(4) that has a population of qualified LEP en-
rollees that is linguistically diverse, requiring inter-
preter services in at least 200 non-English lan-
guages. 
(d) USE OF FUNDS.—A State receiving a grant under 
this section shall use the grant funds to— 
(1) ensure that all health care providers in the 
State participating in the State Medicaid plan have 
access to onsite interpreter services, for the purpose 
of enabling effective communication between such 
providers and qualified LEP enrollees during the 
furnishing of items and services and administrative 
interactions; 
(2) establish, expand, procure, or contract for— 
(A) a statewide health care information 
technology system that is designed to achieve 
efficiencies and economies of scale with respect 
to onsite interpreter services provided to health 
care providers in the State participating in the 
State Medicaid plan; and 
(B) an entity to administer such system, 
the duties of which shall include— 
(i) procuring and scheduling inter-
preter services for qualified LEP enrollees; 
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(ii) procuring and scheduling inter-
preter services for individuals with limited 
English proficiency seeking to enroll in the 
State Medicaid plan; 
(iii) ensuring that interpreters receive 
payment for interpreter services rendered 
under the system; and 
(iv) consulting regularly with organi-
zations 
representing 
consumers, 
inter-
preters, and health care providers; and 
(3) develop mechanisms to establish, improve, 
and strengthen the competency of the medical inter-
pretation workforce that serves qualified LEP enroll-
ees in the State, including a national certification 
process that is valid, credible, and vendor-neutral. 
(e) APPLICATION.—To receive a grant under this sec-
tion, a State shall submit an application at such time and 
containing such information as the Secretary may require, 
which shall include the following: 
(1) A description of the language access needs 
of individuals in the State enrolled in the State Med-
icaid plan. 
(2) A description of the extent to which the 
program will— 
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(A) use the grant funds for the purposes 
described in subsection (d); 
(B) meet the health care needs of rural 
populations of the State; and 
(C) collect information that accurately 
tracks the language services requested by con-
sumers as compared to the language services 
provided by health care providers in the State 
participating in the State Medicaid plan. 
(3) A description of how the program will be 
evaluated, including a proposal for collaboration with 
organizations representing interpreters, consumers, 
and individuals with limited English proficiency. 
(f) DEFINITIONS.—In this section: 
(1) QUALIFIED
LEP
ENROLLEE.—The term 
‘‘qualified LEP enrollee’’ means an individual— 
(A) who is limited English proficient; and 
(B) who is enrolled in a State Medicaid 
plan. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given the term in section 1101(a)(1) of the So-
cial Security Act (42 U.S.C. 1301(a)(1)), for pur-
poses of title XIX of such Act (42 U.S.C. 1396 et 
seq.). 
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(3) STATE MEDICAID PLAN.—The term ‘‘State 
Medicaid plan’’ means a State plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) 
or a waiver of such a plan. 
(4) 
UNITED
STATES.—The 
term 
‘‘United 
States’’ has the meaning given the term in section 
1101(a)(2) of the Social Security Act (42 U.S.C. 
1301(a)(2)), for purposes of title XIX of such Act 
(42 U.S.C. 1396 et seq.). 
(g) CONTINUATION PAST DEMONSTRATION.—Any 
State receiving a grant under this section must agree to 
directly pay for language services in Medicaid for all Med-
icaid providers by the end of the grant period. 
(h) FUNDING.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated $5,000,000 
to carry out this section. 
(2) AVAILABILITY OF FUNDS.—Amounts appro-
priated pursuant to the authorization in paragraph 
(1) are authorized to remain available without fiscal 
year limitation. 
(3) INCREASED FEDERAL FINANCIAL PARTICI-
PATION.—Section 1903(a)(2)(E) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 
inserting ‘‘(or, in the case of a State that was 
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awarded a grant under section 203 of the Health 
Equity and Accountability Act of 2020, 100 percent 
for each quarter occurring during the grant period 
specified in subsection (b) of such section)’’ after 
‘‘75 percent’’. 
(i) LIMITATION.—No Federal funds awarded under 
this section may be used to provide interpreter services 
from a location outside the United States. 
SEC. 206. TRAINING TOMORROW’S DOCTORS FOR CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE CARE: GRADUATE MEDICAL EDU-
CATION. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h)(4) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(L) TREATMENT
OF
CULTURALLY
AND 
LINGUISTICALLY
APPROPRIATE
TRAINING.—In 
determining a hospital’s number of full-time 
equivalent residents for purposes of this sub-
section, all the time that is spent by an intern 
or resident in an approved medical residency 
training program for education and training in 
culturally and linguistically appropriate service 
delivery, which shall include all diverse popu-
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SEC. 207. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID, AND 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAMS. 
(a) LANGUAGE ACCESS GRANTS
FOR MEDICARE 
PROVIDERS.— 
(1) ESTABLISHMENT.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices, acting through the Centers for Medicare & 
Medicaid Services and in consultation with the 
Center for Medicare and Medicaid Innovation 
(as referred to in section 1115A of the Social 
Security Act (42 U.S.C. 1315a)), shall establish 
a demonstration program under which the Sec-
retary shall award grants to eligible Medicare 
service providers to improve communication be-
tween such providers and Medicare beneficiaries 
who are limited English proficient, including 
beneficiaries who live in diverse and under-
served communities. 
(B) 
APPLICATION
OF
INNOVATION 
RULES.—The demonstration project under sub-
paragraph (A) shall be conducted in a manner 
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that is consistent with the applicable provisions 
of subsections (b), (c), and (d) of section 1115A 
of the Social Security Act (42 U.S.C. 1315a). 
(C) NUMBER OF GRANTS.—To the extent 
practicable, the Secretary shall award not less 
than 24 grants under this subsection. 
(D) GRANT PERIOD.—Except as provided 
under paragraph (2)(D), each grant awarded 
under this subsection shall be for a 3-year pe-
riod. 
(2) ELIGIBILITY REQUIREMENTS.—To be eligi-
ble for a grant under this subsection, an entity must 
meet the following requirements: 
(A) MEDICARE
PROVIDER.—The entity 
must be— 
(i) a provider of services under part A 
of title XVIII of the Social Security Act 
(42 U.S.C. 1395c et seq.); 
(ii) a provider of services under part 
B of such title (42 U.S.C. 1395j et seq.); 
(iii) a Medicare Advantage organiza-
tion offering a Medicare Advantage plan 
under part C of such title (42 U.S.C. 
1395w–21 et seq.); or 
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(iv) a PDP sponsor offering a pre-
scription drug plan under part D of such 
title (42 U.S.C. 1395w–101 et seq.). 
(B) UNDERSERVED
COMMUNITIES.—The 
entity must serve a community that, with re-
spect to necessary language services for improv-
ing access and utilization of health care among 
English learners, is disproportionally under-
served. 
(C) APPLICATION.—The entity must pre-
pare and submit to the Secretary an applica-
tion, at such time, in such manner, and accom-
panied by such additional information as the 
Secretary may require. 
(D) REPORTING.—In the case of a grantee 
that received a grant under this subsection in 
a previous year, such grantee is only eligible for 
continued payments under a grant under this 
subsection if the grantee met the reporting re-
quirements under paragraph (9) for such year. 
If a grantee fails to meet the requirement of 
such paragraph for the first year of a grant, the 
Secretary may terminate the grant and solicit 
applications from new grantees to participate in 
the demonstration program. 
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(3) DISTRIBUTION.—To the extent feasible, the 
Secretary shall award— 
(A) at least 6 grants to providers of serv-
ices described in paragraph (2)(A)(i); 
(B) at least 6 grants to service providers 
described in paragraph (2)(A)(ii); 
(C) at least 6 grants to organizations de-
scribed in paragraph (2)(A)(iii); and 
(D) at least 6 grants to sponsors described 
in paragraph (2)(A)(iv). 
(4) CONSIDERATIONS IN AWARDING GRANTS.— 
(A) VARIATION IN GRANTEES.—In award-
ing grants under this subsection, the Secretary 
shall select grantees to ensure the following: 
(i) The grantees provide many dif-
ferent types of language services. 
(ii) The grantees serve Medicare bene-
ficiaries who speak different languages, 
and who, as a population, have differing 
needs for language services. 
(iii) The grantees serve Medicare 
beneficiaries in both urban and rural set-
tings. 
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100 
(iv) The grantees serve Medicare 
beneficiaries in at least two geographic re-
gions, as defined by the Secretary. 
(v) The grantees serve Medicare bene-
ficiaries in at least two large metropolitan 
statistical areas with racial, ethnic, sexual, 
gender, disability, and economically diverse 
populations. 
(B) PRIORITY
FOR
PARTNERSHIPS
WITH 
COMMUNITY ORGANIZATIONS AND AGENCIES.— 
In awarding grants under this subsection, the 
Secretary shall give priority to eligible entities 
that have a partnership with— 
(i) a community organization; or 
(ii) a consortia of community organi-
zations, State agencies, and local agencies, 
that has experience in providing language serv-
ices. 
(5) USE OF FUNDS FOR COMPETENT LANGUAGE 
SERVICES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (E), a grantee may only use grant funds 
received under this subsection to pay for the 
provision of competent language services to 
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101 
Medicare beneficiaries who are English learn-
ers. 
(B) COMPETENT LANGUAGE SERVICES DE-
FINED.—For purposes of this subsection, the 
term ‘‘competent language services’’ means— 
(i) interpreter and translation services 
that— 
(I) subject to the exceptions 
under subparagraph (C)— 
(aa) if the grantee operates 
in a State that has statewide 
health care interpreter standards, 
meet the State standards cur-
rently in effect; or 
(bb) if the grantee operates 
in a State that does not have 
statewide health care interpreter 
standards, utilizes competent in-
terpreters who follow the Na-
tional Council on Interpreting in 
Health Care’s Code of Ethics and 
Standards of Practice and com-
ply with the requirements of sec-
tion 1557 of the Patient Protec-
tion and Affordable Care Act (42 
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103 
family member, friend, or other per-
son provide such services; and 
(II) the grantee documents such 
request in the beneficiary’s medical 
record; or 
(ii) in the case of a medical emergency 
where the delay directly associated with ob-
taining a competent interpreter or trans-
lation services would jeopardize the health 
of the patient. 
Clause (ii) shall not be construed to exempt 
emergency rooms or similar entities that regu-
larly provide health care services in medical 
emergencies to patients who are English learn-
ers from any applicable legal or regulatory re-
quirements related to providing competent in-
terpreter and translation services without undue 
delay. 
(D) MEDICARE
ADVANTAGE
ORGANIZA-
TIONS AND PDP SPONSORS.—If a grantee is a 
Medicare Advantage organization offering a 
Medicare Advantage plan under part C of title 
XVIII of the Social Security Act (42 U.S.C. 
1395w–21 et seq.) or a PDP sponsor offering 
a prescription drug plan under part D of such 
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104 
title (42 U.S.C. 1395w–101 et seq.), such entity 
must provide at least 50 percent of the grant 
funds that the entity receives under this sub-
section directly to the entity’s network providers 
(including all health providers and pharmacists) 
for the purpose of providing support for such 
providers to provide competent language serv-
ices to Medicare beneficiaries who are English 
learners. 
(E) ADMINISTRATIVE
AND
REPORTING 
COSTS.—A grantee may use up to 10 percent of 
the grant funds to pay for administrative costs 
associated with the provision of competent lan-
guage services and for reporting required under 
paragraph (9). 
(6) DETERMINATION
OF
AMOUNT
OF
GRANT 
PAYMENTS.— 
(A) IN GENERAL.—Payments to grantees 
under this subsection shall be calculated based 
on the estimated numbers of Medicare bene-
ficiaries who are English learners in a grantee’s 
service area utilizing— 
(i) data on the numbers of English 
learners who speak English less than ‘‘very 
well’’ from the most recently available data 
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105 
from the Bureau of the Census or other 
State-based study the Secretary determines 
likely to yield accurate data regarding the 
number of such individuals in such service 
area; or 
(ii) data provided by the grantee, if 
the grantee routinely collects data on the 
primary language of the Medicare bene-
ficiaries that the grantee serves and the 
Secretary determines that the data is accu-
rate and shows a greater number of 
English learners than would be estimated 
using the data under clause (i). 
(B) DISCRETION OF SECRETARY.—Subject 
to subparagraph (C), the amount of payment 
made to a grantee under this subsection may be 
modified annually at the discretion of the Sec-
retary, based on changes in the data under sub-
paragraph (A) with respect to the service area 
of a grantee for the year. 
(C) 
LIMITATION
ON
AMOUNT.—The 
amount of a grant made under this subsection 
to a grantee may not exceed $500,000 for the 
period under paragraph (1)(D). 
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106 
(7) ASSURANCES.—Grantees under this sub-
section shall, as a condition of receiving a grant 
under this subsection— 
(A) ensure that clinical and support staff 
receive appropriate ongoing education and 
training in linguistically appropriate service de-
livery; 
(B) ensure the linguistic competence of bi-
lingual providers; 
(C) offer and provide appropriate language 
services at no additional charge to each patient 
who is an English learner for all points of con-
tact between the patient and the grantee, in a 
timely manner during all hours of operation; 
(D) notify Medicare beneficiaries of their 
right to receive language services in their pri-
mary language; 
(E) post signage in the primary languages 
commonly used by the patient population in the 
service area of the organization; and 
(F) ensure that— 
(i) primary language data are col-
lected for recipients of language services 
and such data are consistent with stand-
ards developed under title XXXIV of the 
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107 
Public Health Service Act, as added by 
section 202 of this Act, to the extent such 
standards are available upon the initiation 
of the demonstration program; and 
(ii) consistent with the privacy protec-
tions provided under the regulations pro-
mulgated pursuant to section 264(c) of the 
Health Insurance Portability and Account-
ability Act of 1996 (42 U.S.C. 1320d–2 
note), if the recipient of language services 
is a minor or is incapacitated, primary lan-
guage data are collected on the parent or 
legal guardian of such recipient. 
(8) NO COST SHARING.—Medicare beneficiaries 
who are English learners shall not have to pay cost 
sharing or co-payments for competent language serv-
ices provided under this demonstration program. 
(9) REPORTING
REQUIREMENTS
FOR
GRANT-
EES.—Not later than the end of each calendar year, 
a grantee that receives funds under this subsection 
in such year shall submit to the Secretary a report 
that includes the following information: 
(A) The number of Medicare beneficiaries 
to whom competent language services are pro-
vided. 
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108 
(B) The primary languages of those Medi-
care beneficiaries. 
(C) The types of language services pro-
vided to such beneficiaries. 
(D) Whether such language services were 
provided by employees of the grantee or 
through a contract with external contractors or 
agencies. 
(E) The types of interpretation services 
provided to such beneficiaries, and the approxi-
mate length of time such service is provided to 
such beneficiaries. 
(F) The costs of providing competent lan-
guage services. 
(G) An account of the training or accredi-
tation of bilingual staff, interpreters, and trans-
lators providing services funded by the grant 
under this subsection. 
(10) EVALUATION
AND
REPORT
TO
CON-
GRESS.—Not later than 1 year after the completion 
of a 3-year grant under this subsection, the Sec-
retary shall conduct an evaluation of the demonstra-
tion program under this subsection and shall submit 
to the Congress a report that includes the following: 
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109 
(A) An analysis of the patient outcomes 
and the costs of furnishing care to the Medicare 
beneficiaries who are English learners partici-
pating in the project as compared to such out-
comes and costs for such Medicare beneficiaries 
not participating, based on the data provided 
under paragraph (9) and any other information 
available to the Secretary. 
(B) The effect of delivering language serv-
ices on— 
(i) Medicare beneficiary access to care 
and utilization of services; 
(ii) the efficiency and cost effective-
ness of health care delivery; 
(iii) patient satisfaction; 
(iv) health outcomes; and 
(v) the provision of culturally appro-
priate services provided to such bene-
ficiaries. 
(C) The extent to which bilingual staff, in-
terpreters, and translators providing services 
under such demonstration were trained or ac-
credited and the nature of accreditation or 
training needed by type of provider, service, or 
other category as determined by the Secretary 
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110 
to ensure the provision of high-quality interpre-
tation, translation, or other language services to 
Medicare beneficiaries if such services are ex-
panded pursuant to section 1115A(c) of the So-
cial Security Act (42 U.S.C. 1315a(c)). 
(D) Recommendations, if any, regarding 
the extension of such project to the entire Medi-
care Program, subject to the provisions of such 
section 1115A(c). 
(11) APPROPRIATIONS.—There is appropriated 
to carry out this subsection, in equal parts from the 
Federal Hospital Insurance Trust Fund under sec-
tion 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical In-
surance Trust Fund under section 1841 of such Act 
(42 U.S.C. 1395t), $16,000,000 for each fiscal year 
of the demonstration program. 
(12) ENGLISH
LEARNER
DEFINED.—In this 
subsection, the term ‘‘English learner’’ has the 
meaning given such term in section 8101(20) of the 
Elementary and Secondary Education Act of 1965, 
except that subparagraphs (A), (B), and (D) of such 
section shall not apply. 
(b) LANGUAGE ASSISTANCE SERVICES UNDER THE 
MEDICARE PROGRAM.— 
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111 
(1) INCLUSION
AS
RURAL
HEALTH
CLINIC 
SERVICES.—Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended— 
(A) in subsection (aa)(1)— 
(i) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(ii) by adding ‘‘and’’ at the end of 
subparagraph (C); and 
(iii) by inserting after subparagraph 
(C) the following new subparagraph: 
‘‘(D) language assistance services as defined in 
subsection (jjj)(1),’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Language Assistance Services and Related Terms 
‘‘(kkk)(1) The term ‘language assistance services’ 
means ‘language access’ or ‘language assistance services’ 
(as those terms are defined in section 3400 of the Public 
Health Service Act) furnished by a ‘qualified interpreter 
for an individual with limited English proficiency’ or a 
‘qualified translator’ (as those terms are defined in such 
section 3400) to an ‘individual with limited English pro-
ficiency’ (as defined in such section 3400) or an ‘English 
learner’ (as defined in paragraph (2)). 
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112 
‘‘(2) The term ‘English learner’ has the meaning 
given that term in section 8101(20) of the Elementary and 
Secondary Education Act of 1965, except that subpara-
graphs (A), (B), and (D) of such section shall not apply.’’. 
(2) COVERAGE.—Section 1832(a)(2) of the So-
cial Security Act (42 U.S.C. 1395k(a)(2)) is amend-
ed— 
(A) by striking ‘‘and’’ at the end of sub-
paragraph (I); 
(B) by striking the period at the end of 
subparagraph (J) and inserting ‘‘; and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) language assistance services (as de-
fined in section 1861(jjj)(1)).’’. 
(3) PAYMENT.—Section 1833(a) of the Social 
Security Act (42 U.S.C. 1395l(a)) is amended— 
(A) by striking ‘‘and’’ at the end of para-
graph (8); 
(B) by striking the period at the end of 
paragraph (9) and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (9) the 
following new paragraph: 
‘‘(10) in the case of language assistance serv-
ices (as defined in section 1861(jjj)(1)), 100 percent 
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113 
of the reasonable charges for such services, as deter-
mined in consultation with the Medicare Payment 
Advisory Commission.’’. 
(4) WAIVER
OF
BUDGET
NEUTRALITY.—For 
the 3-year period beginning on the date of enact-
ment of this section, the budget neutrality provision 
of section 1848(c)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 
apply with respect to language assistance services 
(as defined in section 1861(kkk)(1) of such Act). 
(c) MEDICARE PARTS C AND D.— 
(1) IN GENERAL.—Medicare Advantage plans 
under part C of title XVIII of the Social Security 
Act (42 U.S.C. 1395w–21 et seq.) and prescription 
drug plans under part D of such title (42 U.S.C. 
1395q–101) shall comply with title VI of the Civil 
Rights Act of 1964 (42 U.S.C. 2000d et seq.) and 
section 1557 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18116) to provide effective 
language services to enrollees of such plans. 
(2) MEDICARE
ADVANTAGE
PLANS
AND
PRE-
SCRIPTION
DRUG
PLANS
REPORTING
REQUIRE-
MENT.—Section 1857(e) of the Social Security Act 
(42 U.S.C. 1395w–27(e)) is amended by adding at 
the end the following new paragraph: 
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114 
‘‘(5) REPORTING REQUIREMENTS RELATING TO 
EFFECTIVE LANGUAGE SERVICES.—A contract under 
this part shall require a Medicare Advantage organi-
zation (and, through application of section 1860D– 
12(b)(3)(D), a contract under section 1860D–12 
shall require a PDP sponsor) to annually submit 
(for each year of the contract) a report that contains 
information on the internal policies and procedures 
of the organization (or sponsor) related to recruit-
ment and retention efforts directed to workforce di-
versity and linguistically and culturally appropriate 
provision of services in each of the following con-
texts: 
‘‘(A) The collection of data in a manner 
that meets the requirements of title I of the 
Health Equity and Accountability Act of 2020, 
regarding the enrollee population. 
‘‘(B) Education of staff and contractors 
who have routine contact with enrollees regard-
ing the various needs of the diverse enrollee 
population. 
‘‘(C) Evaluation of the language services 
programs and services offered by the organiza-
tion (or sponsor) with respect to the enrollee 
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115 
population, such as through analysis of com-
plaints or satisfaction survey results. 
‘‘(D) Methods by which the plan provides 
to the Secretary information regarding the eth-
nic diversity of the enrollee population. 
‘‘(E) The periodic provision of educational 
information to plan enrollees on the language 
services and programs offered by the organiza-
tion (or sponsor).’’. 
(d) IMPROVING LANGUAGE SERVICES IN MEDICAID 
AND CHIP.— 
(1) 
PAYMENTS
TO
STATES.—Section 
1903(a)(2)(E) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(E)), as amended by section 203(g)(3), 
is further amended by— 
(A) striking ‘‘75’’ and inserting ‘‘95’’; 
(B) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language assistance 
services’’; and 
(C) striking ‘‘children of families’’ and in-
serting ‘‘individuals’’. 
(2) STATE
PLAN
REQUIREMENTS.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended by striking 
‘‘and (29)’’ and inserting ‘‘(29), and (30)’’. 
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116 
(3) DEFINITION
OF
MEDICAL
ASSISTANCE.— 
Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended— 
(A) in paragraph (29), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (30) as 
paragraph (31); and 
(C) by inserting after paragraph (29) the 
following new paragraph: 
‘‘(30) language assistance services, as such 
term is defined in section 1861(kkk)(1), provided in 
a timely manner to individuals with limited English 
proficiency as defined in section 3400 of the Public 
Health Service Act; and’’. 
(4) USE
OF
DEDUCTIONS
AND
COST
SHAR-
ING.—Section 1916(a)(2) of the Social Security Act 
(42 U.S.C. 1396o(a)(2)) is amended— 
(A) by striking ‘‘or’’ at the end of subpara-
graph (D); 
(B) by striking ‘‘; and’’ at the end of sub-
paragraph (E) and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(F) language assistance services described 
in section 1905(a)(29); and’’. 
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117 
(5) CHIP COVERAGE REQUIREMENTS.—Section 
2103 of the Social Security Act (42 U.S.C. 1397cc) 
is amended— 
(A) in subsection (a), in the matter before 
paragraph (1), by striking ‘‘and (7)’’ and in-
serting ‘‘(7), and (10)’’; 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(10) LANGUAGE ASSISTANCE SERVICES.—The 
child health assistance provided to a targeted low-in-
come child shall include coverage of language assist-
ance services, as such term is defined in section 
1861(jjj)(1), provided in a timely manner to individ-
uals with limited English proficiency (as defined in 
section 3400 of the Public Health Service Act).’’; 
and 
(C) in subsection (e)(2)— 
(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
(ii) 
by 
inserting 
‘‘or 
subsection 
(c)(10)’’ after ‘‘subsection (c)(1)(D)’’. 
(6) DEFINITION
OF
CHILD
HEALTH
ASSIST-
ANCE.—Section 2110(a)(27) of the Social Security 
Act (42 U.S.C. 1397jj(a)(27)) is amended by strik-
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118 
ing ‘‘translation’’ and inserting ‘‘language assistance 
services as described in section 2103(c)(10)’’. 
(7) STATE
DATA
COLLECTION.—Pursuant to 
the reporting requirement described in section 
2107(b)(1) of the Social Security Act (42 U.S.C. 
1397gg(b)(1)), the Secretary of Health and Human 
Services shall require that States collect data on— 
(A) the primary language of individuals re-
ceiving child health assistance under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.); and 
(B) in the case of such individuals who are 
minors or incapacitated, the primary language 
of the individual’s parent or guardian. 
(8) CHIP PAYMENTS
TO
STATES.—Section 
2105 of the Social Security Act (42 U.S.C. 1397ee) 
is amended— 
(A) in subsection (a)(1), by striking ‘‘75’’ 
and inserting ‘‘90’’; and 
(B) in subsection (c)(2)(A), by inserting 
before the period at the end the following: ‘‘, 
except that expenditures pursuant to clause (iv) 
of subparagraph (D) of such paragraph shall 
not count towards this total’’. 
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119 
(e) FUNDING
LANGUAGE
ASSISTANCE
SERVICES 
FURNISHED
BY PROVIDERS
OF HEALTH CARE
AND 
HEALTH-CARE-RELATED SERVICES THAT SERVE HIGH 
RATES OF UNINSURED LEP INDIVIDUALS.— 
(1) PAYMENT OF COSTS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services (referred to in this subsection as the 
‘‘Secretary’’) shall make payments (on a quar-
terly basis) directly to eligible entities to sup-
port the provision of language assistance serv-
ices to English learners in an amount equal to 
an eligible entity’s eligible costs for providing 
such services for the quarter. 
(B) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there are 
appropriated to the Secretary of Health and 
Human Services such sums as may be nec-
essary for each of fiscal years 2021 through 
2025. 
(C) RELATION TO MEDICAID DSH.—Pay-
ments under this subsection shall not offset or 
reduce payments under section 1923 of the So-
cial Security Act (42 U.S.C. 1396r–4), nor 
shall payments under such section be consid-
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120 
ered when determining uncompensated costs as-
sociated with the provision of language assist-
ance services for the purposes of this section. 
(2) 
METHODOLOGY
FOR
PAYMENT
OF 
CLAIMS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a methodology to determine the average 
per person cost of language assistance services. 
(B) 
DIFFERENT
ENTITIES.—In 
estab-
lishing such methodology, the Secretary may es-
tablish different methodologies for different 
types of eligible entities. 
(C) NO
INDIVIDUAL
CLAIMS.—The Sec-
retary may not require eligible entities to sub-
mit individual claims for language assistance 
services for individual patients as a requirement 
for payment under this subsection. 
(3) DATA COLLECTION INSTRUMENT.—For pur-
poses of this subsection, the Secretary shall create a 
standard data collection instrument that is con-
sistent with any existing reporting requirements by 
the Secretary or relevant accrediting organizations 
regarding the number of individuals to whom lan-
guage access are provided. 
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121 
(4) GUIDELINES.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary shall establish and distribute guidelines con-
cerning the implementation of this subsection. 
(5) REPORTING REQUIREMENTS.— 
(A) REPORT TO SECRETARY.—Entities re-
ceiving payment under this subsection shall pro-
vide the Secretary with a quarterly report on 
how the entity used such funds. Such report 
shall contain aggregate (and may not contain 
individualized) data collected using the instru-
ment under paragraph (3) and shall otherwise 
be in a form and manner determined by the 
Secretary. 
(B) REPORT
TO
CONGRESS.—Not later 
than 2 years after the date of enactment of this 
Act, and every 2 years thereafter, the Secretary 
shall submit a report to Congress concerning 
the implementation of this subsection. 
(6) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE COSTS.—The term ‘‘eligible 
costs’’ means, with respect to an eligible entity 
that provides language assistance services to 
English learners, the product of— 
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122 
(i) the average per person cost of lan-
guage assistance services, determined ac-
cording to the methodology devised under 
paragraph (2); and 
(ii) the number of English learners 
who are provided language assistance serv-
ices by the entity and for whom no reim-
bursement is available for such services 
under the amendments made by subsection 
(a), (b), (c), or (d) or by private health in-
surance. 
(B) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means an entity that— 
(i) is a Medicaid provider that is— 
(I) a physician; 
(II) a hospital with a low-income 
utilization rate (as defined in section 
1923(b)(3) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(3))) of greater 
than 25 percent; or 
(III) a federally qualified health 
center 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
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123 
(ii) not later than 6 months after the 
date of the enactment of this Act, provides 
language assistance services to not less 
than 8 percent of the entity’s total number 
of patients; and 
(iii) prepares and submits an applica-
tion to the Secretary, at such time, in such 
manner, and accompanied by such infor-
mation as the Secretary may require, to 
ascertain the entity’s eligibility for funding 
under this subsection. 
(C) 
ENGLISH
LEARNER.—The 
term 
‘‘English learner’’ has the meaning given such 
term in section 8101(20) of the Elementary 
and Secondary Education Act of 1965 (20 
U.S.C. 7801(20)), except that subparagraphs 
(A), (B), and (D) of such section shall not 
apply. 
(D) LANGUAGE ASSISTANCE SERVICES.— 
The term ‘‘language assistance services’’ has 
the meaning given such term in section 
1861(kkk)(1) of the Social Security Act, as 
added by subsection (b). 
(f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 
SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 
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OTHER LAWS.—Nothing in this section shall be construed 
to limit otherwise existing obligations of recipients of Fed-
eral financial assistance under title VI of the Civil Rights 
Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 
the Affordable Care Act, or other laws that protect the 
civil rights of individuals. 
(g) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided and subject to paragraph (2), the amendments 
made by this section shall take effect on January 1, 
2021. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) which the Secretary of 
Health and Human Services determines requires 
State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirement imposed by the amendments 
made by this section, the State plan shall not be re-
garded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet 
this additional requirement before the first day of 
the first calendar quarter beginning after the close 
of the first regular session of the State legislature 
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125 
that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the 
case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a 
separate regular session of the State legislature. 
SEC. 208. INCREASING UNDERSTANDING OF AND IMPROV-
ING HEALTH LITERACY. 
(a) IN GENERAL.—The Secretary, acting through the 
Director of the Agency for Healthcare Research and Qual-
ity with respect to grants under subsection (c)(1) and 
through the Administrator of the Health Resources and 
Services Administration with respect to grants under sub-
section (c)(2), in consultation with the Director of the Na-
tional Institute on Minority Health and Health Disparities 
and the Deputy Assistant Secretary for Minority Health, 
shall award grants to eligible entities to improve health 
care for patient populations that have low functional 
health literacy. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
(1) be a hospital, health center or clinic, health 
plan, or other health entity (including a nonprofit 
minority health organization or association); and 
(2) prepare and submit to the Secretary an ap-
plication at such time, in such manner, and con-
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126 
taining such information as the Secretary may rea-
sonably require. 
(c) USE OF FUNDS.— 
(1) AGENCY FOR HEALTHCARE RESEARCH AND 
QUALITY.—A grant awarded under subsection (a) 
through the Director of the Agency for Healthcare 
Research and Quality shall be used— 
(A) to define and increase the under-
standing of health literacy; 
(B) to investigate the correlation between 
low health literacy and health and health care; 
(C) to clarify which aspects of health lit-
eracy have an effect on health outcomes; and 
(D) for any other activity determined ap-
propriate by the Director. 
(2) HEALTH RESOURCES AND SERVICES ADMIN-
ISTRATION.—A grant awarded under subsection (a) 
through the Administrator of the Health Resources 
and Services Administration shall be used to conduct 
demonstration projects for interventions for patients 
with low health literacy that may include— 
(A) the development of new disease man-
agement programs for patients with low health 
literacy; 
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(B) the tailoring of disease management 
programs addressing mental, physical, oral, and 
behavioral health conditions for patients with 
low health literacy; 
(C) the translation of written health mate-
rials for patients with low health literacy; 
(D) the identification, implementation, and 
testing of low health literacy screening tools; 
(E) the conduct of educational campaigns 
for patients and providers about low health lit-
eracy; 
(F) the conduct of educational campaigns 
concerning health directed specifically at pa-
tients with mental disabilities, including those 
with cognitive and intellectual disabilities, de-
signed to reduce the incidence of low health lit-
eracy among these populations, which shall 
have instructional materials in the plain lan-
guage standards promulgated under the Plain 
Writing Act of 2010 (5 U.S.C. 301 note) for 
Federal agencies; and 
(G) other activities determined appropriate 
by the Administrator. 
(d) DEFINITIONS.—In this section, the term ‘‘low 
health literacy’’ means the inability of an individual to ob-
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tain, process, and understand basic health information 
and services needed to make appropriate health decisions. 
(e) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2021 through 2025. 
SEC. 209. REQUIREMENTS FOR HEALTH PROGRAMS OR AC-
TIVITIES RECEIVING FEDERAL FUNDS. 
(a) COVERED ENTITY; COVERED PROGRAM OR AC-
TIVITY.—In this section— 
(1) the term ‘‘covered entity’’ has the meaning 
given such term in section 92.4 of title 42, Code of 
Federal Regulations, as in effect on May 16, 2016; 
and 
(2) the term ‘‘covered program or activity’’ has 
the meaning given such term in section 92.4 of title 
42, Code of Federal Regulations, as in effect on May 
16, 2016. 
(b) REQUIREMENTS.—A covered entity, in order to 
ensure the right of individuals with limited English pro-
ficiency to receive access to high-quality health care 
through the covered program or activity, shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in cul-
turally and linguistically appropriate service delivery; 
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129 
(2) offer and provide appropriate language as-
sistance services at no additional charge to each pa-
tient that is an individual with limited English pro-
ficiency at all points of contact, in a timely manner 
during all hours of operation; 
(3) notify patients of their right to receive lan-
guage services in their primary language; and 
(4) utilize only qualified interpreters for an in-
dividual with limited English proficiency or qualified 
translators, except as provided in subsection (c). 
(c) EXEMPTIONS.—The requirements of subsection 
(b)(4) shall not apply as follows: 
(1) When a patient requests the use of family, 
friends, or other persons untrained in interpretation 
or translation if each of the following conditions are 
met: 
(A) The interpreter requested by the pa-
tient is over the age of 18. 
(B) The covered entity informs the patient 
in the primary language of the patient that he 
or she has the option of having the entity pro-
vide to the patient an interpreter and trans-
lation services without charge. 
(C) The covered entity informs the patient 
that the entity may not require an individual 
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130 
with a limited English proficiency to use a fam-
ily member or friend as an interpreter. 
(D) The covered entity evaluates whether 
the person the patient wishes to use as an in-
terpreter is competent. If the covered entity has 
reason to believe that such person is not com-
petent as an interpreter, the entity provides its 
own interpreter to protect the covered entity 
from liability if the patient’s interpreter is later 
found not competent. 
(E) If the covered entity has reason to be-
lieve that there is a conflict of interest between 
the interpreter and patient, the covered entity 
may not use the patient’s interpreter. 
(F) The covered entity has the patient sign 
a waiver, witnessed by at least 1 individual not 
related to the patient, that includes the infor-
mation stated in subparagraphs (A) through 
(E) and is translated into the patient’s primary 
language. 
(2) When a medical emergency exists and the 
delay directly associated with obtaining competent 
interpreter or translation services would jeopardize 
the health of the patient, but only until a competent 
interpreter or translation service is available. 
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(d) RULE
OF CONSTRUCTION.—Subsection (c)(2) 
shall not be construed to mean that emergency rooms or 
similar entities that regularly provide health care services 
in medical emergencies are exempt from legal or regu-
latory requirements related to competent interpreter serv-
ices. 
SEC. 210. REPORT ON FEDERAL EFFORTS TO PROVIDE CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTH CARE SERVICES. 
(a) REPORT.—Not later than 1 year after the date 
of enactment of this Act and annually thereafter, the Sec-
retary of Health and Human Services shall enter into a 
contract with the National Academy of Medicine for the 
preparation and publication of a report that describes 
Federal efforts to ensure that all individuals with limited 
English proficiency have meaningful access to health care 
services and health-care-related services that are culturally 
and linguistically appropriate. Such report shall include— 
(1) a description and evaluation of the activities 
carried out under this Act; 
(2) a description and analysis of best practices, 
model programs, guidelines, and other effective 
strategies for providing access to culturally and lin-
guistically appropriate health care services; 
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(3) recommendations on the development and 
implementation of policies and practices by providers 
of health care services and health-care-related serv-
ices for individuals with limited English proficiency, 
including people with cognitive, hearing, vision, or 
print impairments; 
(4) recommend guidelines or standards for 
health literacy and plain language, informed consent, 
discharge instructions, and written communications, 
and for improvement of health care access; 
(5) a description of the effect of providing lan-
guage services on quality of health care and access 
to care; and 
(6) a description of the costs associated with or 
savings related to the provision of language services. 
(b) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
such sums as may be necessary for each of fiscal years 
2021 through 2025. 
SEC. 211. ENGLISH FOR SPEAKERS OF OTHER LANGUAGES. 
(a) GRANTS AUTHORIZED.—The Secretary of Edu-
cation is authorized to provide grants to eligible entities 
for the provision of English as a second language (in this 
section referred to as ‘‘ESL’’) instruction and shall deter-
mine, after consultation with appropriate stakeholders, the 
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mechanism for administering and distributing such 
grants. 
(b) ELIGIBLE ENTITY DEFINED.—In this section, 
the term ‘‘eligible entity’’ means a State or community- 
based organization that employs and serves minority popu-
lations. 
(c) APPLICATION.—An eligible entity may apply for 
a grant under this section by submitting such information 
as the Secretary of Education may require and in such 
form and manner 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 individuals to access and regularly nego-
tiate 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 funds available under this section to supple-
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ment rather than supplant any funds expended for 
ESL instruction in the State as of January 1, 2020. 
(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; 
(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 for ESL in-
struction, including how many programs main-
tain 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; 
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(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 
(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) not later than 1 year after the date of en-
actment 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 $250,000,000 for each of fiscal years 2021 through 
2024 to carry out this section. 
SEC. 212. IMPLEMENTATION. 
(a) GENERAL PROVISIONS.— 
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136 
(1) IMMUNITY.—A State shall not be immune 
under the 11th Amendment to the Constitution of 
the United States from suit in Federal court for a 
violation of this title (including an amendment made 
by this title). 
(2) REMEDIES.—In a suit against a State for 
a violation of this title (including an amendment 
made by this title), remedies (including remedies 
both at law and in equity) are available for such a 
violation to the same extent as such remedies are 
available for such a violation in a suit against any 
public or private 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. 2000d et seq.) 
or any other Federal statute. 
SEC. 213. 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.’’. 
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(b) EMPLOYER-SPONSORED MINIMUM ESSENTIAL 
COVERAGE.— 
(1) IN GENERAL.—Section 36B(c)(2)(C) of the 
Internal Revenue Code of 1986 is amended by redes-
ignating clauses (iii) and (iv) as clauses (iv) and (v), 
respectively, and by inserting after clause (ii) the fol-
lowing new clause: 
‘‘(iii) COVERAGE MUST INCLUDE LAN-
GUAGE ACCESS AND SERVICES.—Except as 
provided in clause (iv), an employee shall 
not be treated as eligible for minimum es-
sential coverage if such coverage consists 
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.’’. 
(2) CONFORMING AMENDMENTS.— 
(A) Section 36B(c)(2)(C) of such Code is 
amended by striking ‘‘clause (iii)’’ each place it 
appears in clauses (i) and (ii) and inserting 
‘‘clause (iv)’’. 
(B) Section 36B(c)(2)(C)(iv) of such Code, 
as redesignated by this subsection, is amended 
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138 
by striking ‘‘(i) and (ii)’’ and inserting ‘‘(i), (ii), 
and (iii)’’. 
(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 54.9815–2719(e) of title 
26, Code of Federal Regulations, section 2590.715– 
2719(e) of title 29, Code of Federal Regulations, and sec-
tion 147.136(e) of title 45, Code of Federal Regulations, 
respectively, to require group health plans and health in-
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139 
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 the requirements for pro-
viding relevant notices in a culturally and linguis-
tically appropriate manner in the applicable non- 
English languages, to apply a threshold that 5 per-
cent of the population, or not less than 500 individ-
uals, in the county is literate only in the same non- 
English language in order for the language to be 
considered an applicable non-English language. 
(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 such Act (42 U.S.C. 
18001 et seq.); 
(2) require navigators, certified application 
counselors, and other individuals assisting with en-
rollment to collect and report requests for language 
assistance; and 
(3) require the toll-free telephone hotlines es-
tablished 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 hotline, and any 
entity contracting with the Secretary to provide lan-
guage services, have taken to actively address some 
of the consumer complaints. 
(f) EFFECTIVE DATE.—The amendments made by 
this section shall not apply to plans beginning prior to the 
date of the enactment of this Act. 
SEC. 214. MEDICALLY UNDERSERVED POPULATIONS. 
Section 330(a) of the Public Health Service Act (42 
U.S.C. 254b(a)) is amended by adding at the end the fol-
lowing new paragraph: 
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‘‘(3) MEDICALLY
UNDERSERVED.—The term 
‘medically underserved’, with respect to a popu-
lation, means— 
‘‘(A) the population of an urban or rural 
area designated by the Secretary as— 
‘‘(i) an area with a shortage of per-
sonal health services; or 
‘‘(ii) a population group having a 
shortage of such services; or 
‘‘(B) a population of individuals, not con-
fined to a particular urban or rural area, who 
are designated by the Secretary as having a 
shortage of personal health services due to a 
specific demographic trait.’’. 
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 204, is amended by adding at the end 
the following: 
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‘‘Subtitle B—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 of the Health Resources 
and Services Administration, shall award a grant to an 
entity determined appropriate by the Secretary for the es-
tablishment of a national working group on workforce di-
versity. 
‘‘(b) REPRESENTATION.—In establishing the national 
working group under subsection (a): 
‘‘(1) The grantee shall ensure that the group 
has representatives of each 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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181 
SEC. 308. RULES FOR DETERMINATION OF FULL-TIME 
EQUIVALENT RESIDENTS FOR COST-REPORT-
ING PERIODS. 
(a) DGME DETERMINATIONS.—Section 1886(h)(4) 
of the Social Security Act (42 U.S.C. 1395ww(h)(4)), as 
amended by section 204(a), is amended— 
(1) in subparagraph (E), by striking ‘‘Subject 
to subparagraphs (J) and (K), such rules’’ and in-
serting ‘‘Subject to subparagraphs (J), (K), and 
(M), such rules’’; 
(2) in subparagraph (J), by striking ‘‘Such 
rules’’ and inserting ‘‘Subject to subparagraph (M), 
such rules’’; 
(3) in subparagraph (K), by striking ‘‘In deter-
mining’’ and inserting ‘‘Subject to subparagraph 
(M), in determining’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(M) TREATMENT OF CERTAIN RESIDENTS 
AND INTERNS.—For purposes of cost-reporting 
periods beginning on or after October 1, 2021, 
in determining the hospital’s number of full- 
time equivalent residents for purposes of this 
paragraph, all the time spent by an intern or 
resident in an approved medical residency train-
ing program shall be counted toward the deter-
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