125 
as the Secretary may require and in such form and man-
ner as the Secretary may require. 
(d) USE OF GRANT.—As a condition of receiving a 
grant under this section, an eligible entity shall— 
(1) develop and implement a plan for assuring 
the availability of ESL instruction that effectively 
integrates information about the nature of the 
United States health care system, how to access 
care, and any special language skills that may be re-
quired for them to access and regularly negotiate the 
system effectively; 
(2) develop a plan, including, where appro-
priate, public-private partnerships, for making ESL 
instruction progressively available to all individuals 
seeking instruction; and 
(3) maintain current ESL instruction efforts by 
using the additional funds to supplement rather 
than supplant any funds expended for ESL instruc-
tion in the State as of January 1, 2015. 
(e) ADDITIONAL DUTIES OF THE SECRETARY.—The 
Secretary of Education shall— 
(1) collect and publicize annual data on how 
much Federal, State, and local governments spend 
on ESL instruction; 
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(2) collect data from State and local govern-
ments to identify the unmet needs of English lan-
guage learners for appropriate ESL instruction, in-
cluding— 
(A) the preferred written and spoken lan-
guage of such English language learners; 
(B) the extent of waiting lists including 
how many programs maintain waiting lists and, 
for programs that do not have waiting lists, the 
reasons why not; 
(C) the availability of programs to geo-
graphically isolated communities; 
(D) the impact of course enrollment poli-
cies, including open enrollment, on the avail-
ability of ESL instruction; 
(E) the number individuals in the State 
and each participating locality; 
(F) the effectiveness of the instruction in 
meeting the needs of individuals receiving in-
struction and those needing instruction; 
(G) as assessment of the need for pro-
grams that integrate job training and ESL in-
struction, to assist individuals to obtain better 
jobs; and 
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(H) the availability of ESL slots by State 
and locality; 
(3) determine the cost and most appropriate 
methods of making ESL instruction available to all 
English language learners seeking instruction; and 
(4) within 1 year of the date of enactment of 
this Act, issue a report to Congress that assesses the 
information collected in paragraphs (1), (2), and (3) 
and makes recommendations on steps that should be 
taken to progressively realize the goal of making 
ESL instruction available to all English language 
learners seeking instruction. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to the Secretary of Edu-
cation for each of fiscal years 2015 through 2018 
$250,000,000 to carry out this section. 
SEC. 210. IMPLEMENTATION. 
(a) GENERAL PROVISIONS.— 
(1) A State shall not be immune under the 
Eleventh Amendment of the Constitution of the 
United States from suit in Federal court for failing 
to provide the language access funded pursuant to 
this title. 
(2) In a suit against a State for a violation of 
this title, remedies (including remedies at both at 
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law and in equity) are available for such a violation 
to the same extent as such remedies are available for 
such a violation in the suit against any public or pri-
vate entity other than a State. 
(b) RULE OF CONSTRUCTION.—Nothing in this title 
shall be construed to limit otherwise existing obligations 
of recipients of Federal financial assistance under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 
seq.) or any other statute. 
SEC. 211. LANGUAGE ACCESS SERVICES. 
(a) ESSENTIAL BENEFITS.—Section 1302(b)(1) of 
the Patient Protection and Affordable Care Act (42 
U.S.C. 18022(b)(1)) is amended by adding at the end the 
following: 
‘‘(K) Language access services, including 
oral interpretation and written translations.’’. 
(b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 
COVERAGE.—Section 36B(c)(2)(C) of the Internal Rev-
enue Code of 1986 is amended by adding at the end the 
following: 
‘‘(v) COVERAGE MUST INCLUDE LAN-
GUAGE ACCESS AND SERVICES.—Except as 
provided in clause (iii), an employee shall 
not be treated as eligible for minimum es-
sential coverage if such coverage consists 
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of an eligible employer-sponsored plan (as 
defined in section 5000A(f)(2)) and the 
plan does not provide coverage for lan-
guage access services, including oral inter-
pretation and written translations.’’. 
(c) QUALITY REPORTING.—Section 2717(a)(1) of the 
Public Health Service Act (42 U.S.C. 300gg–17(a)(1)) is 
amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (C); 
(2) by striking the period at the end of sub-
paragraph (D) and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(E) reduce health disparities through the 
provision of language access services, including 
oral interpretation and written translations.’’. 
(d) REGULATIONS REGARDING INTERNAL CLAIMS 
AND APPEALS AND EXTERNAL REVIEW PROCESSES FOR 
HEALTH PLANS AND HEALTH INSURANCE ISSUERS.— 
The Secretary of the Treasury, the Secretary of Labor, 
and the Secretary of Health and Human Services shall 
amend the regulations in section 54.9815–2719T(e) of 
title 26, Code of Federal Regulations, section 2590.715– 
2719(e) of title 29, Code of Federal Regulations, and sec-
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tion 147.136(e) of title 45, Code of Federal Regulations, 
respectively, to require group health plans and health in-
surance issuers offering group or individual health insur-
ance coverage to which such sections apply— 
(1) to provide oral interpretation services with-
out any threshold requirements; 
(2) to provide in the English versions of all no-
tices a statement prominently displayed in not less 
than 15 non-English languages clearly indicating 
how to access the language services provided by the 
plan or issuer; and 
(3) with respect to written translations of no-
tices, to apply a threshold that 5 percent of the pop-
ulation or at least 500 individuals per service area 
are literate only in the same non-English language 
in lieu of 10 percent or more residing in a county. 
(e) DATA COLLECTION AND REPORTING.—The Sec-
retary of Health and Human Services shall— 
(1) amend the single streamlined application 
form developed pursuant to section 1413 of the Pa-
tient Protection and Affordable Care Act (42 U.S.C. 
18083) to collect the preferred spoken and written 
language for each household member applying for 
coverage under a qualified health plan through an 
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Exchange under title I of the Patient Protection and 
Affordable Care Act; 
(2) require navigators, certified application 
counselors, and other enrollment assisters to collect 
and report requests for language assistance; and 
(3) require the Federal and State call centers 
established pursuant to section 1311(d)(4)(b) of the 
Patient Protection and Affordable Care Act (42 
U.S.C. 18031(d)(4)(b)) to submit an annual report 
documenting the number of language assistance re-
quests, the types of languages requested, the range 
and average wait time for a consumer to speak with 
an interpreter, and any steps the call center and lan-
guage line have taken to actively address some of 
the consumer complaints. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall apply to plan years beginning after the 
date of the enactment of this Act. 
TITLE III—HEALTH WORKFORCE 
DIVERSITY 
SEC. 301. AMENDMENT TO THE PUBLIC HEALTH SERVICE 
ACT. 
Title XXXIV of the Public Health Service Act, as 
added by section 202, is amended by adding at the end 
the following: 
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‘‘Subtitle A—Diversifying the 
Health Care Workplace 
‘‘SEC. 3411. NATIONAL WORKING GROUP ON WORKFORCE 
DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Bureau of Health Workforce within the Health Re-
sources and Services Administration, shall award a grant 
to an entity determined appropriate by the Secretary for 
the establishment of a national working group on work-
force diversity. 
‘‘(b) REPRESENTATION.—In establishing the national 
working group under subsection (a): 
‘‘(1) The grantee shall ensure that the group 
has representatives of the following: 
‘‘(A) The Health Resources and Services 
Administration. 
‘‘(B) The Department of Health and 
Human Services Data Council. 
‘‘(C) The Office of Minority Health of the 
Department of Health and Human Services. 
‘‘(D) The Substance Abuse and Mental 
Health Services Administration. 
‘‘(E) The Bureau of Labor Statistics of 
the Department of Labor. 
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‘‘(F) The Public Health Practice Program 
Office—Office of Workforce Policy and Plan-
ning. 
‘‘(G) The National Institute on Minority 
Health and Health Disparities. 
‘‘(H) The Agency for Healthcare Research 
and Quality. 
‘‘(I) The Institute of Medicine Study Com-
mittee for the 2004 workforce diversity report. 
‘‘(J) The Indian Health Service. 
‘‘(K) Minority-serving academic institu-
tions. 
‘‘(L) Consumer organizations. 
‘‘(M) Health professional associations, in-
cluding those that represent underrepresented 
minority populations. 
‘‘(N) Researchers in the area of health 
workforce. 
‘‘(O) Health workforce accreditation enti-
ties. 
‘‘(P) Private foundations that have spon-
sored workforce diversity initiatives. 
‘‘(Q) Local and State health departments. 
‘‘(R) Representatives of community mem-
bers to be included on admissions committees 
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for health profession schools pursuant to sub-
section (c)(8). 
‘‘(S) Other entities determined appropriate 
by the Secretary. 
‘‘(2) The grantee shall ensure that, in addition 
to the representatives under paragraph (1), the 
group has not less than 5 health professions stu-
dents representing various health profession fields 
and levels of training. 
‘‘(c) ACTIVITIES.—The working group established 
under subsection (a) shall convene at least twice each year 
to complete the following activities: 
‘‘(1) Review current public and private health 
workforce diversity initiatives. 
‘‘(2) Identify successful health workforce diver-
sity programs and practices. 
‘‘(3) Examine challenges relating to the devel-
opment and implementation of health workforce di-
versity initiatives. 
‘‘(4) Draft a national strategic work plan for 
health workforce diversity, including recommenda-
tions for public and private sector initiatives. 
‘‘(5) Develop a framework and methods for the 
evaluation of current and future health workforce di-
versity initiatives. 
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‘‘(6) Develop recommended standards for work-
force diversity that could be applicable to all health 
professions programs and programs funded under 
this Act. 
‘‘(7) Develop guidelines to train health profes-
sionals to care for a diverse population. 
‘‘(8) Develop a strategy for the inclusion of 
community members on admissions committees for 
health profession schools. 
‘‘(9) Other activities determined appropriate by 
the Secretary. 
‘‘(d) ANNUAL REPORT.—Not later than 1 year after 
the establishment of the working group under subsection 
(a), and annually thereafter, the working group shall pre-
pare and make available to the general public for com-
ment, an annual report on the activities of the working 
group. Such report shall include the recommendations of 
the working group for improving health workforce diver-
sity. 
‘‘(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 
2015 through 2020. 
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‘‘SEC. 3412. TECHNICAL CLEARINGHOUSE FOR HEALTH 
WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Deputy Assistant Secretary for Minority Health, and 
in collaboration with the Bureau of Health Workforce 
within the Health Resources and Services Administration, 
the National Institute on Minority Health and Health Dis-
parities, shall establish a technical clearinghouse on health 
workforce diversity within the Office of Minority Health 
and coordinate current and future clearinghouses. 
‘‘(b) INFORMATION AND SERVICES.—The clearing-
house established under subsection (a) shall offer the fol-
lowing information and services: 
‘‘(1) Information on the importance of health 
workforce diversity. 
‘‘(2) Statistical information relating to under-
represented minority representation in health and al-
lied health professions and occupations. 
‘‘(3) Model health workforce diversity practices 
and programs, including integrated models of care. 
‘‘(4) Admissions policies that promote health 
workforce diversity and are in compliance with Fed-
eral and State laws. 
‘‘(5) Retainment policies that promote comple-
tion of health profession degrees for underserved 
populations. 
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‘‘(6) Lists of scholarship, loan repayment, and 
loan cancellation grants as well as fellowship infor-
mation for underserved populations for health pro-
fessions schools. 
‘‘(7) Foundation and other large organizational 
initiatives relating to health workforce diversity. 
‘‘(c) CONSULTATION.—In carrying out this section, 
the Secretary shall consult with non-Federal entities which 
may include minority health professional associations and 
minority sections of major health professional associations 
to ensure the adequacy and accuracy of information. 
‘‘(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 
2015 through 2020. 
‘‘SEC. 3413. SUPPORT FOR INSTITUTIONS COMMITTED TO 
WORKFORCE DIVERSITY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Administrator of the Health Resources and Services 
Administration and the Centers for Disease Control and 
Prevention, shall award grants to eligible entities that 
demonstrate a commitment to health workforce diversity. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
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‘‘(1) be an educational institution or entity that 
historically produces or trains meaningful numbers 
of underrepresented minority health professionals, 
including— 
‘‘(A) historically Black colleges and univer-
sities; 
‘‘(B) Hispanic-serving health professions 
schools; 
‘‘(C) Hispanic-serving institutions; 
‘‘(D) tribal colleges and universities; 
‘‘(E) Asian-American, Native American, 
and Pacific Islander-serving institutions; 
‘‘(F) institutions that have programs to re-
cruit and retain underrepresented minority 
health professionals, in which a significant 
number of the enrolled participants are under-
represented minorities; 
‘‘(G) 
health 
professional 
associations, 
which may include underrepresented minority 
health professional associations; and 
‘‘(H) institutions— 
‘‘(i) located in communities with pre-
dominantly underrepresented minority pop-
ulations; 
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‘‘(ii) with whom partnerships have 
been formed for the purpose of increasing 
workforce diversity; and 
‘‘(iii) in which at least 20 percent of 
the enrolled participants are underrep-
resented minorities; and 
‘‘(2) 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 under subsection (a) shall be used to expand existing 
workforce diversity programs, implement new workforce 
diversity programs, or evaluate existing or new workforce 
diversity programs, including with respect to mental 
health care professions. Such programs shall enhance di-
versity by considering minority status as part of an indi-
vidualized consideration of qualifications. Possible activi-
ties may include— 
‘‘(1) educational outreach programs relating to 
opportunities in the health professions; 
‘‘(2) scholarship, fellowship, grant, loan repay-
ment, and loan cancellation programs; 
‘‘(3) postbaccalaureate programs; 
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‘‘(4) academic enrichment programs, particu-
larly targeting those who would not be competitive 
for health professions schools; 
‘‘(5) kindergarten through 12th grade and 
other health pipeline programs; 
‘‘(6) mentoring programs; 
‘‘(7) internship or rotation programs involving 
hospitals, health systems, health plans, and other 
health entities; 
‘‘(8) community partnership development for 
purposes relating to workforce diversity; or 
‘‘(9) leadership training. 
‘‘(d) REPORTS.—Not later than 1 year after receiving 
a grant under this section, and annually for the term of 
the grant, a grantee shall submit to the Secretary a report 
that summarizes and evaluates all activities conducted 
under the grant. 
‘‘(e) DEFINITION.—In this section, the term ‘Asian- 
American, Native American, and Pacific Islander-serving 
institutions’ has the same meaning as the term ‘Asian 
American and Native American Pacific Islander-serving 
institution’ as defined in section 371(c) of the Higher 
Education Act of 1965 (20 U.S.C. 1067q(c)). 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
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such sums as may be necessary for each of fiscal years 
2015 through 2020. 
‘‘SEC. 3414. CAREER DEVELOPMENT FOR SCIENTISTS AND 
RESEARCHERS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the National Institutes of Health, the Di-
rector of the Centers for Disease Control and Prevention, 
the Commissioner of Food and Drugs, the Director of the 
Agency for Healthcare Research and Quality, and the Ad-
ministrator of the Health Resources and Services Admin-
istration, shall award grants that expand existing opportu-
nities for scientists and researchers and promote the inclu-
sion of underrepresented minorities in the health profes-
sions. 
‘‘(b) RESEARCH FUNDING.—The head of each entity 
within the Department of Health and Human Services 
shall establish or expand existing programs to provide re-
search funding to scientists and researchers in training. 
Under such programs, the head of each such entity shall 
give priority in allocating research funding to support 
health research in traditionally underserved communities, 
including underrepresented minority communities, and re-
search classified as community or participatory. 
‘‘(c) DATA COLLECTION.—The head of each entity 
within the Department of Health and Human Services 
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shall collect data on the number (expressed as an absolute 
number and a percentage) of underrepresented minority 
and nonminority applicants who receive and are denied 
agency funding at every stage of review. Such data shall 
be reported annually to the Secretary and the appropriate 
committees of Congress. 
‘‘(d) STUDENT LOAN REIMBURSEMENT.—The Sec-
retary shall establish a student loan reimbursement pro-
gram to provide student loan reimbursement assistance to 
researchers who focus on racial and ethnic disparities in 
health. The Secretary shall promulgate regulations to de-
fine the scope and procedures for the program under this 
subsection. 
‘‘(e) STUDENT LOAN CANCELLATION.—The Sec-
retary shall establish a student loan cancellation program 
to provide student loan cancellation assistance to research-
ers who focus on racial and ethnic disparities in health. 
Students participating in the program shall make a min-
imum 5-year commitment to work at an accredited health 
profession school. The Secretary shall promulgate addi-
tional regulations to define the scope and procedures for 
the program under this subsection. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
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such sums as may be necessary for each of fiscal years 
2015 through 2020. 
‘‘SEC. 3415. CAREER SUPPORT FOR NONRESEARCH HEALTH 
PROFESSIONALS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, the Administrator of the Substance Abuse and 
Mental Health Services Administration, the Administrator 
of the Health Resources and Services Administration, and 
the Administrator of the Centers for Medicare & Medicaid 
Services, shall establish a program to award grants to eli-
gible individuals for career support in nonresearch-related 
health and wellness professions. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an individual shall— 
‘‘(1) be a student in a health professions school, 
a graduate of such a school who is working in a 
health profession, an individual working in a health 
or wellness profession (including mental and behav-
ioral health), or a faculty member of such a school; 
and 
‘‘(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require. 
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‘‘(c) USE
OF
FUNDS.—An individual shall use 
amounts received under a grant under this section to— 
‘‘(1) support the individual’s health activities or 
projects that involve underserved communities, in-
cluding racial and ethnic minority communities; 
‘‘(2) support health-related career advancement 
activities; 
‘‘(3) to pay, or as reimbursement for payments 
of, student loans or training or credentialing costs 
for individuals who are health professionals and are 
focused on health issues affecting underserved com-
munities, including racial and ethnic minority com-
munities; and 
‘‘(4) to establish and promote leadership train-
ing programs to decrease health disparities and to 
increase cultural competence with the goal of in-
creasing diversity in leadership positions. 
‘‘(d) DEFINITION.—In this section, the term ‘career 
in nonresearch-related health and wellness professions’ 
means employment or intended employment in the field 
of public health, health policy, health management, health 
administration, medicine, nursing, pharmacy, psychology, 
social work, psychiatry, other mental and behavioral 
health, allied health, community health, social work, or 
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other fields determined appropriate by the Secretary, 
other than in a position that involves research. 
‘‘(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 
2015 through 2020. 
‘‘SEC. 3416. RESEARCH ON THE EFFECT OF WORKFORCE DI-
VERSITY ON QUALITY. 
‘‘(a) IN GENERAL.—The Director of the Agency for 
Healthcare Research and Quality, in collaboration with 
the Deputy Assistant Secretary for Minority Health and 
the Director of the National Institute on Minority Health 
and Health Disparities, shall award grants to eligible enti-
ties to expand research on the link between health work-
force diversity and quality health care. 
‘‘(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 research entity or other entity determined ap-
propriate by the Director; and 
‘‘(2) 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-
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port research that investigates the effect of health work-
force diversity on— 
‘‘(1) language access; 
‘‘(2) cultural competence; 
‘‘(3) patient satisfaction; 
‘‘(4) timeliness of care; 
‘‘(5) safety of care; 
‘‘(6) effectiveness of care; 
‘‘(7) efficiency of care; 
‘‘(8) patient outcomes; 
‘‘(9) community engagement; 
‘‘(10) resource allocation; 
‘‘(11) organizational structure; 
‘‘(12) compliance of care; or 
‘‘(13) other topics determined appropriate by 
the Director. 
‘‘(d) PRIORITY.—In awarding grants under sub-
section (a), the Director shall give individualized consider-
ation to all relevant aspects of the applicant’s background. 
Consideration of prior research experience involving the 
health of underserved communities shall be such a factor. 
‘‘(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 
2015 through 2020. 
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215 
(B) that includes— 
(i) members selected from among— 
(I) public health departments; 
(II) community-based organiza-
tions; 
(III) university and research or-
ganizations; 
(IV) American Indian tribal or-
ganizations, national American Indian 
organizations, Indian Health Service, 
or organizations serving Alaska Na-
tives; and 
(V) interested public or private 
health care providers or organizations 
as deemed appropriate by the Sec-
retary; and 
(ii) at least 1 member from a commu-
nity-based organization that represents the 
targeted racial or ethnic minority group; 
and 
(2) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require, which shall 
include— 
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smartinez on DSK4TPTVN1PROD with BILLS