of the payments and sub-
ject to the availability of appropriations for the fiscal year 
involved to make the payments. This subsection may not 
be construed as establishing a limitation on the number 
of grants under such subsection that may be made to an 
entity. 
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients. 
‘‘(2) the term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care. 
‘‘(3) the term ‘health disparity population’ 
means a population where there exists a significant 
disparity in the overall rate of disease incidence, 
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
‘‘(A) racial and ethnic minority groups as 
defined in section 1707; and
215
‘‘(B) medically underserved groups, such 
as rural and low-income individuals and individ-
uals with low levels of literacy. 
‘‘(4)(A) the term ‘patient navigator’ means an 
individual whose functions include—
‘‘(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the 
healthcare system to accomplish the follow-up 
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease, including pro-
viding information about clinical trials; and 
‘‘(ii) identifying, anticipating, and helping 
patients overcome barriers within the healthcare 
system to ensure prompt diagnostic and treat-
ment resolution of an abnormal finding of can-
cer or other chronic disease. 
‘‘(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) MODEL PROGRAMS.—For the purpose of 
carrying out subsection (a), there are authorized to
216
be appropriated such sums as may be necessary for 
each of the fiscal years 2005 through 2010. 
‘‘(2) PATIENT NAVIGATORS.—For the purpose 
of carrying out subsection (b), there are authorized 
to be appropriated such sums as may be necessary 
for each of the fiscal years 2005 through 2010. 
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs 
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs.’’. 
SEC. 428. IHS GRANTS FOR MODEL COMMUNITY CANCER 
AND CHRONIC DISEASE CARE AND PREVEN-
TION; IHS GRANTS FOR PATIENT NAVIGA-
TORS. 
(a) MODEL COMMUNITY CANCER AND CHRONIC DIS-
EASE CARE AND PREVENTION.—
(1) IN GENERAL.—The Director of the Indian 
Health Service may make grants to Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, and qualified 
nonprofit entities demonstrating the ability to per-
form all of the functions outlined in this subsection 
and subsections (b) and (c) that partner with pro-
viders or centers providing healthcare serving Native
217
American populations to provide navigation services, 
for the development and operation of model pro-
grams that—
(A) provide to individuals of health dis-
parity populations prevention, early detection, 
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases; 
(B) ensure that the health services are pro-
vided to such individuals in a culturally com-
petent manner; 
(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
(ii) facilitate access to appropriate 
healthcare services within the healthcare 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
218
ance with transportation arrangements, 
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
(D) require training for patient navigators 
employed through such model programs to en-
sure the ability of navigators to perform all of 
the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
(2) OUTREACH SERVICES.—A condition for the 
receipt of a grant under paragraph (1) is that the 
applicant involved agree to provide ongoing outreach 
activities while receiving the grant, in a manner that 
is culturally competent for the health disparity popu-
lation served by the program, to inform the public 
and the specific community that the program is 
serving of the services of the model program under 
the grant. Such activities shall include facilitating 
access to appropriate healthcare services and patient
219
navigators within the healthcare system to ensure 
optimal patient utilization of these services. 
(3) DATA COLLECTION AND REPORT.—In order 
to allow for effective program evaluation, the grantee 
shall collect specific patient data recording services 
provided to each patient served by the program and 
shall establish and implement procedures and proto-
cols, consistent with applicable Federal and State 
laws (including 45 C.F.R. 160 and 164) to ensure 
the confidentiality of all information shared by a 
participant in the program, or their personal rep-
resentative and their healthcare providers, group 
health plans, or health insurance insurers with the 
program. The program may, consistent with applica-
ble Federal and State confidentiality laws, collect, 
use or disclose aggregate information that is not in-
dividually identifiable (as defined in 45 C.F.R. 160 
and 164). With this data, the grantee shall submit 
an annual report to the Secretary that summarizes 
and analyzes these data, provides information on 
needs for navigation services, types of access difficul-
ties resolved, sources of repeated resolution and 
flaws in the system of access, including insurance 
barriers.
220
(4) APPLICATION FOR GRANT.—A grant may be 
made under paragraph (1) only if an application for 
the grant is submitted to the Secretary and the ap-
plication is in such form, is made in such manner, 
and contains such agreements, assurances, and in-
formation as the Secretary determines to be nec-
essary to carry out this section. 
(5) EVALUATIONS.—
(A) IN GENERAL.—The Secretary, acting 
through the Director of the Indian Health Serv-
ice, shall, directly or through grants or con-
tracts, provide for evaluations to determine 
which outreach activities under paragraph (2) 
were most effective in informing the public and 
the specific community that the program is 
serving of the model program services and to 
determine the extent to which such programs 
were effective in providing culturally competent 
services to the health disparity population 
served by the programs. 
(B) DISSEMINATION
OF
FINDINGS.—The 
Secretary shall as appropriate disseminate to 
public and private entities the findings made in 
evaluations under subparagraph (A).
221
(6) COORDINATION WITH OTHER PROGRAMS.—
The Secretary shall coordinate the program under 
this subsection with the program under subsection 
(b), with the program under section 417D, and to 
the extent practicable, with programs for prevention 
centers that are carried out by the Director of the 
Centers for Disease Control and Prevention. 
(b) PROGRAM FOR PATIENT NAVIGATORS.—
(1) 
IN
GENERAL.—The 
Secretary, 
acting 
through the Director of the Indian Health Service, 
may make grants to Indian Health Service Centers, 
tribal governments, urban Indian organizations, trib-
al organizations, and qualified nonprofit entities 
demonstrating the ability to perform all of the func-
tions outlined in this subsection and subsections (a) 
and (c) that partner with providers or centers pro-
viding healthcare serving Native American popu-
lations to provide navigation services, for the devel-
opment and operation of model programs to pay the 
costs of such organizations in—
(A) assigning patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for individuals of health disparity populations 
for the duration of receiving health services 
from the health centers, including aid in coordi-
222
nating and scheduling appointments and refer-
rals, community outreach, assistance with 
transportation arrangements, and assistance 
with insurance issues and other barriers to care 
and providing information about clinical trials; 
(B) ensuring that the services provided by 
the patient navigators to such individuals in-
clude case management and psychosocial as-
sessment and care or information and referral 
to such services; 
(C) ensuring that patient navigators with 
direct knowledge of the communities they serve 
provide services to such individuals in a cul-
turally competent manner; 
(D) developing model practices for patient 
navigators, including with respect to—
(i) coordination of health services, in-
cluding psychosocial assessment and care; 
(ii) appropriate follow-up care, includ-
ing psychosocial assessment and care; 
(iii) 
determining 
coverage 
under 
health insurance and health plans for all 
services; 
(iv) ensuring the initiation, continu-
ation and/or sustained access to care pre-
223
scribed by the patients’ healthcare pro-
viders; and 
(v) aiding patients with health insur-
ance coverage issues; 
(E) requiring training for patient naviga-
tors to ensure the ability of navigators to per-
form all of the duties required in this sub-
section and in subsection (a), including training 
to ensure that navigators are informed about 
health insurance systems and are able to aid 
patients in resolving access issues; and 
(F) ensuring that consumers have direct 
access to patient navigators during regularly 
scheduled hours of business operation. 
(2) OUTREACH SERVICES.—A condition for the 
receipt of a grant under paragraph (1) is that the 
applicant involved agree to provide ongoing outreach 
activities while receiving the grant, in a manner that 
is culturally competent for the health disparity popu-
lation served by the program, to inform the public 
and the specific community that the patient navi-
gator is serving of the services of the model program 
under the grant. 
(3) DATA COLLECTION AND REPORT.—In order 
to allow for effective patient navigator program eval-
235
laborate with academic institutions. Nothing in this sec-
tion shall be construed to require such collaboration.
‘‘(f) QUALITY ASSURANCE
AND COST-EFFECTIVE-
NESS.—The Secretary shall establish guidelines for assur-
ing the quality of the training and supervision of commu-
nity health workers under the programs funded under this 
section and for assuring the cost-effectiveness of such pro-
grams. 
‘‘(g) MONITORING.—The Secretary shall monitor 
community health worker programs identified in approved 
applications and shall determine whether such programs 
are in compliance with the guidelines established under 
subsection (e). 
‘‘(h) TECHNICAL ASSISTANCE.—The Secretary may 
provide technical assistance to community health worker 
programs identified in approved applications with respect 
to planning, developing, and operating programs under the 
grant. 
‘‘(i) REPORT TO CONGRESS.— 
‘‘(1) IN
GENERAL.—Not later than 4 years 
after the date on which the Secretary first awards 
grants under subsection (a), the Secretary shall sub-
mit to Congress a report regarding the grant 
project.
250
(G) A review of the degree of minority en-
tity participation in the program, and an identi-
fication of a strategy to increase such participa-
tion. 
(H) Any other reviews or recommendations 
determined to be appropriate by the coordi-
nating committee. 
(d) REPORT.—The Director of the Office of Minority 
Health and the Administrator of the Health Resources 
and Services Administration shall submit a joint annual 
report to the appropriate committees of Congress on the 
results of the implementation of programs under this sec-
tion. 
(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 
2005 through 2010. 
Subtitle B—Targeting Diseases and 
Conditions 
with 
Particularly 
Disparate Impact 
CHAPTER 1—CANCER REDUCTION 
SEC. 441. CANCER REDUCTION. 
(a) PREVENTIVE HEALTH MEASURES WITH RE-
SPECT TO BREAST AND CERVICAL CANCER.—
287
the preceding sentence shall be expended to expand such 
Program. 
SEC. 472. ASTHMA-RELATED ACTIVITIES OF CENTERS FOR 
DISEASE CONTROL AND PREVENTION. 
(a) EXPANSION OF PUBLIC HEALTH SURVEILLANCE 
ACTIVITIES; PROGRAM
FOR PROVIDING INFORMATION 
AND EDUCATION TO PUBLIC.—The Secretary of Health 
and Human Services, acting through the Director of the 
Centers for Disease Control and Prevention, shall collabo-
rate with the States to expand the scope of—
(1) activities that are carried out to determine 
the incidence and prevalence of asthma; and 
(2) activities that are carried out to prevent the 
health consequences of asthma, including through 
the provision of information and education to the 
public regarding asthma, which may include the use 
of public service announcements through the media 
and such other means as such Director determines 
to be appropriate. 
(b) COMPILATION
OF
DATA.—The Secretary of 
Health and Human Services, acting through the Director 
of the Centers for Disease Control and Prevention and in 
consultation with the National Asthma Education Preven-
tion Program Coordinating Committee, shall—