504 
(2) youth; 
(3) persons who engage in intravenous drug 
abuse; 
(4) women; 
(5) homeless individuals; and 
(6) individuals incarcerated or in the penal sys-
tem. 
(d) AUTHORIZATION OF APPROPRIATIONS.—For car-
rying out this section, there are authorized to be appro-
priated $610,000,0000 for fiscal year 2015 and such sums 
as may be necessary for each of fiscal years 2016 through 
2019. 
SEC. 749. HEALTH CARE PROFESSIONALS TREATING INDI-
VIDUALS WITH HIV/AIDS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services, acting through the Administrator of the 
Health Resources and Services Administration, shall ex-
pand, intensify, and coordinate workforce initiatives of the 
Health Resources and Services Administration to increase 
the capacity of the health workforce focusing primarily on 
HIV/AIDS to meet the demand for culturally competent 
care, and may award grants for any of the following: 
(1) Development of curricula for training pri-
mary care providers in HIV/AIDS prevention and 
care, including routine HIV testing. 
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(2) Support to expand access to culturally and 
linguistically accessible benefits counselors, trained 
peer navigators, and mental and behavioral health 
professionals with expertise in HIV/AIDS. 
(3) Training health care professionals to pro-
vide care to individuals with HIV/AIDS. 
(4) Development by grant recipients under title 
XXVI of the Public Health Service Act (42 U.S.C. 
300ff–11 et seq.; commonly referred to as the Ryan 
White HIV/AIDS Program) and other persons, of 
policies for providing culturally relevant and sen-
sitive treatment to individuals with HIV/AIDS, with 
particular emphasis on treatment to racial and eth-
nic minorities, men who have sex with men, and 
women, young people, and children with HIV/AIDS. 
(5) Development and implementation of pro-
grams to increase the use of telehealth to respond to 
HIV/AIDS-specific health care needs in rural and 
minority communities, with particular emphasis 
given to medically underserved communities and in-
sular areas. 
(6) Evaluating interdisciplinary medical pro-
vider care team models that promote high quality 
care, with particular emphasis on care to racial and 
ethnic minorities. 
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(7) Training health care professionals to make 
them aware of the high rates of chronic hepatitis B 
and chronic hepatitis C in adult racial and ethnic 
populations, and the importance of prevention, de-
tection, and medical management of hepatitis B and 
hepatitis C and of liver cancer screening. 
(b) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2015 
through 2019. 
SEC. 750. HIV/AIDS PROVIDER LOAN REPAYMENT PRO-
GRAM. 
(a) IN GENERAL.—The Secretary may enter into an 
agreement with any physician, nurse practitioner, or phy-
sician assistant under which— 
(1) the physician, nurse practitioner, or physi-
cian assistant agrees to serve as a medical provider 
for a period of not less than 2 years— 
(A) at a Ryan White-funded or title X- 
funded facility with a critical shortage of doc-
tors (as determined by the Secretary); or 
(B) in an area with a high incidence of 
HIV/AIDS; and 
(2) the Secretary agrees to make payments in 
accordance with subsection (b) on the professional 
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education loans of the physician, nurse practitioner, 
or physician assistant. 
(b) MANNER
OF PAYMENTS.—The payments de-
scribed in subsection (a) shall be made by the Secretary 
as follows: 
(1) Upon completion by the physician, nurse 
practitioner, or physician assistant for whom the 
payments are to be made of the first year of the 
service specified in the agreement entered into with 
the Secretary under subsection (a), the Secretary 
shall pay 30 percent of the principal of and the in-
terest on the individual’s professional education 
loans. 
(2) Upon completion by the physician, nurse 
practitioner, or physician assistant of the second 
year of such service, the Secretary shall pay another 
30 percent of the principal of and the interest on 
such loans. 
(3) Upon completion by that individual of a 
third year of such service, the Secretary shall pay 
another 25 percent of the principal of and the inter-
est on such loans. 
(c) APPLICABILITY OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D of title III of the Public 
Health Service Act (42 U.S.C. 254l et seq.) shall, except 
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as inconsistent with this section, apply to the program car-
ried out under this section in the same manner and to 
the same extent as such provisions apply to the National 
Health Service Corps Loan Repayment Program. 
(d) REPORTS.—Not later than 18 months after the 
date of the enactment of this Act, and annually thereafter, 
the Secretary shall prepare and submit to the Congress 
a report describing the program carried out under this sec-
tion, including statements regarding the following: 
(1) The number of physicians, nurse practi-
tioners, and physician assistants enrolled in the pro-
gram. 
(2) The number and amount of loan repay-
ments. 
(3) The placement location of loan repayment 
recipients at facilities described in subsection (a)(1). 
(4) The default rate and actions required. 
(5) The amount of outstanding default funds. 
(6) To the extent that it can be determined, the 
reason for the default. 
(7) The demographics of individuals partici-
pating in the program. 
(8) An evaluation of the overall costs and bene-
fits of the program. 
(e) DEFINITIONS.—In this section: 
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(1) The term ‘‘HIV/AIDS’’ means human im-
munodeficiency virus and acquired immune defi-
ciency syndrome. 
(2) The term ‘‘nurse practitioner’’ means a reg-
istered nurse who has completed an accredited grad-
uate degree program in advanced nurse practice and 
has successfully passed a national certification exam. 
(3) The term ‘‘physician’’ means a graduate of 
a school of medicine who has completed post-
graduate training in general or pediatric medicine. 
(4) The term ‘‘physician assistant’’ means a 
medical provider who completed an accredited physi-
cian assistant training program and successfully 
passed the Physician Assistant National Certifying 
Examination. 
(5) The term ‘‘professional education loan’’— 
(A) means a loan that is incurred for the 
cost of attendance (including tuition, other rea-
sonable educational expenses, and reasonable 
living costs) at a school of medicine, nursing, or 
physician assistant training program; and 
(B) includes only the portion of the loan 
that is outstanding on the date the physician, 
nurse practitioner, or physician assistant in-
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volved begins the service specified in the agree-
ment under subsection (a). 
(6) The term ‘‘Ryan White-funded’’ means, 
with respect to a facility, receiving funds under title 
XXVI of the Public Health Service Act (42 U.S.C. 
300ff–11 et seq.). 
(7) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(8) The term ‘‘school of medicine’’ has the 
meaning given to that term in section 799B of the 
Public Health Service Act (42 U.S.C. 295p). 
(9) The term ‘‘title X-funded’’ means, with re-
spect to a facility, receiving funds under title X of 
the Public Health Service Act (42 U.S.C. 300 et 
seq.). 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2015 
through 2019. 
SEC. 751. DENTAL EDUCATION LOAN REPAYMENT PRO-
GRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services may enter into an agreement with any 
dentist under which— 
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(1) the dentist agrees to serve as a dentist for 
a period of not less than 2 years at a facility with 
a critical shortage of dentists (as determined by the 
Secretary) in an area with a high incidence of HIV/ 
AIDS; and 
(2) the Secretary agrees to make payments in 
accordance with subsection (b) on the dental edu-
cation loans of the dentist. 
(b) MANNER
OF PAYMENTS.—The payments de-
scribed in subsection (a) shall be made by the Secretary 
as follows: 
(1) Upon completion by the dentist for whom 
the payments are to be made of the first year of the 
service specified in the agreement entered into with 
the Secretary under subsection (a), the Secretary 
shall pay 30 percent of the principal of and the in-
terest on the dental education loans of the dentist. 
(2) Upon completion by the dentist of the sec-
ond year of such service, the Secretary shall pay an-
other 30 percent of the principal of and the interest 
on such loans. 
(3) Upon completion by that individual of a 
third year of such service, the Secretary shall pay 
another 25 percent of the principal of and the inter-
est on such loans. 
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(c) APPLICABILITY OF CERTAIN PROVISIONS.—The 
provisions of subpart III of part D of title III of the Public 
Health Service Act (42 U.S.C. 254l et seq.) shall, except 
as inconsistent with this section, apply to the program car-
ried out under this section in the same manner and to 
the same extent as such provisions apply to the National 
Health Service Corps Loan Repayment Program. 
(d) REPORTS.—Not later than 18 months after the 
date of the enactment of this Act, and annually thereafter, 
the Secretary shall prepare and submit to the Congress 
a report describing the program carried out under this sec-
tion, including statements regarding the following: 
(1) The number of dentists enrolled in the pro-
gram. 
(2) The number and amount of loan repay-
ments. 
(3) The placement location of loan repayment 
recipients at facilities described in subsection (a)(1). 
(4) The default rate and actions required. 
(5) The amount of outstanding default funds. 
(6) To the extent that it can be determined, the 
reason for the default. 
(7) The demographics of individuals partici-
pating in the program. 
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(8) An evaluation of the overall costs and bene-
fits of the program. 
(e) DEFINITIONS.—In this section: 
(1) The term ‘‘dental education loan’’— 
(A) means a loan that is incurred for the 
cost of attendance (including tuition, other rea-
sonable educational expenses, and reasonable 
living costs) at a school of dentistry; and 
(B) includes only the portion of the loan 
that is outstanding on the date the dentist in-
volved begins the service specified in the agree-
ment under subsection (a). 
(2) The term ‘‘dentist’’ means a graduate of a 
school of dentistry who has completed postgraduate 
training in general or pediatric dentistry. 
(3) The term ‘‘HIV/AIDS’’ means human im-
munodeficiency virus and acquired immune defi-
ciency syndrome. 
(4) The term ‘‘school of dentistry’’ has the 
meaning given to that term in section 799B of the 
Public Health Service Act (42 U.S.C. 295p). 
(5) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(f) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
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such sums as may be necessary for each of fiscal years 
2015 through 2019. 
SEC. 752. REDUCING NEW HIV INFECTIONS AMONG INJECT-
ING DRUG USERS. 
(a) SENSE OF CONGRESS.—It is the sense of the Con-
gress that providing sterile syringes and sterilized equip-
ment to injecting drug users substantially reduces risk of 
HIV infection, increases the probability that they will ini-
tiate drug treatment, and does not increase drug use. 
(b) IN GENERAL.—The Secretary of Health and 
Human Services may provide grants and technical assist-
ance for the purpose of reducing the rate of HIV infections 
among injecting drug users through a comprehensive 
package of services for such users, including the provision 
of sterile syringes, education and outreach, access to infec-
tious disease testing, overdose prevention, and treatment 
for drug dependence. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2015 
through 2019. 
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SEC. 753. SUPPORT FOR EXPANSION OF COMPREHENSIVE 
SEXUAL 
HEALTH 
AND 
EDUCATION 
PRO-
GRAMS. 
(a) SENSE OF CONGRESS.—It is the sense of Con-
gress that— 
(1) federally funded sex education programs 
should aim to— 
(A) reduce unintended pregnancy and sex-
ually transmitted infections, including HIV; 
(B) promote safe and healthy relation-
ships; 
(C) use, and be informed by, the best sci-
entific information available; 
(D) be built on characteristics of effective 
programs; 
(E) expand the existing body of evidence 
on comprehensive sex education programs 
through program evaluation; 
(F) expand training programs for teachers 
of comprehensive sex education; 
(G) build on the personal responsibility 
education programs funded under section 513 
of the Social Security Act (42 U.S.C. 713) and 
the President’s Teen Pregnancy Prevention pro-
gram, funded under title II of the Consolidated 
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Appropriations Act, 2010 (Public Law 111– 
117; 123 Stat. 3253); and 
(H) promote and uphold the rights of 
young people to information in order to make 
healthy and responsible decisions about their 
sexual health; and 
(2) no Federal funds should be used for health 
education programs that— 
(A) deliberately withhold life-saving infor-
mation about HIV; 
(B) are medically inaccurate or have been 
scientifically shown to be ineffective; 
(C) promote gender stereotypes; 
(D) are insensitive and unresponsive to the 
needs of sexually active adolescents; 
(E) are insensitive and unresponsive to the 
needs of lesbian, gay, bisexual, or transgender 
youth; or 
(F) are inconsistent with the ethical im-
peratives of medicine and public health. 
(b) GRANTS FOR COMPREHENSIVE SEX EDUCATION 
FOR ADOLESCENTS.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Director of the Office of Ado-
lescent Health, shall award grants, on a competitive 
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basis, to eligible entities to enable such eligible enti-
ties to carry out programs that provide adolescents 
with comprehensive sex education, as described in 
paragraph (6). 
(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) ELIGIBLE ENTITY.—In this subsection, the 
term ‘‘eligible entity’’ means a public or private enti-
ty that focuses on adolescent health or education or 
has experience working with adolescents, which may 
include— 
(A) a State educational agency; 
(B) a local educational agency; 
(C) a tribe or tribal organization, as de-
fined in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 
450b); 
(D) a State or local department of health; 
(E) a State or local department of edu-
cation; 
(F) a nonprofit organization; 
(G) a nonprofit or public institution of 
higher education; or 
(H) a hospital. 
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(4) APPLICATIONS.—An eligible entity desiring 
a grant under this subsection shall submit an appli-
cation to the Secretary at such time, in such man-
ner, and containing such information as the Sec-
retary may require, including the evaluation plan de-
scribed in paragraph (7)(A). 
(5) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to eligi-
ble entities that— 
(A) are State or local public entities, with 
an additional priority for State or local edu-
cational agencies; and 
(B) address health disparities among 
young people that are at highest risk for not 
less than 1 of the following: 
(i) Unintended pregnancies. 
(ii) Sexually transmitted infections, 
including HIV. 
(iii) Dating violence and sexual as-
sault. 
(6) USE OF FUNDS.— 
(A) IN
GENERAL.—Each eligible entity 
that receives a grant under this subsection shall 
use grant funds to carry out a program that 
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provides adolescents with comprehensive sex 
education that— 
(i) replicates evidence-based sex edu-
cation programs; 
(ii) substantially incorporates ele-
ments of evidence-based sex education pro-
grams; or 
(iii) creates a demonstration project 
based on generally accepted characteristics 
of effective sex education programs. 
(B) CONTENTS OF SEX EDUCATION PRO-
GRAMS.—The sex education programs funded 
under this subsection shall include curricula 
and program materials that address— 
(i) abstinence and delaying sexual ini-
tiation; 
(ii) the health benefits and side effects 
of all contraceptive and barrier methods as 
a means to prevent pregnancy and sexually 
transmitted infections, including HIV; 
(iii) healthy relationships, including 
the development of healthy attitudes and 
skills necessary for understanding— 
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(I) healthy relationships between 
oneself and family, others, and soci-
ety; and 
(II) the prevention of sexual 
abuse, teen dating violence, bullying, 
harassment, and suicide; 
(iv) healthy life skills including goal- 
setting, decisionmaking, interpersonal skills 
(such as communication, assertiveness, and 
peer refusal skills), critical thinking, self- 
esteem and self-efficacy, and stress man-
agement; 
(v) how to make responsible decisions 
about sex and sexuality, including— 
(I) how to avoid, and how to 
avoid making, unwanted verbal, phys-
ical, and sexual advances; and 
(II) how alcohol and drug use 
can affect responsible decisionmaking; 
(vi) the development of healthy atti-
tudes and values about such topics as ado-
lescent growth and development, body 
image, gender roles and gender identity, 
racial and ethnic diversity, and sexual ori-
entation; and 
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(vii) referral services for local health 
clinics and services where adolescents can 
obtain additional information and services 
related to sexual and reproductive health, 
dating violence and sexual assault, and sui-
cide prevention. 
(7) EVALUATION; REPORT.— 
(A) INDEPENDENT
EVALUATION.—Each 
eligible entity applying for a grant under this 
subsection shall develop and submit to the Sec-
retary a plan for a rigorous independent evalua-
tion of such grant program. The plan shall de-
scribe an independent evaluation that— 
(i) uses sound statistical methods and 
techniques 
relating 
to 
the 
behavioral 
sciences, including random assignment 
methodologies, whenever possible; 
(ii) uses quantitative data for assess-
ments and impact evaluations, whenever 
possible; and 
(iii) is carried out by an entity inde-
pendent from such eligible entity. 
(B) SELECTION
OF
EVALUATED
PRO-
GRAMS; BUDGET.— 
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measures to assess the implementation and im-
pact of grant programs funded under this sub-
section. Such performance measures shall in-
clude— 
(i) output measures, such as the num-
ber of individuals served and the number 
of hours of service delivery; 
(ii) 
outcome 
measures, 
including 
measures relating to— 
(I) the knowledge that youth par-
ticipating in the grant program have 
gained about— 
(aa) adolescent growth and 
development; 
(bb) relationship dynamics; 
(cc) ways to prevent unin-
tended pregnancy and sexually 
transmitted infections, including 
HIV; and 
(dd) sexual health; 
(II) the skills that adolescents 
participating in the grant program 
have gained regarding— 
(aa) negotiation and commu-
nication; 
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(bb) 
decisionmaking 
and 
goal-setting; 
(cc) interpersonal skills and 
healthy relationships; and 
(dd) condom use; and 
(III) the behaviors of adolescents 
participating in the grant program, 
including data about— 
(aa) age of first intercourse; 
(bb) number of sexual part-
ners; 
(cc) condom and contracep-
tive use at first intercourse; 
(dd) recent condom and con-
traceptive use; and 
(ee) dating abuse and life-
time history of domestic violence, 
sexual assault, dating violence, 
bullying, harassment, and stalk-
ing. 
(E) REPORT TO THE SECRETARY.—Eligi-
ble entities receiving a grant under this sub-
section who have been selected to receive funds 
to carry out the evaluation plan described in 
subparagraph (A), in accordance with subpara-
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graph (B)(i), shall collect and report to the Sec-
retary— 
(i) the results of the independent eval-
uation described in subparagraph (A); and 
(ii) information about the perform-
ance measures described in subparagraph 
(B). 
(F) EFFECTIVE
PROGRAMS.—The Sec-
retary, in coordination with the Director of the 
Centers for Disease Control and Prevention, 
shall publish on the Web site of the Centers for 
Disease Control and Prevention, a list of pro-
grams funded under this subsection that the 
Secretary has determined to be effective pro-
grams. 
(c) GRANTS FOR COMPREHENSIVE SEX EDUCATION 
AT INSTITUTIONS OF HIGHER EDUCATION.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Office of Adolescent Health 
and the Secretary of Education, shall award grants, 
on a competitive basis, to institutions of higher edu-
cation to enable such institutions to provide young 
people with comprehensive sex education, described 
in paragraph (5)(B), with an emphasis on reducing 
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HIV, other sexually transmitted infections, and un-
intended pregnancy through instruction about— 
(A) abstinence and contraception; 
(B) reducing dating violence, sexual as-
sault, bullying, and harassment; 
(C) increasing healthy relationships; and 
(D) academic achievement. 
(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) APPLICATIONS.—An institution of higher 
education desiring a grant under this subsection 
shall submit an application to the Secretary at such 
time, in such manner, and containing such informa-
tion as the Secretary may require. 
(4) PRIORITY.—In awarding grants under this 
subsection, the Secretary shall give priority to an in-
stitution of higher education that— 
(A) has an enrollment of needy students as 
defined in section 318(b) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1059e(b)); 
(B) is a Hispanic-serving institution, as 
defined in section 502(a) of such Act (20 
U.S.C. 1101a(a)); 
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(C) is a Tribal College or University, as 
defined in section 316(b) of such Act (20 
U.S.C. 1059c(b)); 
(D) is an Alaska Native-serving institution, 
as defined in section 317(b) of such Act (20 
U.S.C. 1059d(b)); 
(E) is a Native Hawaiian-serving institu-
tion, as defined in section 317(b) of such Act 
(20 U.S.C. 1059d(b)); 
(F) is a Predominately Black Institution, 
as defined in section 318(b) of such Act (20 
U.S.C. 1059e(b)); 
(G) is a Native American-serving, non-
tribal institution, as defined in section 319(b) 
of such Act (20 U.S.C. 1059f(b)); 
(H) is an Asian American and Native 
American Pacific Islander-serving institution, as 
defined in section 320(b) of such Act (20 
U.S.C. 1059g(b)); or 
(I) is a minority institution, as defined in 
section 365 of such Act (20 U.S.C. 1067k), 
with an enrollment of needy students, as de-
fined in section 312 of such Act (20 U.S.C. 
1058). 
(5) USES OF FUNDS.— 
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(A) IN GENERAL.—An institution of higher 
education receiving a grant under this sub-
section may use grant funds to integrate issues 
relating to comprehensive sex education into the 
academic or support sectors of the institution of 
higher education in order to reach a large num-
ber of students, by carrying out 1 or more of 
the following activities: 
(i) Developing educational content for 
issues relating to comprehensive sex edu-
cation that will be incorporated into first- 
year orientation or core courses. 
(ii) 
Developing 
and 
employing 
schoolwide educational programming out-
side of class that delivers elements of com-
prehensive sex education programs to stu-
dents, faculty, and staff. 
(iii) Creating innovative technology- 
based approaches to deliver sex education 
to students, faculty, and staff. 
(iv) Developing and employing peer- 
outreach and education programs to gen-
erate discussion, educate, and raise aware-
ness among students about issues relating 
to comprehensive sex education. 
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(B) CONTENTS OF SEX EDUCATION PRO-
GRAMS.—Each institution of higher education’s 
program of comprehensive sex education funded 
under this subsection shall include curricula 
and program materials that address informa-
tion about— 
(i) safe and responsible sexual behav-
ior with respect to the prevention of preg-
nancy and sexually transmitted infections, 
including HIV, including through— 
(I) abstinence; 
(II) a reduced number of sexual 
partners; and 
(III) the use of condoms and con-
traception; 
(ii) healthy relationships, including 
the development of healthy attitudes and 
insights necessary for understanding— 
(I) relationships between oneself, 
family, partners, others, and society; 
and 
(II) the prevention of sexual 
abuse, dating violence, bullying, har-
assment, and suicide; and 
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(iii) referral services to local health 
clinics where young people can obtain addi-
tional information and services related to 
sexual and reproductive health, dating vio-
lence and sexual assault, and suicide pre-
vention. 
(C) OPTIONAL COMPONENTS OF SEX EDU-
CATION.—Each institution of higher education’s 
program of comprehensive sex education may 
also include information and skills development 
relating to— 
(i) how to make responsible decisions 
about sex and sexuality, including— 
(I) how to avoid, and avoid mak-
ing, unwanted verbal, physical, and 
sexual advances; and 
(II) how alcohol and drug use 
can affect responsible decisionmaking; 
(ii) healthy life skills, including— 
(I) goal-setting and decision-
making; 
(II) interpersonal skills, such as 
communication, 
assertiveness, 
and 
peer refusal skills; 
(III) critical thinking; 
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(IV) self-esteem and self-efficacy; 
and 
(V) stress management; 
(iii) the development of healthy atti-
tudes and values about such topics as body 
image, gender roles and gender identity, 
racial and ethnic diversity, and sexual ori-
entation; and 
(iv) the responsibilities of parenting 
and the skills necessary to parent well. 
(6) EVALUATION; REPORT.—The requirements 
described in section 125B(g) shall also apply to eligi-
ble entities receiving a grant under this subsection 
in the same manner as such requirements apply to 
eligible entities receiving grants under section 125B. 
(d) GRANTS
FOR PRE-SERVICE
AND IN-SERVICE 
TEACHER TRAINING.— 
(1) PROGRAM AUTHORIZED.—The Secretary, in 
coordination with the Director of the Centers for 
Disease Control and Prevention and the Secretary of 
Education, shall award grants, on a competitive 
basis, to eligible entities to enable such eligible enti-
ties to carry out the activities described in para-
graph (5). 
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(2) DURATION.—Grants awarded under this 
subsection shall be for a period of 5 years. 
(3) ELIGIBLE ENTITY.—In this subsection, the 
term ‘‘eligible entity’’ means— 
(A) a State educational agency; 
(B) a local educational agency; 
(C) a tribe or tribal organization, as de-
fined in section 4 of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 
450b); 
(D) a State or local department of health; 
(E) a State or local department of edu-
cation; 
(F) a nonprofit institution of higher edu-
cation; 
(G) a national or statewide nonprofit orga-
nization that has as its primary purpose the im-
provement of provision of comprehensive sex 
education through effective teaching of com-
prehensive sex education; or 
(H) a consortium of nonprofit organiza-
tions that has as its primary purpose the im-
provement of provision of comprehensive sex 
education through effective teaching of com-
prehensive sex education. 
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(4) APPLICATION.—An eligible entity desiring a 
grant under this subsection shall submit an applica-
tion to the Secretary at such time, in such manner, 
and containing such information as the Secretary 
may require. 
(5) AUTHORIZED ACTIVITIES.— 
(A) REQUIRED
ACTIVITY.—Each eligible 
entity receiving a grant under this subsection 
shall use grant funds to train targeted faculty 
and staff, in order to increase effective teaching 
of comprehensive sex education for elementary 
school and secondary school students. 
(B) PERMISSIBLE ACTIVITIES.—Each eligi-
ble entity receiving a grant under this sub-
section may use grant funds to— 
(i) strengthen and expand the eligible 
entity’s relationships with— 
(I) institutions of higher edu-
cation; 
(II) State educational agencies; 
(III) local educational agencies; 
or 
(IV) other public and private or-
ganizations with a commitment to 
comprehensive sex education and the 
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benefits of comprehensive sex edu-
cation; 
(ii) support and promote research- 
based training of teachers of comprehen-
sive sex education and related disciplines 
in 
elementary 
schools 
and 
secondary 
schools as a means of broadening student 
knowledge about issues related to human 
development, relationships, personal skills, 
sexual behavior, sexual health, and society 
and culture; 
(iii) support the dissemination of in-
formation on effective practices and re-
search findings concerning the teaching of 
comprehensive sex education; 
(iv) support research on— 
(I) effective comprehensive sex 
education teaching practices; and 
(II) the development of assess-
ment instruments and strategies to 
document— 
(aa) student understanding 
of comprehensive sex education; 
and 
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(bb) the effects of com-
prehensive sex education; 
(v) convene national conferences on 
comprehensive sex education, in order to 
effectively train teachers in the provision of 
comprehensive sex education; and 
(vi) develop and disseminate appro-
priate research-based materials to foster 
comprehensive sex education. 
(C) SUBGRANTS.—Each eligible entity re-
ceiving a grant under this subsection may 
award subgrants to nonprofit organizations, 
State educational agencies, or local educational 
agencies to enable such organizations or agen-
cies to— 
(i) train teachers in comprehensive 
sex education; 
(ii) support Internet or distance learn-
ing related to comprehensive sex education; 
(iii) promote rigorous academic stand-
ards and assessment techniques to guide 
and measure student performance in com-
prehensive sex education; 
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(iv) encourage replication of best 
practices and model programs to promote 
comprehensive sex education; 
(v) develop and disseminate effective, 
research-based comprehensive sex edu-
cation learning materials; 
(vi) develop academic courses on the 
pedagogy of sex education at institutions 
of higher education; or 
(vii) convene State-based conferences 
to train teachers in comprehensive sex edu-
cation and to identify strategies for im-
provement. 
(e) REPORT TO CONGRESS.— 
(1) IN GENERAL.—Not later than 1 year after 
the date of the enactment of this Act, and annually 
thereafter for a period of 5 years, the Secretary shall 
prepare and submit to the appropriate committees of 
Congress a report on the activities to provide adoles-
cents and young people with comprehensive sex edu-
cation funded under this section. 
(2) REPORT ELEMENTS.—The report described 
in paragraph (1) shall include information about— 
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(A) the number of eligible entities and in-
stitutions of higher education that are receiving 
grant funds under subsections (b) and (c); 
(B) the specific activities supported by 
grant funds awarded under subsections (b) and 
(c); 
(C) the number of adolescents served by 
grant programs funded under subsection (b); 
(D) the number of young people served by 
grant programs funded under subsection (c); 
and 
(E) the status of program evaluations de-
scribed under subsections (b) and (c). 
(f) LIMITATION.—No Federal funds provided under 
this section may be used for health education programs 
that— 
(1) deliberately withhold life-saving information 
about HIV; 
(2) are medically inaccurate or have been sci-
entifically shown to be ineffective; 
(3) promote gender stereotypes; 
(4) are insensitive and unresponsive to the 
needs of sexually active youth or lesbian, gay, bisex-
ual, or transgender youth; or 
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(5) are inconsistent with the ethical imperatives 
of medicine and public health. 
(g) DEFINITIONS.—In this section: 
(1) ESEA DEFINITIONS.—The terms ‘‘elemen-
tary school’’, ‘‘local educational agency’’, ‘‘secondary 
school’’, and ‘‘State educational agency’’ have the 
meanings given the terms in section 9101 of the Ele-
mentary and Secondary Education Act of 1965 (20 
U.S.C. 7801). 
(2) AGE
AND
DEVELOPMENTALLY
APPRO-
PRIATE.—The term ‘‘age and developmentally appro-
priate’’ means suitable for a particular age or age 
group of children and adolescents, based on devel-
oping cognitive, emotional, and behavioral capacity 
typical for that age or age group. 
(3) ADOLESCENTS.—The term ‘‘adolescents’’ 
means individuals who are ages 10 through 19 at 
the time of commencement of participation in a pro-
gram supported under this section. 
(4) CHARACTERISTICS
OF
EFFECTIVE
PRO-
GRAMS.—The term ‘‘characteristics of effective pro-
grams’’ means the aspects of evidence-based pro-
grams, including development, content, and imple-
mentation of such programs, that— 
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(A) have been shown to be effective in 
terms of increasing knowledge, clarifying values 
and attitudes, increasing skills, and impacting 
upon behavior; and 
(B) are widely recognized by leading med-
ical and public health agencies to be effective in 
changing sexual behaviors that lead to sexually 
transmitted infections, including HIV, unin-
tended pregnancy, and dating violence and sex-
ual assault among young people. 
(5) COMPREHENSIVE
SEX
EDUCATION.—The 
term ‘‘comprehensive sex education’’ means a pro-
gram that— 
(A) includes age- and developmentally ap-
propriate, culturally and linguistically relevant 
information on a broad set of topics related to 
sexuality including human development, rela-
tionships, decisionmaking, communication, ab-
stinence, contraception, and disease and preg-
nancy prevention; 
(B) provides students with opportunities 
for developing skills as well as learning informa-
tion; 
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(C) is inclusive of lesbian, gay, bisexual, 
transgender, and heterosexual young people; 
and 
(D) aims to— 
(i) provide scientifically accurate and 
realistic information about human sexu-
ality; 
(ii) provide opportunities for individ-
uals to understand their own, their fami-
lies’, and their communities’ values, atti-
tudes, and insights about sexuality; 
(iii) help individuals develop healthy 
relationships and interpersonal skills; and 
(iv) help individuals exercise responsi-
bility regarding sexual relationships, which 
includes addressing abstinence, pressures 
to become prematurely involved in sexual 
intercourse, and the use of contraception 
and other sexual health measures. 
(6) EVIDENCE-BASED
PROGRAM.—The term 
‘‘evidence-based program’’ means a sex education 
program that has been proven through rigorous eval-
uation to be effective in changing sexual behavior or 
incorporates elements of other sex education pro-
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grams that have been proven to be effective in 
changing sexual behavior. 
(7) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the 
meaning given the term in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001). 
(8) MEDICALLY ACCURATE AND COMPLETE.— 
The term ‘‘medically accurate and complete’’, when 
used with respect to a sex education program, means 
that— 
(A) the information provided through the 
program is verified or supported by the weight 
of research conducted in compliance with ac-
cepted scientific methods and is published in 
peer-reviewed journals, where applicable; or 
(B)(i) the program contains information 
that leading professional organizations and 
agencies with relevant expertise in the field rec-
ognize as accurate, objective, and complete; and 
(ii) the program does not withhold infor-
mation about the effectiveness and benefits of 
correct and consistent use of condoms and 
other contraceptives. 
(9) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
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(10) YOUNG PEOPLE.—The term ‘‘young peo-
ple’’ means individuals who are ages 10 through 24 
at the time of commencement of participation in a 
program supported under this section. 
(h) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal years 2015 
through 2019. 
SEC. 754. ELIMINATION OF ABSTINENCE-ONLY EDUCATION 
PROGRAM. 
(a) IN GENERAL.—Title V of the Social Security Act 
(42 U.S.C. 701 et seq.) is amended by striking section 
510. 
(b) RESCISSION.—Amounts appropriated for fiscal 
years 2013 and 2014 under section 510(d) of the Social 
Security Act (42 U.S.C. 710(d)) (as in effect on the day 
before the date of enactment of this Act) that are unobli-
gated as of the date of enactment of this Act are re-
scinded. 
(c) REPROGRAM OF ELIMINATED ABSTINENCE-ONLY 
FUNDS FOR THE PERSONAL RESPONSIBILITY EDUCATION 
PROGRAM (PREP).—Section 513(f) of the Social Security 
Act (42 U.S.C. 713(f)) is amended by striking 
‘‘$75,000,000 for each of fiscal years 2011 through 2015’’ 
and inserting ‘‘$75,000,000 for each of fiscal years 2011 
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through 2014, an amount for fiscal year 2015 equal to 
$75,000,000 increased by an amount equal to the unobli-
gated portion of funds appropriated for fiscal year 2014 
and 2015 under section 510(d) that are rescinded by sec-
tion 754(b) of the Health Equity and Accountability Act 
of 2014, and $125,000,000 for each of fiscal years 2016 
and 2017’’. 
SEC. 755. REPORT ON IMPACT OF HIV/AIDS IN VULNERABLE 
POPULATIONS. 
(a) IN GENERAL.—The Secretary shall submit to the 
Congress and the President an annual report on the im-
pact of HIV/AIDS for racial and ethnic minority commu-
nities, women, and youth aged 24 and younger. 
(b) CONTENTS.—The report under subsection (a) 
shall include information on the— 
(1) progress that has been made in reducing 
the impact of HIV/AIDS in such communities; 
(2) opportunities that exist to make additional 
progress in reducing the impact of HIV/AIDS in 
such communities; 
(3) challenges that may impede such additional 
progress; and 
(4) Federal funding necessary to achieve sub-
stantial reductions in HIV/AIDS in racial and ethnic 
minority communities. 
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SEC. 756. NATIONAL HIV/AIDS OBSERVANCE DAYS. 
(a) NATIONAL OBSERVANCE DAYS.—It is the sense 
of the Congress that national observance days highlighting 
the impact of HIV/AIDS on communities of color include 
the following: 
(1) National Black HIV/AIDS Awareness Day. 
(2) National Latino AIDS Awareness Day. 
(3) National Asian and Pacific Islander HIV/ 
AIDS Awareness Day. 
(4) National Native American HIV/AIDS 
Awareness Day. 
(5) Caribbean-American HIV/AIDS Awareness 
Day. 
(6) National Youth HIV/AIDS Awareness Day. 
(7) National Black Clergy HIV/AIDS Aware-
ness Sunday. 
(b) CALL TO ACTION.—It is the sense of the Con-
gress that the President should call on members of com-
munities of color— 
(1) to become involved at the local community 
level in HIV/AIDS testing, policy, and advocacy; 
(2) to become aware, engaged, and empowered 
on the HIV/AIDS epidemic within their commu-
nities; and 
(3) to urge members of their communities to re-
duce risk factors, practice safe sex and other preven-
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tive measures, be tested for HIV/AIDS, and seek 
care when appropriate. 
SEC. 757. REVIEW OF ALL FEDERAL AND STATE LAWS, 
POLICIES, AND REGULATIONS REGARDING 
THE CRIMINAL PROSECUTION OF INDIVID-
UALS FOR HIV-RELATED OFFENSES. 
(a) DEFINITIONS.— 
(1) HIV AND HIV/AIDS.—The terms ‘‘HIV’’ and 
‘‘HIV/AIDS’’ have the meanings given to such terms 
in section 2689 of the Public Health Service Act (42 
U.S.C. 300ff–88). 
(2) STATE.—The term ‘‘State’’ includes the 
District of Columbia, American Samoa, the Com-
monwealth of the Northern Mariana Islands, Guam, 
Puerto Rico, and the United States Virgin Islands. 
(b) SENSE OF CONGRESS REGARDING LAWS OR REG-
ULATIONS DIRECTED AT PEOPLE LIVING WITH HIV/ 
AIDS.—It is the sense of the Congress that Federal and 
State laws, policies, and regulations regarding people liv-
ing with HIV/AIDS— 
(1) should not place unique or additional bur-
dens on such individuals solely as a result of their 
HIV status; and 
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(2) should instead demonstrate a public health- 
oriented, evidence-based, medically accurate, and 
contemporary understanding of— 
(A) the multiple factors that lead to HIV 
transmission; 
(B) the relative risk of HIV transmission 
routes; 
(C) the current health implications of liv-
ing with HIV; 
(D) the associated benefits of treatment 
and support services for people living with HIV; 
and 
(E) the impact of punitive HIV-specific 
laws and policies on public health, on people liv-
ing with or affected by HIV, and on their fami-
lies and communities. 
(c) REVIEW OF ALL FEDERAL AND STATE LAWS, 
POLICIES, AND REGULATIONS REGARDING THE CRIMINAL 
PROSECUTION OF INDIVIDUALS FOR HIV-RELATED OF-
FENSES.— 
(1) REVIEW OF FEDERAL AND STATE LAWS.— 
(A) IN GENERAL.—No later than 90 days 
after the date of the enactment of this Act, the 
Attorney General, the Secretary of Health and 
Human Services, and the Secretary of Defense 
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acting jointly (in this paragraph and paragraph 
(2) referred to as the ‘‘designated officials’’) 
shall initiate a national review of Federal and 
State laws, policies, regulations, and judicial 
precedents and decisions regarding criminal and 
related civil commitment cases involving people 
living with HIV/AIDS, including in regards to 
the Uniform Code of Military Justice. 
(B) CONSULTATION.—In carrying out the 
review under subparagraph (A), the designated 
officials shall ensure diverse participation and 
consultation from each State, including with— 
(i) State attorneys general (or their 
representatives); 
(ii) State public health officials (or 
their representatives); 
(iii) State judicial and court system 
officers, including judges, district attor-
neys, prosecutors, defense attorneys, law 
enforcement, and correctional officers; 
(iv) members of the United States 
Armed Forces, including members of other 
Federal services subject to the Uniform 
Code of Military Justice; 
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(v) people living with HIV/AIDS, par-
ticularly those who have been subject to 
HIV-related prosecution or who are from 
communities whose members have been 
disproportionately subject to HIV-specific 
arrests and prosecutions; 
(vi) legal advocacy and HIV/AIDS 
service organizations that work with people 
living with HIV/AIDS; 
(vii) nongovernmental health organi-
zations that work on behalf of people living 
with HIV/AIDS; and 
(viii) trade organizations or associa-
tions representing persons or entities de-
scribed in clauses (i) through (vii). 
(C) RELATION
TO
OTHER
REVIEWS.—In 
carrying out the review under subparagraph 
(A), the designated officials may utilize other 
existing reviews of criminal and related civil 
commitment cases involving people living with 
HIV/AIDS, including any such review con-
ducted by any Federal or State agency or any 
public health, legal advocacy, or trade organiza-
tion or association if the designated officials de-
termine that such reviews were conducted in ac-
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cordance with the principles set forth in sub-
section (b). 
(2) REPORT.—No later than 180 days after ini-
tiating the review required by paragraph (1), the At-
torney General shall transmit to the Congress and 
make publicly available a report containing the re-
sults of the review, which includes the following: 
(A) For each State and for the Uniform 
Code of Military Justice, a summary of the rel-
evant laws, policies, regulations, and judicial 
precedents and decisions regarding criminal 
cases involving people living with HIV/AIDS, 
including, if applicable, the following: 
(i) A determination of whether such 
laws, policies, regulations, and judicial 
precedents and decisions place any unique 
or additional burdens upon people living 
with HIV/AIDS. 
(ii) A determination of whether such 
laws, policies, regulations, and judicial 
precedents and decisions demonstrate a 
public 
health-oriented, 
evidence-based, 
medically accurate, and contemporary un-
derstanding of— 
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(I) the multiple factors that lead 
to HIV transmission; 
(II) the relative risk of HIV 
transmission routes; 
(III) the current health implica-
tions of living with HIV; 
(IV) the associated benefits of 
treatment and support services for 
people living with HIV; and 
(V) the impact of punitive HIV- 
specific laws and policies on public 
health, on people living with or af-
fected by HIV, and on their families 
and communities. 
(iii) An analysis of the public health 
and legal implications of such laws, poli-
cies, regulations, and judicial precedents, 
including an analysis of the consequences 
of having a similar penal scheme applied to 
comparable situations involving other com-
municable diseases. 
(iv) An analysis of the proportionality 
of punishments imposed under HIV-spe-
cific laws, policies, regulations, and judicial 
precedents, taking into consideration pen-
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alties attached to violation of State laws 
against similar degrees of endangerment or 
harm, such as driving while intoxicated 
(DWI) or transmission of other commu-
nicable diseases, or more serious harms, 
such as vehicular manslaughter offenses. 
(B) An analysis of common elements 
shared among State laws, policies, regulations, 
and judicial precedents. 
(C) A set of best practice recommendations 
directed to State governments, including State 
attorneys general, public health officials, and 
judicial officers, in order to ensure that laws, 
policies, regulations, and judicial precedents re-
garding people living with HIV/AIDS are in ac-
cordance with the principles set forth in sub-
section (b). 
(D) Recommendations for adjustments to 
the Uniform Code of Military Justice, as may 
be necessary, in order to ensure that laws, poli-
cies, regulations, and judicial precedents re-
garding people living with HIV/AIDS are in ac-
cordance with the principles set forth in sub-
section (b). 
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(3) GUIDANCE.—Within 90 days of the release 
of the report required by paragraph (2), the Attor-
ney General and the Secretary of Health and 
Human Services, acting jointly, shall develop and 
publicly release updated guidance for States based 
on the set of best practice recommendations required 
by paragraph (2)(C) in order to assist States dealing 
with criminal and related civil commitment cases re-
garding people living with HIV/AIDS. 
(4) MONITORING AND EVALUATION SYSTEM.— 
Within 60 days of the release of the guidance re-
quired by paragraph (3), the Attorney General and 
the Secretary of Health and Human Services, acting 
jointly, shall establish an integrated monitoring and 
evaluation system which includes, where appropriate, 
objective and quantifiable performance goals and in-
dicators to measure progress toward statewide im-
plementation in each State of the best practice rec-
ommendations required in paragraph (2)(C), includ-
ing to monitor, track, and evaluate the effectiveness 
of assistance provided pursuant to subsection (d). 
(5) ADJUSTMENTS TO FEDERAL LAWS, POLI-
CIES, OR REGULATIONS.—Within 90 days of the re-
lease of the report required by paragraph (2), the 
Attorney General, the Secretary of Health and 
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Human Services, and the Secretary of Defense, act-
ing jointly, shall develop and transmit to the Presi-
dent and the Congress, and make publicly available, 
such proposals as may be necessary to implement 
adjustments to Federal laws, policies, or regulations, 
including to the Uniform Code of Military Justice, 
based on the recommendations required by para-
graph (2)(D), either through Executive order or 
through changes to statutory law. 
(6) AUTHORIZATION OF APPROPRIATIONS.— 
(A) IN GENERAL.—There are authorized to 
be appropriated such sums as may be necessary 
for the purpose of carrying out this subsection. 
Amounts authorized to be appropriated by the 
preceding sentence are in addition to amounts 
otherwise authorized to be appropriated for 
such purpose. 
(B) AVAILABILITY
OF
FUNDS.—Amounts 
appropriated pursuant to the authorization of 
appropriations in subparagraph (A) are author-
ized to remain available until expended. 
(d) AUTHORIZATION TO PROVIDE GRANTS.— 
(1) GRANTS BY ATTORNEY GENERAL.— 
(A) IN GENERAL.—The Attorney General 
may provide assistance to eligible State and 
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local entities and eligible nongovernmental orga-
nizations for the purpose of incorporating the 
best practice recommendations developed under 
subsection (c)(2)(C) within relevant State laws, 
policies, regulations, and judicial decisions re-
garding people living with HIV/AIDS. 
(B) AUTHORIZED ACTIVITIES.—The assist-
ance authorized by subparagraph (A) may in-
clude— 
(i) direct technical assistance to eligi-
ble State and local entities in order to de-
velop, disseminate, or implement State 
laws, policies, regulations, or judicial deci-
sions that conform with the best practice 
recommendations developed under sub-
section (c)(2)(C); 
(ii) direct technical assistance to eligi-
ble nongovernmental organizations in order 
to provide education and training, includ-
ing through classes, conferences, meetings, 
and other educational activities, to eligible 
State and local entities; and 
(iii) subcontracting authority to allow 
eligible State and local entities and eligible 
nongovernmental organizations to seek 
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technical assistance from legal and public 
health experts with a demonstrated under-
standing of the principles underlying the 
best practice recommendations developed 
under subsection (c)(2)(C). 
(2) GRANTS BY SECRETARY OF HEALTH AND 
HUMAN SERVICES.— 
(A) 
IN
GENERAL.—The 
Secretary 
of 
Health and Human Services, acting through the 
Director of the Centers for Disease Control and 
Prevention, may provide assistance to State and 
local public health departments and eligible 
nongovernmental organizations for the purpose 
of supporting eligible State and local entities to 
incorporate the best practice recommendations 
developed under subsection (c)(2)(C) within rel-
evant State laws, policies, regulations, and judi-
cial decisions regarding people living with HIV/ 
AIDS. 
(B) AUTHORIZED ACTIVITIES.—The assist-
ance authorized by subparagraph (A) may in-
clude— 
(i) direct technical assistance to State 
and local public health departments in 
order to support the development, dissemi-
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nation, or implementation of State laws, 
policies, regulations, or judicial decisions 
that conform with the set of best practice 
recommendations developed under sub-
section (c)(2)(C); 
(ii) direct technical assistance to eligi-
ble nongovernmental organizations in order 
to provide education and training, includ-
ing through classes, conferences, meetings, 
and other educational activities, to State 
and local public health departments; and 
(iii) subcontracting authority to allow 
State and local public health departments 
and eligible nongovernmental organizations 
to seek technical assistance from legal and 
public health experts with a demonstrated 
understanding of the principles underlying 
the best practice recommendations devel-
oped under subsection (c)(2)(C). 
(3) LIMITATION.—As a condition of receiving 
assistance through this subsection, eligible State and 
local entities, State and local public health depart-
ments, and eligible nongovernmental organizations 
shall agree— 
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(A) not to place any unique or additional 
burdens on people living with HIV/AIDS solely 
as a result of their HIV status; and 
(B) that if the entity, department, or orga-
nization promulgates any laws, policies, regula-
tions, or judicial decisions regarding people liv-
ing with HIV/AIDS, such actions shall dem-
onstrate a public health-oriented, evidence- 
based, medically accurate, and contemporary 
understanding of— 
(i) the multiple factors that lead to 
HIV transmission; 
(ii) the relative risk of HIV trans-
mission routes; 
(iii) the current health implications of 
living with HIV; 
(iv) the associated benefits of treat-
ment and support services for people living 
with HIV; and 
(v) the impact of punitive HIV-spe-
cific laws and policies on public health, on 
people living with or affected by HIV, and 
on their families and communities. 
(4) REPORT.—No later than 1 year after the 
date of the enactment of this Act, and annually 
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558 
thereafter, the Attorney General and the Secretary 
of Health and Human Services, acting jointly, shall 
transmit to Congress and make publicly available a 
report describing, for each State, the impact and ef-
fectiveness of the assistance provided through this 
Act. Each such report shall include— 
(A) a detailed description of the progress 
each State has made, if any, in implementing 
the best practice recommendations developed 
under subsection (c)(2)(C) as a result of the as-
sistance provided under this subsection, and 
based on the performance goals and indicators 
established as part of the monitoring and eval-
uation system in subsection (c)(4); 
(B) a brief summary of any outreach ef-
forts undertaken during the prior year by the 
Attorney General and the Secretary of Health 
and Human Services to encourage States to 
seek assistance under this subsection in order 
to implement the best practice recommenda-
tions developed under subsection (c)(2)(C); 
(C) a summary of how assistance provided 
through this subsection is being utilized by eli-
gible State and local entities, State and local 
public health departments, and eligible non-
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governmental organizations and, if applicable, 
any contractors, including with respect to non-
governmental organizations, the type of tech-
nical assistance provided, and an evaluation of 
the impact of such assistance on eligible State 
and local entities; and 
(D) a summary and description of eligible 
State and local entities, State and local public 
health departments, and eligible nongovern-
mental 
organizations 
receiving 
assistance 
through this subsection, including if applicable, 
a summary and description of any contractors 
selected to assist in implementing such assist-
ance. 
(5) DEFINITIONS.—For the purposes of this 
subsection: 
(A) ELIGIBLE
STATE
AND
LOCAL
ENTI-
TIES.—The term ‘‘eligible State and local enti-
ties’’ means the relevant individuals, offices, or 
organizations that directly participate in the de-
velopment, dissemination, or implementation of 
State laws, policies, regulations, or judicial deci-
sions, including— 
(i) State governments, including State 
attorneys general, State departments of 
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justice, and State National Guards, or 
their equivalents; 
(ii) State judicial and court systems, 
including trial courts, appellate courts, 
State supreme courts and courts of appeal, 
and State correctional facilities, or their 
equivalents; and 
(iii) local governments, including city 
and county governments, district attorneys, 
and local law enforcement departments, or 
their equivalents. 
(B) STATE AND LOCAL PUBLIC HEALTH 
DEPARTMENTS.—The term ‘‘State and local 
public health departments’’ means the fol-
lowing: 
(i) State public health departments, or 
their equivalents, including the chief officer 
of such departments and infectious disease 
and communicable disease specialists with-
in such departments. 
(ii) Local public health departments, 
or their equivalents, including city and 
county public health departments, the chief 
officer of such departments, and infectious 
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disease and communicable disease special-
ists within such departments. 
(iii) Public health departments or offi-
cials, or their equivalents, within State or 
local correctional facilities. 
(iv) Public health departments or offi-
cials, or their equivalents, within State Na-
tional Guards. 
(v) Any other recognized State or 
local public health organization or entity 
charged with carrying out official State or 
local public health duties. 
(C) ELIGIBLE NONGOVERNMENTAL ORGA-
NIZATIONS.—The term ‘‘eligible nongovern-
mental organizations’’ means the following: 
(i) Nongovernmental organizations, 
including trade organizations or associa-
tions that represent— 
(I) State attorneys general, or 
their equivalents; 
(II) State public health officials, 
or their equivalents; 
(III) State judicial and court offi-
cers, including judges, district attor-
neys, prosecutors, defense attorneys, 
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law enforcement, and correctional offi-
cers; 
(IV) State National Guards; 
(V) people living with HIV/AIDS; 
(VI) legal advocacy and HIV/ 
AIDS service organizations that work 
with people living with HIV/AIDS; 
and 
(VII) nongovernmental health or-
ganizations that work on behalf of 
people living with HIV/AIDS. 
(ii) Nongovernmental organizations, 
including trade organizations or associa-
tions that demonstrate a public-health ori-
ented, evidence-based, medically accurate, 
and contemporary understanding of— 
(I) the multiple factors that lead 
to HIV transmission; 
(II) the relative risk of HIV 
transmission routes; 
(III) the current health implica-
tions of living with HIV; 
(IV) the associated benefits of 
treatment and support services for 
people living with HIV; and 
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(V) the impact of punitive HIV- 
specific laws and policies on public 
health, on people living with or af-
fected by HIV, and on their families 
and communities. 
(6) AUTHORIZATION OF APPROPRIATIONS.— 
(A) IN GENERAL.—In addition to amounts 
otherwise made available, there are authorized 
to be appropriated to the Attorney General and 
the Secretary of Health and Human Services 
such sums as may be necessary to carry out 
this subsection for each of the fiscal years 2015 
through 2019. 
(B) AVAILABILITY
OF
FUNDS.—Amounts 
appropriated pursuant to the authorizations of 
appropriations in subparagraph (A) are author-
ized to remain available until expended. 
SEC. 758. REPEAL OF LIMITATION AGAINST USE OF FUNDS 
FOR 
EDUCATION 
OR 
INFORMATION 
DE-
SIGNED TO PROMOTE OR ENCOURAGE, DI-
RECTLY, HOMOSEXUAL OR HETEROSEXUAL 
ACTIVITY 
OR 
INTRAVENOUS 
SUBSTANCE 
ABUSE. 
Section 2500 of the Public Health Service Act (42 
U.S.C. 300ee) is amended— 
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(1) by striking subsection (c); and 
(2) by redesignating subsection (d) as sub-
section (c). 
SEC. 759. EXPANDING SUPPORT FOR CONDOMS IN PRIS-
ONS. 
(a) AUTHORITY TO ALLOW COMMUNITY ORGANIZA-
TIONS TO PROVIDE STI COUNSELING, STI PREVENTION 
EDUCATION, AND SEXUAL BARRIER PROTECTION DE-
VICES IN FEDERAL CORRECTIONAL FACILITIES.— 
(1) DIRECTIVE TO ATTORNEY GENERAL.—Not 
later than 30 days after the date of enactment of 
this Act, the Attorney General shall direct the Bu-
reau of Prisons to allow community organizations to 
distribute sexual barrier protection devices and to 
engage in STI counseling and STI prevention edu-
cation in Federal correctional facilities. These activi-
ties shall be subject to all relevant Federal laws and 
regulations which govern visitation in correctional 
facilities. 
(2) INFORMATION
REQUIREMENT.—Any com-
munity organization permitted to distribute sexual 
barrier protection devices under paragraph (1) shall 
ensure that the persons to whom the devices are dis-
tributed are informed about the proper use and dis-
posal of sexual barrier protection devices in accord-
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ance with established public health practices. Any 
community organization conducting STI counseling 
or STI prevention education under paragraph (1) 
shall offer comprehensive sexuality education. 
(3) POSSESSION OF DEVICE PROTECTED.—No 
Federal correctional facility may, because of the pos-
session or use of a sexual barrier protection device— 
(A) take adverse action against an incar-
cerated person; or 
(B) consider possession or use as evidence 
of prohibited activity for the purpose of any 
Federal correctional facility administrative pro-
ceeding. 
(4) IMPLEMENTATION.—The Attorney General 
and Bureau of Prisons shall implement this section 
according to established public health practices in a 
manner that protects the health, safety, and privacy 
of incarcerated persons and of correctional facility 
staff. 
(b) SENSE OF CONGRESS REGARDING DISTRIBUTION 
OF SEXUAL BARRIER PROTECTION DEVICES IN STATE 
PRISON SYSTEMS.—It is the sense of the Congress that 
States should allow for the legal distribution of sexual bar-
rier protection devices in State correctional facilities to re-
duce the prevalence and spread of STIs in those facilities. 
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(c) SURVEY OF AND REPORT ON CORRECTIONAL FA-
CILITY PROGRAMS AIMED AT REDUCING THE SPREAD OF 
STIS.— 
(1) SURVEY.—The Attorney General, after con-
sulting with the Secretary of Health and Human 
Services, State officials, and community organiza-
tions, shall, to the maximum extent practicable, con-
duct a survey of all Federal and State correctional 
facilities, not later than 180 days after the date of 
enactment of this Act and annually thereafter for 5 
years, to determine the following: 
(A) COUNSELING, TREATMENT, AND SUP-
PORTIVE SERVICES.—Whether the correctional 
facility requires incarcerated persons to partici-
pate in counseling, treatment, and supportive 
services related to STIs, or whether it offers 
such programs to incarcerated persons. 
(B) ACCESS TO SEXUAL BARRIER PROTEC-
TION DEVICES.—Whether incarcerated persons 
can— 
(i) possess sexual barrier protection 
devices; 
(ii) purchase sexual barrier protection 
devices; 
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(iii) purchase sexual barrier protection 
devices at a reduced cost; and 
(iv) obtain sexual barrier protection 
devices without cost. 
(C) INCIDENCE OF SEXUAL VIOLENCE.— 
The incidence of sexual violence and assault 
committed by incarcerated persons and by cor-
rectional facility staff. 
(D) PREVENTION EDUCATION OFFERED.— 
The type of prevention education, information, 
or training offered to incarcerated persons and 
correctional facility staff regarding sexual vio-
lence and the spread of STIs, including whether 
such education, information, or training— 
(i) constitutes comprehensive sexuality 
education; 
(ii) is compulsory for new incarcerated 
persons and for new staff; and 
(iii) is offered on an ongoing basis. 
(E) STI TESTING.—Whether the correc-
tional facility tests incarcerated persons for 
STIs or gives them the option to undergo such 
testing— 
(i) at intake; 
(ii) on a regular basis; and 
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(iii) prior to release. 
(F) STI TEST RESULTS.—The number of 
incarcerated persons who are tested for STIs 
and the outcome of such tests at each correc-
tional facility, disaggregated to include results 
for— 
(i) the type of sexually transmitted in-
fection tested for; 
(ii) the race and/or ethnicity of indi-
viduals tested; 
(iii) the age of individuals tested; and 
(iv) the gender of individuals tested. 
(G) PRERELEASE
REFERRAL
POLICY.— 
Whether incarcerated persons are informed 
prior to release about STI-related services or 
other health services in their communities, in-
cluding free and low-cost counseling and treat-
ment options. 
(H) PRERELEASE
REFERRALS
MADE.— 
The number of referrals to community-based 
organizations or public health facilities offering 
STI-related or other health services provided to 
incarcerated persons prior to release, and the 
type of counseling or treatment for which the 
referral was made. 
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(I) REINSTATEMENT OF MEDICAID BENE-
FITS.—Whether the correctional facility assists 
incarcerated persons that were enrolled in the 
State Medicaid program prior to their incarcer-
ation, in reinstating their enrollment upon re-
lease and whether such individuals receive refer-
rals as provided by subparagraph (G) to entities 
that accept the State Medicaid program, includ-
ing if applicable— 
(i) the number of such individuals, in-
cluding those diagnosed with the human 
immunodeficiency virus, that have been re-
instated; 
(ii) a list of obstacles to reinstating 
enrollment or to making determinations of 
eligibility for reinstatement, if any; and 
(iii) the number of individuals denied 
enrollment. 
(J) OTHER ACTIONS TAKEN.—Whether the 
correctional facility has taken any other action, 
in conjunction with community organizations or 
otherwise, to reduce the prevalence and spread 
of STIs in that facility. 
(2) PRIVACY.—In conducting the survey, the 
Attorney General shall not request or retain the 
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570 
identity of any person who has sought or been of-
fered counseling, treatment, testing, or prevention 
education information regarding an STI (including 
information about sexual barrier protection devices), 
or who has tested positive for an STI. 
(3) REPORT.—The Attorney General shall 
transmit to Congress and make publicly available 
the results of the survey required under paragraph 
(1), both for the Nation as a whole and 
disaggregated as to each State and each correctional 
facility. To the maximum extent possible, the Attor-
ney General shall issue the first report no later than 
1 year after the date of enactment of this Act and 
shall issue reports annually thereafter for 5 years. 
(d) STRATEGY.— 
(1) DIRECTIVE TO ATTORNEY GENERAL.—The 
Attorney General, in consultation with the Secretary 
of Health and Human Services, State officials, and 
community organizations, shall develop and imple-
ment a 5-year strategy to reduce the prevalence and 
spread of STIs in Federal and State correctional fa-
cilities. To the maximum extent possible, the strat-
egy shall be developed, transmitted to Congress, and 
made publicly available no later than 180 days after 
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the transmission of the first report required under 
subsection (c)(3). 
(2) CONTENTS
OF
STRATEGY.—The strategy 
shall include the following: 
(A) PREVENTION EDUCATION.—A plan for 
improving prevention education, information, 
and training offered to incarcerated persons 
and correctional facility staff, including infor-
mation and training on sexual violence and the 
spread of STIs, and comprehensive sexuality 
education. 
(B) SEXUAL BARRIER PROTECTION DEVICE 
ACCESS.—A plan for expanding access to sexual 
barrier protection devices in correctional facili-
ties. 
(C) SEXUAL
VIOLENCE
REDUCTION.—A 
plan for reducing the incidence of sexual vio-
lence among incarcerated persons and correc-
tional facility staff, developed in consultation 
with the National Prison Rape Elimination 
Commission. 
(D) COUNSELING AND SUPPORTIVE SERV-
ICES.—A plan for expanding access to coun-
seling and supportive services related to STIs in 
correctional facilities. 
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572 
(E) TESTING.—A plan for testing incarcer-
ated persons for STIs during intake, during 
regular health exams, and prior to release, and 
that— 
(i) is conducted in accordance with 
guidelines established by the Centers for 
Disease Control and Prevention; 
(ii) includes pretest counseling; 
(iii) requires that incarcerated persons 
are notified of their option to decline test-
ing at any time; 
(iv) requires that incarcerated persons 
are confidentially notified of their test re-
sults in a timely manner; and 
(v) ensures that incarcerated persons 
testing positive for STIs receive post-test 
counseling, care, treatment, and supportive 
services. 
(F) TREATMENT.—A plan for ensuring 
that correctional facilities have the necessary 
medicine and equipment to treat and monitor 
STIs and for ensuring that incarcerated per-
sons living with or testing positive for STIs re-
ceive and have access to care and treatment 
services. 
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(G) 
STRATEGIES
FOR
DEMOGRAPHIC 
GROUPS.—A plan for developing and imple-
menting culturally appropriate, sensitive, and 
specific strategies to reduce the spread of STIs 
among demographic groups heavily impacted by 
STIs. 
(H) LINKAGES
WITH
COMMUNITIES
AND 
FACILITIES.—A plan for establishing and 
strengthening linkages to local communities and 
health facilities that— 
(i) provide counseling, testing, care, 
and treatment services; 
(ii) may receive persons recently re-
leased from incarceration who are living 
with STIs; and 
(iii) accept payment through the State 
Medicaid program. 
(I) ENROLLMENT
IN
STATE
MEDICAID 
PROGRAMS.—Plans to ensure that incarcerated 
persons who were— 
(i) enrolled in their State Medicaid 
program prior to incarceration in a correc-
tional facility are automatically re-enrolled 
in such program upon their release; and 
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(ii) not enrolled in their State Med-
icaid program prior to incarceration, but 
who are diagnosed with the human im-
munodeficiency virus while incarcerated in 
a correctional facility, are automatically 
enrolled in such program upon their re-
lease. 
(J) OTHER PLANS.—Any other plans de-
veloped by the Attorney General for reducing 
the spread of STIs or improving the quality of 
health care in correctional facilities. 
(K) MONITORING SYSTEM.—A monitoring 
system that establishes performance goals re-
lated to reducing the prevalence and spread of 
STIs in correctional facilities and which, where 
feasible, expresses such goals in quantifiable 
form. 
(L) MONITORING
SYSTEM
PERFORMANCE 
INDICATORS.—Performance 
indicators 
that 
measure or assess the achievement of the per-
formance goals described in subparagraph (K). 
(M) COST ESTIMATE.—A detailed estimate 
of the funding necessary to implement the 
strategy at the Federal and State levels for all 
5 years, including the amount of funds required 
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by community organizations to implement the 
parts of the strategy in which they take part. 
(3) REPORT.—The Attorney General shall 
transmit to Congress and make publicly available an 
annual progress report regarding the implementation 
and effectiveness of the strategy described in para-
graph (1). The progress report shall include an eval-
uation of the implementation of the strategy using 
the monitoring system and performance indicators 
provided for in subparagraphs (K) and (L) of para-
graph (2). 
(e) AUTHORIZATION OF APPROPRIATIONS.— 
(1) IN GENERAL.—There are authorized to be 
appropriated such sums as may be necessary to 
carry out this section for each of fiscal years 2015 
through 2020. 
(2) AVAILABILITY OF FUNDS.—Amounts made 
available under paragraph (1) are authorized to re-
main available until expended. 
(f) DEFINITIONS.—For the purposes of this section: 
(1) COMMUNITY
ORGANIZATION.—The term 
‘‘community organization’’ means a public health 
care facility or a nonprofit organization which pro-
vides health- or STI-related services according to es-
tablished public health standards. 
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(2) COMPREHENSIVE SEXUALITY EDUCATION.— 
The term ‘‘comprehensive sexuality education’’ 
means sexuality education that includes information 
about abstinence and about the proper use and dis-
posal of sexual barrier protection devices and which 
is— 
(A) evidence-based; 
(B) medically accurate; 
(C) age and developmentally appropriate; 
(D) gender and identity sensitive; 
(E) culturally and linguistically appro-
priate; and 
(F) structured to promote critical thinking, 
self-esteem, respect for others, and the develop-
ment of healthy attitudes and relationships. 
(3) CORRECTIONAL FACILITY.—The term ‘‘cor-
rectional facility’’ means any prison, penitentiary, 
adult detention facility, juvenile detention facility, 
jail, or other facility to which persons may be sent 
after conviction of a crime or act of juvenile delin-
quency within the United States. 
(4) INCARCERATED PERSON.—The term ‘‘incar-
cerated person’’ means any person who is serving a 
sentence in a correctional facility after conviction of 
a crime. 
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(5) SEXUALLY TRANSMITTED INFECTION.—The 
term ‘‘sexually transmitted infection’’ or ‘‘STI’’ 
means any disease or infection that is commonly 
transmitted through sexual activity, including HIV/ 
AIDS, gonorrhea, chlamydia, syphilis, genital her-
pes, viral hepatitis, and human papillomavirus. 
(6) SEXUAL BARRIER PROTECTION DEVICE.— 
The term ‘‘sexual barrier protection device’’ means 
any FDA-approved physical device which has not 
been tampered with and which reduces the prob-
ability of STI transmission or infection between sex-
ual partners, including female condoms, male 
condoms, and dental dams. 
(7) STATE.—The term ‘‘State’’ includes the 
District of Columbia, American Samoa, the Com-
monwealth of the Northern Mariana Islands, Guam, 
Puerto Rico, and the United States Virgin Islands. 
SEC. 760. AUTOMATIC REINSTATEMENT OR ENROLLMENT 
IN MEDICAID FOR PEOPLE WHO TEST POSI-
TIVE FOR HIV BEFORE REENTERING COMMU-
NITIES. 
(a) IN GENERAL.—Section 1902(e) of the Social Se-
curity Act (42 U.S.C. 1396a(e)) is amended by adding at 
the end the following: 
‘‘(15) ENROLLMENT OF EX-OFFENDERS.— 
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‘‘(A) AUTOMATIC ENROLLMENT OR REIN-
STATEMENT.— 
‘‘(i) IN
GENERAL.—The State plan 
shall provide for the automatic enrollment 
or reinstatement of enrollment of an eligi-
ble individual— 
‘‘(I) if such individual is sched-
uled to be released from a public insti-
tution due to the completion of sen-
tence, not less than 30 days prior to 
the scheduled date of the release; and 
‘‘(II) if such individual is to be 
released from a public institution on 
parole or on probation, as soon as 
possible after the date on which the 
determination to release such indi-
vidual was made, and before the date 
such individual is released. 
‘‘(ii) EXCEPTION.—If a State makes a 
determination that an individual is not eli-
gible to be enrolled under the State plan— 
‘‘(I) on or before the date by 
which the individual would be enrolled 
under clause (i), such clause shall not 
apply to such individual; or 
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‘‘(II) after such date, the State 
may terminate the enrollment of such 
individual. 
‘‘(B) RELATIONSHIP OF ENROLLMENT TO 
PAYMENT FOR SERVICES.— 
‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (A)(ii), an eligible individual 
who is enrolled, or whose enrollment is re-
instated, under subparagraph (A) shall be 
eligible for medical assistance that is pro-
vided after the date that the eligible indi-
vidual is released from the public institu-
tion. 
‘‘(ii) RELATIONSHIP
TO
PAYMENT 
PROHIBITION FOR INMATES.—No provision 
of this paragraph may be construed to per-
mit payment for care or services for which 
payment is excluded under the subdivision 
(A) that follows paragraph (29) of section 
1905(a). 
‘‘(C) TREATMENT OF CONTINUOUS ELIGI-
BILITY.— 
‘‘(i) SUSPENSION FOR INMATES.—Any 
period of continuous eligibility under this 
title shall be suspended on the date an in-
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is lifted under clause (ii), such clause 
shall not apply to such individual; or 
‘‘(II) after such date, the State 
may terminate the enrollment of such 
individual. 
‘‘(D) AUTOMATIC ENROLLMENT OR REIN-
STATEMENT OF ENROLLMENT DEFINED.—For 
purposes of this paragraph, the term ‘automatic 
enrollment or reinstatement of enrollment’ 
means that the State determines eligibility for 
medical assistance under the State plan without 
a program application from, or on behalf of, the 
eligible individual, but an individual can only be 
automatically enrolled in the State Medicaid 
plan if the individual affirmatively consents to 
being enrolled through affirmation in writing, 
by telephone, orally, through electronic signa-
ture, or through any other means specified by 
the Secretary. 
‘‘(E) ELIGIBLE
INDIVIDUAL
DEFINED.— 
For purposes of this paragraph, the term ‘eligi-
ble individual’ means an individual who is an 
inmate of a public institution (except as a pa-
tient in a medical institution)— 
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‘‘(i) who was enrolled under the State 
plan for medical assistance immediately be-
fore becoming an inmate of such an insti-
tution; or 
‘‘(ii) is diagnosed with human im-
munodeficiency virus.’’. 
(b) SUPPLEMENTAL FUNDING FOR STATE IMPLE-
MENTATION OF AUTOMATIC REINSTATEMENT OF MED-
ICAID BENEFITS.— 
(1) IN GENERAL.—Subject to paragraph (6), 
for each State for which the Secretary of Health and 
Human Services has approved an application under 
paragraph (3), the Federal matching payments (in-
cluding payments based on the Federal medical as-
sistance percentage) made to such State under sec-
tion 1903 of the Social Security Act (42 U.S.C. 
1396b) shall be increased by 5.0 percentage points 
for payments to the State for the activities per-
mitted under paragraph (2) or a period of one year. 
(2) USE OF FUNDS.—A State may only use in-
creased matching payments authorized under para-
graph (1)— 
(A) to strengthen the State’s enrollment 
and administrative resources for the purpose of 
improving processes for enrolling (or reinstating 
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the enrollment of) eligible individuals (as such 
term is defined in subparagraph (E) of para-
graph (15) of section 1902(e) of the Social Se-
curity Act (as amended by subsection (a))); and 
(B) for medical assistance (as such term is 
defined in section 1905(a) of the Social Secu-
rity Act) provided to such eligible individuals. 
(3) APPLICATION AND AGREEMENT.—The Sec-
retary may only make payments to a State in the in-
creased amount if— 
(A) the State has amended the State plan 
under section 1902(e) of the Social Security 
Act to incorporate the requirements of para-
graph (15) of such section (as added by sub-
section (a)); 
(B) the State has submitted an application 
to the Secretary that includes a plan for imple-
menting 
the 
requirements 
of 
section 
1902(e)(15) of the Social Security Act under 
the State’s amended State plan before the end 
of the 90-day period beginning on the date that 
the State receives increased matching payments 
under paragraph (1); 
(C) the State’s application meets the satis-
faction of the Secretary; and 
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(D) the State enters an agreement with 
the Secretary that states that— 
(i) the State will only use the in-
creased matching funds for the uses per-
mitted under paragraph (2); and 
(ii) at the end of the period under 
paragraph (1), the State will submit to the 
Secretary, and make publicly available, a 
report that contains the information re-
quired under paragraph (4). 
(4) REQUIRED REPORT INFORMATION.—The in-
formation that is required in the report under para-
graph (3)(D)(ii) includes— 
(A) the results of an evaluation of the im-
pact of the implementation of the requirements 
of section 1902(e)(15) of the Social Security 
Act on improving the State’s processes for en-
rolling of individuals who are released from 
public institutions into the Medicaid program; 
(B) the number of individuals who were 
automatically enrolled (or whose enrollment is 
reinstated) under such section 1902(e)(15) dur-
ing the period under paragraph (1); and 
(C) any other information that is required 
by the Secretary. 
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(5) INCREASE IN CAP ON MEDICAID PAYMENTS 
TO
TERRITORIES.—Subject to paragraph (6), the 
amounts otherwise determined for Puerto Rico, the 
United States Virgin Islands, Guam, the Northern 
Mariana Islands, and American Samoa under sub-
sections (f) and (g) of section 1108 of the Social Se-
curity Act (42 U.S.C. 1308) shall each be increased 
by the necessary amount to allow for the increase in 
the Federal matching payments under paragraph 
(1), but only for the period under such paragraph 
for such State. In the case of such an increase for 
a territory, subsection (a)(1) of such section 1108 
shall be applied without regard to any increase in 
payment made to the territory under part E of title 
IV of such Act that is attributable to the increase 
in Federal medical assistance percentage effected 
under paragraph (1) for the territory. 
(6) LIMITATIONS.— 
(A) TIMING.—With respect to a State, at 
the end of the period under paragraph (1), no 
increased matching payments may be made to 
such State under this subsection. 
(B) MAINTENANCE OF ELIGIBILITY.— 
(i) IN
GENERAL.—Subject to clause 
(ii), a State is not eligible for an increase 
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in its Federal matching payments under 
paragraph (1), or an increase in a cap 
amount under paragraph (5), if eligibility 
standards, methodologies, or procedures 
under its State plan under title XIX of the 
Social Security Act (including any waiver 
under such title or under section 1115 of 
such Act (42 U.S.C. 1315)) are more re-
strictive than the eligibility standards, 
methodologies, or procedures, respectively, 
under such plan (or waiver) as in effect on 
the date of enactment of this Act. 
(ii) STATE REINSTATEMENT OF ELIGI-
BILITY PERMITTED.—A State that has re-
stricted eligibility standards, methodolo-
gies, or procedures under its State plan 
under title XIX of the Social Security Act 
(including any waiver under such title or 
under section 1115 of such Act (42 U.S.C. 
1315)) after the date of enactment of this 
Act, is no longer ineligible under subpara-
graph (A) beginning with the first calendar 
quarter in which the State has reinstated 
eligibility standards, methodologies, or pro-
cedures that are no more restrictive than 
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the eligibility standards, methodologies, or 
procedures, respectively, under such plan 
(or waiver) as in effect on such date. 
(C) NO
WAIVER
AUTHORITY.—The Sec-
retary may not waive the application of this 
subsection under section 1115 of the Social Se-
curity Act or otherwise. 
(D) LIMITATION OF MATCHING PAYMENTS 
TO 100 PERCENT.—In no case shall an increase 
in Federal matching payments under this sub-
section result in Federal matching payments 
that exceed 100 percent. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by subsection (a) 
shall take effect 180 days after the date of the en-
actment of this Act and shall apply to services fur-
nished on or after such date. 
(2) RULE
FOR
CHANGES
REQUIRING
STATE 
LEGISLATION.—In the case of a State plan for med-
ical assistance under title XIX of the Social Security 
Act which the Secretary of Health and Human Serv-
ices determines requires State legislation (other than 
legislation appropriating funds) in order for the plan 
to meet the additional requirement imposed by the 
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amendments made by this section, the State plan 
shall not be regarded 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 that begins after the date of the en-
actment 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. 761. STOP AIDS IN PRISON. 
(a) SHORT TITLE.—This section may be cited as the 
‘‘Stop AIDS in Prison Act’’. 
(b) IN GENERAL.—The Bureau of Prisons (herein-
after in this section referred to as the ‘‘Bureau’’) shall 
develop a comprehensive policy to provide HIV testing, 
treatment, and prevention for inmates within the correc-
tional setting and upon reentry. 
(c) PURPOSE.—The purposes of this policy shall be 
as follows: 
(1) To stop the spread of HIV/AIDS among in-
mates. 
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(2) To protect prison guards and other per-
sonnel from HIV/AIDS infection. 
(3) To provide comprehensive medical treat-
ment to inmates who are living with HIV/AIDS. 
(4) To promote HIV/AIDS awareness and pre-
vention among inmates. 
(5) To encourage inmates to take personal re-
sponsibility for their health. 
(6) To reduce the risk that inmates will trans-
mit HIV/AIDS to other persons in the community 
following their release from prison. 
(d) CONSULTATION.—The Bureau shall consult with 
appropriate officials of the Department of Health and 
Human Services, the Office of National Drug Control Pol-
icy, the Office of National AIDS Policy, and the Centers 
for Disease Control and Prevention regarding the develop-
ment of this policy. 
(e) TIME LIMIT.—The Bureau shall draft appro-
priate regulations to implement this policy not later than 
1 year after the date of the enactment of this Act. 
(f) REQUIREMENTS FOR POLICY.—The policy created 
under subsection (b) shall provide for the following: 
(1) TESTING
AND
COUNSELING
UPON
IN-
TAKE.— 
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(A) Health care personnel shall provide 
routine HIV testing to all inmates as a part of 
a comprehensive medical examination imme-
diately following admission to a facility. (Health 
care personnel need not provide routine HIV 
testing to an inmate who is transferred to a fa-
cility from another facility if the inmate’s med-
ical records are transferred with the inmate and 
indicate that the inmate has been tested pre-
viously.) 
(B) To all inmates admitted to a facility 
prior to the effective date of this policy, health 
care personnel shall provide routine HIV testing 
within no more than 6 months. HIV testing for 
these inmates may be performed in conjunction 
with other health services provided to these in-
mates by health care personnel. 
(C) All HIV tests under this paragraph 
shall comply with the opt-out provision. 
(2) PRE-TEST AND POST-TEST COUNSELING.— 
Health care personnel shall provide confidential pre- 
test and post-test counseling to all inmates who are 
tested for HIV. Counseling may be included with 
other general health counseling provided to inmates 
by health care personnel. 
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(3) HIV/AIDS PREVENTION EDUCATION.— 
(A) Health care personnel shall improve 
HIV/AIDS awareness through frequent edu-
cational programs for all inmates. HIV/AIDS 
educational programs may be provided by com-
munity-based organizations, local health depart-
ments, and inmate peer educators. 
(B) HIV/AIDS educational materials shall 
be made available to all inmates at orientation, 
at health care clinics, at regular educational 
programs, and prior to release. Both written 
and audiovisual materials shall be made avail-
able to all inmates. 
(C)(i) The HIV/AIDS educational pro-
grams and materials under this paragraph shall 
include information on— 
(I) modes of transmission, including 
transmission through tattooing, sexual con-
tact, and intravenous drug use; 
(II) prevention methods; 
(III) treatment; and 
(IV) disease progression. 
(ii) The programs and materials shall be 
culturally sensitive, written or designed for low- 
literacy levels, available in a variety of lan-
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guages, and present scientifically accurate in-
formation in a clear and understandable man-
ner. 
(4) HIV TESTING UPON REQUEST.— 
(A) Health care personnel shall allow in-
mates to obtain HIV tests upon request once 
per year or whenever an inmate has a reason to 
believe the inmate may have been exposed to 
HIV. Health care personnel shall, both orally 
and in writing, inform inmates, during orienta-
tion and periodically throughout incarceration, 
of their right to obtain HIV tests. 
(B) Health care personnel shall encourage 
inmates to request HIV tests if the inmate is 
sexually active, has been raped, uses intra-
venous drugs, receives a tattoo, or if the inmate 
is concerned that the inmate may have been ex-
posed to HIV/AIDS. 
(C) An inmate’s request for an HIV test 
shall not be considered an indication that the 
inmate has put him/herself at risk of infection 
and/or committed a violation of prison rules. 
(5) HIV TESTING OF PREGNANT WOMAN.— 
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(A) Health care personnel shall provide 
routine HIV testing to all inmates who become 
pregnant. 
(B) All HIV tests under this paragraph 
shall comply with the opt-out provision. 
(6) COMPREHENSIVE TREATMENT.— 
(A) Health care personnel shall provide all 
inmates who test positive for HIV— 
(i) 
timely, 
comprehensive 
medical 
treatment; 
(ii) confidential counseling on man-
aging their medical condition and pre-
venting its transmission to other persons; 
and 
(iii) voluntary partner notification 
services. 
(B) Health care provided under this para-
graph shall be consistent with current Depart-
ment of Health and Human Services guidelines 
and standard medical practice. Health care per-
sonnel shall discuss treatment options, the im-
portance of adherence to antiretroviral therapy, 
and the side effects of medications with inmates 
receiving treatment. 
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(C) Health care personnel and pharmacy 
personnel shall ensure that the facility for-
mulary contains all Food and Drug Administra-
tion-approved medications necessary to provide 
comprehensive treatment for inmates living with 
HIV/AIDS, and that the facility maintains ade-
quate supplies of such medications to meet in-
mates’ medical needs. Health care personnel 
and pharmacy personnel shall also develop and 
implement automatic renewal systems for these 
medications to prevent interruptions in care. 
(D) Correctional staff, health care per-
sonnel, and pharmacy personnel shall develop 
and implement distribution procedures to en-
sure timely and confidential access to medica-
tions. 
(7) PROTECTION OF CONFIDENTIALITY.— 
(A) Health care personnel shall develop 
and implement procedures to ensure the con-
fidentiality of inmate tests, diagnoses, and 
treatment. Health care personnel and correc-
tional staff shall receive regular training on the 
implementation of these procedures. Penalties 
for violations of inmate confidentiality by health 
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care personnel or correctional staff shall be 
specified and strictly enforced. 
(B) HIV testing, counseling, and treat-
ment shall be provided in a confidential setting 
where other routine health services are provided 
and in a manner that allows the inmate to re-
quest and obtain these services as routine med-
ical services. 
(8) TESTING, COUNSELING, AND
REFERRAL 
PRIOR TO REENTRY.— 
(A) Health care personnel shall provide 
routine HIV testing to all inmates no more 
than 3 months prior to their release and re-
entry into the community. (Inmates who are al-
ready known to be infected need not be tested 
again.) This requirement may be waived if an 
inmate’s release occurs without sufficient notice 
to the Bureau to allow health care personnel to 
perform a routine HIV test and notify the in-
mate of the results. 
(B) All HIV tests under this paragraph 
shall comply with the opt-out provision. 
(C) To all inmates who test positive for 
HIV and all inmates who already are known to 
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have HIV/AIDS, health care personnel shall 
provide— 
(i) confidential prerelease counseling 
on managing their medical condition in the 
community, accessing appropriate treat-
ment and services in the community, and 
preventing the transmission of their condi-
tion to family members and other persons 
in the community; 
(ii) referrals to appropriate health 
care providers and social service agencies 
in the community that meet the inmate’s 
individual needs, including voluntary part-
ner notification services and prevention 
counseling services for people living with 
HIV/AIDS; and 
(iii) a 30-day supply of any medically 
necessary medications the inmate is cur-
rently receiving. 
(9) OPT-OUT PROVISION.—Inmates shall have 
the right to refuse routine HIV testing. Inmates 
shall be informed both orally and in writing of this 
right. Oral and written disclosure of this right may 
be included with other general health information 
and counseling provided to inmates by health care 
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597 
personnel. If an inmate refuses a routine test for 
HIV, health care personnel shall make a note of the 
inmate’s refusal in the inmate’s confidential medical 
records. However, the inmate’s refusal shall not be 
considered a violation of prison rules or result in dis-
ciplinary action. Any reference in this section to the 
‘‘opt-out provision’’ shall be deemed a reference to 
the requirement of this paragraph. 
(10) EXCLUSION OF TESTS PERFORMED UNDER 
SECTION 4014(b) FROM THE DEFINITION OF ROUTINE 
HIV TESTING.—HIV testing of an inmate under sec-
tion 4014(b) of title 18, United States Code, is not 
routine HIV testing for the purposes of the opt-out 
provision. Health care personnel shall document the 
reason for testing under section 4014(b) of title 18, 
United States Code, in the inmate’s confidential 
medical records. 
(11) TIMELY
NOTIFICATION
OF
TEST
RE-
SULTS.—Health care personnel shall provide timely 
notification to inmates of the results of HIV tests. 
(g) CHANGES IN EXISTING LAW.— 
(1) SCREENING IN GENERA.—Section 4014(a) 
of title 18, United States Code, is amended— 
(A) by striking ‘‘for a period of 6 months 
or more’’; 
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(B) by striking ‘‘, as appropriate,’’; and 
(C) by striking ‘‘if such individual is deter-
mined to be at risk for infection with such virus 
in accordance with the guidelines issued by the 
Bureau of Prisons relating to infectious disease 
management’’ and inserting ‘‘unless the indi-
vidual declines. The Attorney General shall also 
cause such individual to be so tested before re-
lease unless the individual declines.’’. 
(2) INADMISSIBILITY OF HIV TEST RESULTS IN 
CIVIL
AND
CRIMINAL
PROCEEDINGS.—Section 
4014(d) of title 18, United States Code, is amended 
by inserting ‘‘or under the Stop AIDS in Prison 
Act’’ after ‘‘under this section’’. 
(3) SCREENING AS PART OF ROUTINE SCREEN-
ING.—Section 4014(e) of title 18, United States 
Code, is amended by adding at the end the fol-
lowing: ‘‘Such rules shall also provide that the initial 
test under this section be performed as part of the 
routine health screening conducted at intake.’’. 
(h) REPORTING REQUIREMENTS.— 
(1) REPORT ON HEPATITIS AND OTHER DIS-
EASES.—Not later than 1 year after the date of the 
enactment of this Act, the Bureau shall provide a re-
port to the Congress on Bureau policies and proce-
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dures to provide testing, treatment, and prevention 
education programs for hepatitis and other diseases 
transmitted through sexual activity and intravenous 
drug use. The Bureau shall consult with appropriate 
officials of the Department of Health and Human 
Services, the Office of National Drug Control Policy, 
the Office of National AIDS Policy, and the Centers 
for Disease Control and Prevention regarding the 
development of this report. 
(2) ANNUAL REPORTS.— 
(A) GENERALLY.—Not later than 2 years 
after the date of the enactment of this Act, and 
then annually thereafter, the Bureau shall re-
port to Congress on the incidence among in-
mates of diseases transmitted through sexual 
activity and intravenous drug use. 
(B) MATTERS
PERTAINING
TO
VARIOUS 
DISEASES.—Reports under paragraph (1) shall 
discuss— 
(i) the incidence among inmates of 
HIV/AIDS, hepatitis, and other diseases 
transmitted through sexual activity and in-
travenous drug use; and 
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(ii) updates on Bureau testing, treat-
ment, and prevention education programs 
for these diseases. 
(C) MATTERS
PERTAINING
TO
HIV/AIDS 
ONLY.—Reports under paragraph (1) shall also 
include— 
(i) the number of inmates who tested 
positive for HIV upon intake; 
(ii) the number of inmates who tested 
positive prior to reentry; 
(iii) the number of inmates who were 
not tested prior to reentry because they 
were released without sufficient notice; 
(ix) the number of inmates who opted- 
out of taking the test; 
(x) the number of inmates who were 
tested under section 4014(b) of title 18, 
United States Code; and 
(xi) the number of inmates under 
treatment for HIV/AIDS. 
(D) CONSULTATION.—The Bureau shall 
consult with appropriate officials of the Depart-
ment of Health and Human Services, the Office 
of National Drug Control Policy, the Office of 
National AIDS Policy, and the Centers for Dis-
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ease Control and Prevention regarding the de-
velopment of reports under paragraph (1). 
SEC. 762. SUPPORT DATA SYSTEM REVIEW AND INDICA-
TORS FOR MONITORING HIV CARE. 
The Secretary of Health and Human Services, in col-
laboration with the Assistant Secretary for Health, the Di-
rector of the Office of HIV/AIDS and Infectious Disease 
Policy, the Director of the Centers for Disease Control and 
Prevention, the Administrator of the Substance Abuse and 
Mental Health Services Administration, the Director of 
the Department of Housing and Urban Development, the 
Director of the Office of AIDS Research, the Adminis-
trator of the Health Resources and Services Administra-
tion, and the Administrator of the Centers for Medicare 
& Medicaid Services, shall expand and coordinate efforts 
to align metrics across agencies and modify Federal data 
systems, to— 
(1) adopt the Institute of Medicine’s clinical 
HIV care indicators as the core metrics for moni-
toring the quality of HIV care, mental health, sub-
stance abuse, and supportive services; 
(2) better enable assessment of the impact of 
the National HIV/AIDS Strategy and the Patient 
Protection and Affordable Care Act on improving 
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HIV/AIDS care and access to supportive services for 
individuals with HIV; 
(3) expand the demographic data elements to be 
captured by Federal data systems relevant to HIV 
care to permit calculation of the indicators for sub-
groups of the population of people with diagnosed 
HIV infection, including— 
(A) age; 
(B) race; 
(C) ethnicity; 
(D) sex (assigned at birth); 
(E) gender identity; 
(F) sexual orientation; 
(G) current geographic marker of resi-
dence; 
(H) income or poverty level; and 
(I) primary means of reimbursement for 
medical services (including Medicaid, Medicare, 
the Ryan White HIV/AIDS Program, private 
insurance, health maintenance organizations, 
and no coverage); and 
(4) streamline data collection and systematically 
review all existing reporting requirements for feder-
ally funded HIV/AIDS programs to ensure that only 
essential data are collected. 
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SEC. 763. TRANSFER OF FUNDS FOR IMPLEMENTATION OF 
NATIONAL HIV/AIDS STRATEGY. 
Title II of the Public Health Service Act (42 U.S.C. 
202 et seq.) is amended by inserting after section 241 the 
following: 
‘‘SEC. 241A. TRANSFER OF FUNDS FOR IMPLEMENTATION 
OF NATIONAL HIV/AIDS STRATEGY. 
‘‘(a) TRANSFER AUTHORIZATION.—Of the discre-
tionary appropriations made available to the Department 
of Health and Human Services for any fiscal year for pro-
grams and activities that, as determined by the Secretary 
of Health and Human Services, pertain to HIV/AIDS, the 
Secretary, in coordination with the Director of the Office 
of National HIV/AIDS Policy, may transfer up to 1 per-
cent of such appropriations to the Office of the Assistant 
Secretary for Health for implementation of the National 
HIV/AIDS Strategy. 
‘‘(b) CONGRESSIONAL NOTIFICATION.—Not less than 
30 days before making any transfer under this section, 
the Secretary shall give notice of the transfer to the Con-
gress. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) The term ‘HIV/AIDS’ has the meaning 
given to such term in section 2689. 
‘‘(2) The term ‘National HIV/AIDS Strategy’ 
means the National HIV/AIDS Strategy for the 
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United States issued by the President in July 2010 
and includes any subsequent revisions to such Strat-
egy.’’. 
SEC. 764. HIV INTEGRATED SERVICES DELIVERY MODEL 
DEMONSTRATION. 
(a) IN GENERAL.—Consistent with the National 
HIV/AIDS Strategy for the United States and in accord-
ance with this section, the Secretary of Health and 
Human Services acting through the Center for Medicare 
& Medicaid Innovation and in cooperation with CDC, 
HRSA, SAMHSA, and HUD, shall conduct a 3-year dem-
onstration project that is designed to integrate services 
and funding under the Medicare and Medicaid programs, 
under HIV-related programs conducted by the CDC, and 
under the Ryan White HIV/AIDS Program, to reduce new 
HIV infections, to increase the proportion of people who 
know their status, to increase access to care, to improve 
health outcomes, to reduce HIV-related health disparities 
among Medicaid and Medicare beneficiaries, and to reduce 
the cost of care provided to HIV positive Medicare and 
Medicaid beneficiaries. 
(b) OBJECTIVES.—The objectives of the demonstra-
tion are the following: 
(1) To ensure the early identification of HIV 
positive beneficiaries to reduce costly HIV-related 
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(c) DEMONSTRATION DESIGN.— 
(1) IN GENERAL.—The Secretary shall design 
the demonstration to test both— 
(A) the service delivery model described in 
paragraph (2); and 
(B) the payment model described in para-
graph (3). 
(2) SERVICE DELIVERY MODEL.— 
(A) IN GENERAL.—Under the service deliv-
ery model described in this paragraph, the dem-
onstration shall test comprehensive HIV test-
ing, linkage to care, HIV medical care, and an-
cillary services to individuals enrolled under 
Medicare, Medicaid, or both. The service deliv-
ery model will integrate services furnished 
under Medicare and Medicaid with prevention 
services funded by CDC for HIV positive bene-
ficiaries, intensive case management services 
funded by HRSA, behavioral services funded by 
SAMHSA, and housing assistance services 
funded through HUD. 
(B) CORE ELEMENTS.—The model under 
this paragraph shall have the following 8 core 
elements: 
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(i) HIV testing services that apply the 
CDC’s 2006 recommendations for uni-
versal opt-out testing among Medicare and 
Medicaid beneficiary populations. 
(ii) Rapid linkage from HIV testing 
settings to treatment for HIV positive 
beneficiaries to ensure they are engaged in 
care in a timely basis. 
(iii) Access to high quality HIV expe-
rienced medical care, laboratory moni-
toring, HIV medications, and other re-
quired services. 
(iv) Routine screening and treatment 
for HIV-related and other chronic condi-
tions, including behavioral health. 
(v) Prevention and treatment edu-
cation services, including an adapted Medi-
cation Therapy Management (MTM) pro-
gram model, to optimize the benefit of 
HIV therapeutics. 
(vi) Risk-stratified medical case man-
agement. 
(vii) Provision of preventive care, in-
cluding counseling to prevent secondary 
HIV infection. 
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(viii) Wrap-around support and hous-
ing services. 
(3) PAYMENT
MODEL.—Under the payment 
model described in this paragraph, the demonstra-
tion shall test the following: 
(A) A prepaid capitated payment model 
that adjusts payment for HIV and behavioral 
health acuity, to be applied under contracts 
with managed care organizations with dem-
onstrated HIV experience. 
(B) Use of funds under the Ryan White 
HIV/AIDS Program to purchase capitated serv-
ices from the contracted managed care organi-
zations. 
(C) Provision of additional funds to sup-
port services to the extent that Medicaid and 
Medicare coverage is limited, including for serv-
ices such as HIV testing (for Medicaid bene-
ficiaries), medical case management, prevention 
case management, treatment education, case 
finding, behavioral health services, and housing 
assistance. 
(d) BENEFICIARY CRITERIA.—Beneficiaries eligible 
for participation in the demonstration are the following: 
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(1) MEDICAID
FFS
BENEFICIARIES.—Fee-for- 
service Medicaid beneficiaries 18 years of age or 
older. 
(2) DUAL ELIGIBLES.—Individuals who are— 
(A) entitled to medical assistance under 
Medicaid; and 
(B) entitled to benefits under part A, and 
enrolled under part B, of Medicare but are not 
enrolled under a Medicare Advantage plan 
under Medicare. 
(e) ROLES AND RESPONSIBILITIES IN DEMONSTRA-
TION.— 
(1) IN GENERAL.—Consistent with the National 
HIV/AIDS Strategy for the United States, Federal 
agencies shall coordinate their funding for the se-
lected States or cities covered under the demonstra-
tion to provide resources to fund the delivery of serv-
ices within the demonstration. 
(2) HHS.—In carrying out the demonstration, 
the Secretary shall— 
(A) design the application process; 
(B) solicit applications from 5 to 7 State 
Medicaid agencies to host the demonstration; 
(C) with respect to the service delivery 
model described in subsection (c)(2), collaborate 
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with the CDC, HRSA, and the National Insti-
tutes of Health to design a minimum service de-
livery model that reflects the current standard 
of care as established by the Public Health 
Service and CDC guidelines and recommenda-
tions; and 
(D) fund an evaluation of the demonstra-
tion to ensure collection of system, provider, 
and beneficiary-level data to address their rou-
tine reporting requirements. 
The Secretary may carry out the Secretary’s author-
ity under this paragraph through CMMI. 
(3) CDC.—The CDC shall collaborate with the 
Secretary and CDC-funded HIV prevention grantees 
in the selected States and cities to provide technical 
assistance to design cost-effective HIV and sexually 
transmitted infection (STI) screening and testing 
services for Medicaid and Medicare beneficiaries, in-
cluding partner notification services and commu-
nicable disease reporting. CDC and CMS shall deter-
mine the extent to which testing funds shall be sup-
ported jointly or separately by these agencies. 
(4) HRSA.—HRSA shall allocate funds avail-
able through the Special Projects of National Sig-
nificance (SPNS) Initiative Program (under subpart 
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I of part F of the Ryan White HIV/AIDS Program) 
to support wrap-around core and support services 
not covered under Medicare or Medicaid and shall 
authorize the use of Ryan White HIV/AIDS Pro-
gram funds to purchase services through capitated 
managed care programs that meet or exceed the 
services covered by the Ryan White HIV/AIDS Pro-
gram at rates that are no greater than current per 
capita expenditures. HRSA is authorized to use 
funds under SPNS, and to waive such requirements 
of SPNS as may be necessary, to carry out the dem-
onstration. 
(5) SAMHSA.—SAMHSA shall allocate funds 
through the Minority HIV/AIDS Initiative or other 
programs to support behavioral health services not 
covered under Medicare or Medicaid. 
(6) HOPWA.—HUD shall directly allocate 
funds under the Housing Opportunities for People 
With AIDS (HOPWA) program to the States or cit-
ies participating in the demonstration to provide 
supportive housing and other housing assistance to 
beneficiaries who otherwise meet HOPWA eligibility 
criteria. HUD is authorized to use such HOPWA 
funds, and to waive such requirements under 
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HOPWA as may be necessary, to carry out the dem-
onstration. 
(7) STATE MEDICAID AGENCIES.—Single State 
agencies responsible for administration of the Med-
icaid program for individuals who are accepted to 
participate in the demonstration shall— 
(A) collaborate with CMS to design or re-
fine a prepaid capitated payment model, to allo-
cate and award contracts with capitated man-
aged care plans, to ensure such plans meet 
State statutory or regulatory requirements, to 
contract with a coordinating agency to organize 
and deliver integrated HIV testing, medical 
care, support, and housing services funded 
under Medicare and Medicaid, other Federal, 
State, and local government sponsors, and to 
coordinate their activities with the State HIV/ 
AIDS program; and 
(B) identify and contract with a coordi-
nating agency to organize the demonstration in 
the State, to establish a coordinating body rep-
resenting State, local, and provider agencies 
participating in the demonstration, to establish 
systems of care that integrate HIV prevention, 
testing, treatment, support, and housing serv-
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ices, to establish mechanisms to gather evalua-
tion data for reporting to CMMI and other par-
ticipating Federal agencies, and to establish a 
quality management program to monitor pro-
vider performance in delivering the services pro-
vided to participating beneficiaries under the 
demonstration. 
(8) 
MANAGED
CARE
ORGANIZATIONS.— 
Capitated managed care organizations participating 
in the demonstration shall organize and deliver serv-
ices as specified by the minimum service delivery 
model established by CMMI through a network of 
providers with demonstrated HIV experience, high 
quality, and sufficient provider capacity. 
(f) DEFINITIONS.—In this section: 
(1) CDC.—The term ‘‘CDC’’ means the Direc-
tor of the Centers for Disease Control and Preven-
tion. 
(2) CMMI.—The term ‘‘CMMI’’ means the Di-
rector of the Center for Medicare & Medicaid Inno-
vation. 
(3) CMS.—The term ‘‘CMS’’ means the Ad-
ministrator of the Centers for Medicare & Medicaid 
Services. 
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(4) DEMONSTRATION.—The term ‘‘demonstra-
tion’’ means the demonstration conducted under this 
section. 
(5) HRSA.—The term ‘‘HRSA’’ means the Ad-
ministrator of the Health Resources and Services 
Administration. 
(6) HUD.—The term ‘‘HUD’’ means the Sec-
retary of Housing and Urban Development. 
(7) MEDICARE; MEDICAID.—The terms ‘‘Medi-
care’’ and ‘‘Medicaid’’ mean the programs under ti-
tles XVIII and XIX, respectively, of the Social Secu-
rity Act. 
(8) NATIONAL
HIV/AIDS
STRATEGY
FOR
THE 
UNITED STATES.—The term ‘‘National HIV/AIDS 
Strategy for the United States’’ has the meaning 
given such term under section 241A(b) of the Public 
Health Service Act. 
(9) RYAN
WHITE
HIV/AIDS
PROGRAM.—The 
term ‘‘Ryan White HIV/AIDS Program’’ means the 
program under title XXVI of the Public Health 
Service Act. 
(10) SAMHSA.—The term ‘‘SAMHSA’’ means 
the Substance Abuse and Mental Health Services 
Administration. 
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(11) 
SECRETARY.—The 
term 
‘‘Secretary’’ 
means the Secretary of Health and Human Services, 
acting through CMMI. 
SEC. 765. REPORT ON THE IMPLEMENTATION OF GOAL 4 
(IMPROVED COORDINATION) OF THE NA-
TIONAL HIV/AIDS STRATEGY. 
(a) REPORT REQUIRED.—The President, in consulta-
tion with the heads of all relevant Federal departments 
and agencies including the Department of Education, the 
Department of Health and Human Services, the Depart-
ment of Housing and Urban Development, the Depart-
ment of Justice, the Department of Labor, the Depart-
ment of Veteran Affairs, and the Social Security Adminis-
tration, shall transmit to the Congress and make publicly 
available a report on the status of implementation of Goal 
4 of the National HIV/AIDS Strategy. 
(b) CONTENTS.—The report required by subsection 
(a) shall include a description, an analysis, and an evalua-
tion of— 
(1) the extent to which the National HIV/AIDS 
Strategy has improved coordination of efforts, en-
hanced capacity, and strengthened infrastructure in 
order to maximize the effective delivery of HIV/ 
AIDS prevention, care, and treatment services at the 
community level, including coordination— 
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(A) within and among Federal agencies 
and departments; 
(B) between the Federal Government and 
State and local governments and health depart-
ments; 
(C) between the Federal Government and 
nonprofit foundations and civil society organiza-
tions, including community- and faith-based or-
ganizations focused on addressing the issue of 
HIV/AIDS; and 
(D) between the Federal Government and 
private businesses; and 
(2) efforts by the Federal Government to edu-
cate, involve, and establish and strengthen partner-
ships with civil society organizations, including 
community- and faith-based organizations, in order 
to implement the National HIV/AIDS Strategy and 
achieve its goals. 
(c) DEFINITION.—In this section, the term ‘‘National 
HIV/AIDS Strategy’’ means the National HIV/AIDS 
Strategy for the United States issued by the President in 
July 2010 and includes any subsequent revisions to such 
Strategy. 
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Subtitle F—Diabetes 
SEC. 771. RESEARCH, TREATMENT, AND EDUCATION. 
Subpart 3 of part C of title IV of the Public Health 
Service Act (42 U.S.C. 285c et seq.) is amended by adding 
at the end the following new section: 
‘‘SEC. 434B. DIABETES IN MINORITY POPULATIONS. 
‘‘(a) IN GENERAL.—The Director of NIH shall ex-
pand, intensify, and support ongoing research and other 
activities with respect to prediabetes and diabetes, particu-
larly type 2, in minority populations. 
‘‘(b) RESEARCH.— 
‘‘(1) DESCRIPTION.—Research under subsection 
(a) shall include investigation into— 
‘‘(A) the causes of diabetes, including so-
cioeconomic, geographic, clinical, environmental, 
genetic, and other factors that may contribute 
to increased rates of diabetes in minority popu-
lations; and 
‘‘(B) the causes of increased incidence of 
diabetes complications in minority populations, 
and possible interventions to decrease such inci-
dence. 
‘‘(2) INCLUSION OF MINORITY PARTICIPANTS.— 
In conducting and supporting research described in 
subsection (a), the Director of NIH shall seek to in-
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clude minority participants as study subjects in clin-
ical trials. 
‘‘(c) REPORT; COMPREHENSIVE PLAN.— 
‘‘(1) IN
GENERAL.—The Diabetes Mellitus 
Interagency Coordinating Committee shall— 
‘‘(A) prepare and submit to the Congress, 
not later than 6 months after the date of enact-
ment of this section, a report on Federal re-
search and public health activities with respect 
to prediabetes and diabetes in minority popu-
lations; and 
‘‘(B) develop and submit to the Congress, 
not later than 1 year after the date of enact-
ment of this section, an effective and com-
prehensive Federal plan (including all appro-
priate Federal health programs) to address 
prediabetes and diabetes in minority popu-
lations. 
‘‘(2) CONTENTS.—The report under paragraph 
(1)(A) shall at minimum address each of the fol-
lowing: 
‘‘(A) Research on diabetes and prediabetes 
in minority populations, including such research 
on— 
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‘‘(i) genetic, behavioral, and environ-
mental factors; and 
‘‘(ii) prevention and complications 
among individuals within these populations 
who have already developed diabetes. 
‘‘(B) Surveillance and data collection on 
diabetes and prediabetes in minority popu-
lations, including with respect to— 
‘‘(i) efforts to better determine the 
prevalence of diabetes among Asian-Amer-
ican and Pacific Islander subgroups; and 
‘‘(ii) efforts to coordinate data collec-
tion on the American Indian population. 
‘‘(C) Community-based interventions to ad-
dress diabetes and prediabetes targeting minor-
ity populations, including— 
‘‘(i) the evidence base for such inter-
ventions; 
‘‘(ii) the cultural appropriateness of 
such interventions; and 
‘‘(iii) efforts to educate the public on 
the causes and consequences of diabetes. 
‘‘(D) Education and training programs for 
health 
professionals 
(including 
community 
health workers) on the prevention and manage-
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ment of diabetes and its related complications 
that is supported by the Health Resources and 
Services Administration, including such pro-
grams supported by— 
‘‘(i) the National Health Service 
Corps; or 
‘‘(ii) the community health centers 
program under section 330. 
‘‘(d) EDUCATION.—The Director of NIH shall— 
‘‘(1) through the National Institute on Minority 
Health and Health Disparities and the National Di-
abetes Education Program— 
‘‘(A) make grants to programs funded 
under section 464z–4 (relating to centers of ex-
cellence) for the purpose of establishing a men-
toring program for health care professionals to 
be more involved in weight counseling, obesity 
research, and nutrition; and 
‘‘(B) provide for the participation of mi-
nority health professionals in diabetes-focused 
research programs; and 
‘‘(2) make grants for programs to establish a 
pipeline from high school to professional school that 
will increase minority representation in diabetes-fo-
cused health fields by expanding Minority Access to 
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Research Careers (MARC) program internships and 
mentoring opportunities for recruitment. 
‘‘(e) DEFINITIONS.—For purposes of this section: 
‘‘(1) The ‘Diabetes Mellitus Interagency Coordi-
nating Committee’ means the Diabetes Mellitus 
Interagency Coordinating Committee established 
under section 429. 
‘‘(2) The term ‘minority population’ means a 
racial and ethnic minority group, as defined in sec-
tion 1707.’’. 
SEC. 772. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 
Part B of title III of the Public Health Service Act 
(42 U.S.C. 243 et seq.) is amended by inserting after sec-
tion 317T the following section: 
‘‘SEC. 317U. DIABETES IN MINORITY POPULATIONS. 
‘‘(a) RESEARCH AND OTHER ACTIVITIES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the Centers for Disease 
Control and Prevention, shall conduct and support 
research and public health activities with respect to 
diabetes in minority populations. 
‘‘(2) CERTAIN
ACTIVITIES.—Activities under 
paragraph (1) regarding diabetes in minority popu-
lations shall include the following: 
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‘‘(A) Further enhancing the National 
Health and Nutrition Examination Survey by 
over-sampling Asian-American, Native Hawai-
ian, and Other Pacific Islanders in appropriate 
geographic areas to better determine the preva-
lence of diabetes in such populations as well as 
to improve the data collection of diabetes pene-
tration disaggregated into major ethnic groups 
within such populations. The Secretary shall en-
sure that any such oversampling does not re-
duce the oversampling of other minority popu-
lations including African-American and Latino 
populations. 
‘‘(B) Through the Division of Diabetes 
Translation— 
‘‘(i) providing for prevention research 
to better understand how to influence 
health care systems changes to improve 
quality of care being delivered to such pop-
ulations; 
‘‘(ii) carrying out model demonstra-
tion projects to design, implement, and 
evaluate effective diabetes prevention and 
control interventions for minority popu-
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lations, including culturally appropriate 
community-based interventions; 
‘‘(iii) developing and implementing a 
strategic plan to reduce diabetes in minor-
ity populations through applied research to 
reduce disparities and culturally and lin-
guistically appropriate community-based 
interventions; 
‘‘(iv) supporting, through the national 
diabetes prevention program under section 
399V–3, diabetes prevention program sites 
in underserved regions highly impacted by 
diabetes; and 
‘‘(v) implementing, through the na-
tional diabetes prevention program under 
section 399V–3, a demonstration program 
developing new metrics measuring health 
outcomes related to diabetes that can be 
stratified by specific minority populations. 
‘‘(b) EDUCATION.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall direct the Division of Diabetes Translation 
to conduct and support both programs to educate the pub-
lic on diabetes in minority populations and programs to 
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educate minority populations about the causes and effects 
of diabetes. 
‘‘(c) DIABETES; HEALTH PROMOTION, PREVENTION 
ACTIVITIES, AND ACCESS.—The Secretary, acting through 
the Director of the Centers for Disease Control and Pre-
vention and the National Diabetes Education Program, 
shall conduct and support programs to educate specific 
minority populations through culturally appropriate and 
linguistically appropriate information campaigns about 
prevention of, and managing, diabetes. 
‘‘(d) DEFINITION.—For purposes of this section, the 
term ‘minority population’ means a racial and ethnic mi-
nority group, as defined in section 1707.’’. 
SEC. 773. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended, is further amended 
by adding at the end the following new section: 
‘‘SEC. 399V–7. PROGRAMS TO EDUCATE HEALTH PRO-
VIDERS ON THE CAUSES AND EFFECTS OF DI-
ABETES IN MINORITY POPULATIONS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Health Resources and Services Admin-
istration, shall conduct and support programs described 
in subsection (b) to educate health professionals on the 
causes and effects of diabetes in minority populations. 
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‘‘(b) PROGRAMS.—Programs described in this sub-
section, with respect to education on diabetes in minority 
populations, shall include the following: 
‘‘(1) Giving priority, under the primary care 
training and enhancement program under section 
747— 
‘‘(A) to awarding grants to focus on or ad-
dress diabetes; and 
‘‘(B) adding minority populations to the 
list of vulnerable populations that should be 
served by such grants. 
‘‘(2) Providing additional funds for the Health 
Careers Opportunity Program, Centers for Excel-
lence, and the Minority Faculty Fellowship Program 
to partner with the Office of Minority Health under 
section 1707 and the National Institutes of Health 
to strengthen programs for career opportunities fo-
cused on diabetes treatment and care within under-
served regions highly impacted by diabetes. 
‘‘(3) Developing a diabetes focus within, and 
providing additional funds for, the National Health 
Service Corps Scholarship Program— 
‘‘(A) to place individuals in areas that are 
disproportionately affected by diabetes and to 
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provide diabetes treatment and care in such 
areas; and 
‘‘(B) to provide such individuals continuing 
medical education specific to diabetes care.’’. 
SEC. 774. RESEARCH, EDUCATION, AND OTHER ACTIVITIES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.), as amended, is further amended 
by adding at the end the following section: 
‘‘SEC. 399V–8. RESEARCH, EDUCATION, AND OTHER ACTIVI-
TIES REGARDING DIABETES IN AMERICAN IN-
DIAN POPULATIONS. 
‘‘In addition to activities under sections 317V–6 and 
434B, the Secretary, acting through the Indian Health 
Service and in collaboration with other appropriate Fed-
eral agencies, shall— 
‘‘(1) conduct and support research and other 
activities with respect to diabetes; and 
‘‘(2) coordinate the collection of data on clini-
cally and culturally appropriate diabetes treatment, 
care, prevention, and services by health care profes-
sionals to the American Indian population.’’. 
SEC. 775. UPDATED REPORT ON HEALTH DISPARITIES. 
The Secretary of Health and Human Services shall 
seek to enter into an arrangement with the Institute of 
Medicine under which the Institute will— 
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(1) not later than 1 year after the date of en-
actment of this Act, submit to the Congress an up-
dated version of the Institute’s 2002 report entitled 
‘‘Unequal Treatment: Confronting Racial and Ethnic 
Disparities in Health Care’’; and 
(2) in such updated version, address how racial 
and ethnic health disparities have changed since the 
publication of the original report. 
Subtitle G—Lung Disease 
SEC. 776. EXPANSION OF THE NATIONAL ASTHMA EDU-
CATION AND PREVENTION PROGRAM. 
(a) IN GENERAL.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall convene a working group com-
prised of patient groups, nonprofit organizations, medical 
societies, and other relevant governmental and nongovern-
mental entities, including those that participate in the Na-
tional Asthma Education and Prevention Program, to de-
velop a report to Congress that— 
(1) catalogs, with respect to asthma prevention, 
management, and surveillance— 
(A) the activities of the Federal Govern-
ment, including identifying all Federal pro-
grams that carry out asthma-related activities, 
as well as assessment of the progress of the 
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Federal Government and States, with respect to 
achieving the goals of the Healthy People 2020 
initiative; and 
(B) the activities of other entities that par-
ticipate in the program, including nonprofit or-
ganizations, patient advocacy groups, and med-
ical societies; and 
(2) makes recommendations for the future di-
rection of asthma activities, in consultation with re-
searchers from the National Institutes of Health and 
other member bodies of the National Asthma Edu-
cation and Prevention Program who are qualified to 
review and analyze data and evaluate interventions, 
including— 
(A) description of how the Federal Govern-
ment may better coordinate and improve its re-
sponse to asthma including identifying any bar-
riers that may exist; 
(B) description of how the Federal Govern-
ment may continue, expand, and improve its 
private-public partnerships with respect to asth-
ma including identifying any barriers that may 
exist; 
(C) identification of steps that may be 
taken to reduce the— 
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(i) morbidity, mortality, and overall 
prevalence of asthma; 
(ii) financial burden of asthma on so-
ciety; 
(iii) burden of asthma on dispropor-
tionately affected areas, particularly those 
in medically underserved populations (as 
defined in section 330(b)(3) of the Public 
Health 
Service 
Act 
(42 
U.S.C. 
254b(b)(3))); and 
(iv) burden of asthma as a chronic 
disease; 
(D) identification of programs and policies 
that have achieved the steps described in sub-
paragraph (C), and steps that may be taken to 
expand such programs and policies to benefit 
larger populations; and 
(E) recommendations for future research 
and interventions. 
(b) REPORT TO CONGRESS.—At the end of the 5-year 
period following the submission of the report under sub-
section (a), the National Asthma Education and Preven-
tion Program shall evaluate the analyses and rec-
ommendations under such report and determine whether 
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a new report to the Congress is necessary, and make ap-
propriate recommendations to the Congress. 
SEC. 777. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 
FOR DISEASE CONTROL AND PREVENTION. 
Section 317I of the Public Health Service Act (42 
U.S.C. 247b–10) is amended to read as follows: 
‘‘SEC. 317I. ASTHMA-RELATED ACTIVITIES OF THE CENTERS 
FOR DISEASE CONTROL AND PREVENTION. 
‘‘(a) PROGRAM FOR PROVIDING INFORMATION AND 
EDUCATION
TO
THE PUBLIC.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall collaborate with State and local 
health departments to conduct activities, including the 
provision of information and education to the public re-
garding asthma including— 
‘‘(1) deterring the harmful consequences of un-
controlled asthma; and 
‘‘(2) disseminating health education and infor-
mation regarding prevention of asthma episodes and 
strategies for managing asthma. 
‘‘(b) DEVELOPMENT OF STATE ASTHMA PLANS.— 
The Secretary, acting through the Director of the Centers 
for Disease Control and Prevention, shall collaborate with 
State and local health departments to develop State plans 
incorporating public health responses to reduce the burden 
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of asthma, particularly regarding disproportionately af-
fected populations. 
‘‘(c) COMPILATION OF DATA.—The Secretary, acting 
through the Director of the Centers for Disease Control 
and Prevention, shall, in cooperation with State and local 
public health officials— 
‘‘(1) conduct asthma surveillance activities to 
collect data on the prevalence and severity of asth-
ma, the effectiveness of public health asthma inter-
ventions, and the quality of asthma management, in-
cluding— 
‘‘(A) collection of household data on the 
local burden of asthma; 
‘‘(B) surveillance of health care facilities; 
and 
‘‘(C) collection of data not containing indi-
vidually identifiable information from electronic 
health records or other electronic communica-
tions; 
‘‘(2) compile and annually publish data regard-
ing the prevalence and incidence of childhood asth-
ma, the child mortality rate, and the number of hos-
pital admissions and emergency department visits by 
children associated with asthma nationally and in 
each State and at the county level by age, sex, race, 
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and ethnicity, as well as lifetime and current preva-
lence; and 
‘‘(3) compile and annually publish data regard-
ing the prevalence and incidence of adult asthma, 
the adult mortality rate, and the number of hospital 
admissions and emergency department visits by 
adults associated with asthma nationally and in each 
State and at the county level by age, sex, race, eth-
nicity, industry, and occupation, as well as lifetime 
and current prevalence. 
‘‘(d) COORDINATION OF DATA COLLECTION.—The 
Director of the Centers for Disease Control and Preven-
tion, in conjunction with State and local health depart-
ments, shall coordinate data collection activities under 
subsection (c)(2) so as to maximize comparability of re-
sults. 
‘‘(e) COLLABORATION.—The Centers for Disease 
Control and Prevention are encouraged to collaborate with 
national, State, and local nonprofit organizations to pro-
vide information and education about asthma, and to 
strengthen such collaborations when possible. 
‘‘(f) ADDITIONAL FUNDING.—In addition to any 
other authorization of appropriations that is available to 
the Centers for Disease Control and Prevention for the 
purpose of carrying out this section, there are authorized 
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to be appropriated to such Centers such sums as may be 
necessary for each of fiscal years 2015 through 2019 for 
the purpose of carrying out this section.’’. 
SEC. 778. INFLUENZA AND PNEUMONIA VACCINATION CAM-
PAIGN. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall— 
(1) enhance the annual campaign by the De-
partment of Health and Human Services to increase 
the number of people vaccinated each year for influ-
enza and pneumonia; and 
(2) include in such campaign the use of written 
educational materials, public service announcements, 
physician education, and any other means which the 
Secretary deems effective. 
(b) MATERIALS AND ANNOUNCEMENTS.—In carrying 
out the annual campaign described in subsection (a), the 
Secretary of Health and Human Services shall ensure 
that— 
(1) educational materials and public service an-
nouncements are readily and widely available in 
communities experiencing disparities in the incidence 
and mortality rates of influenza and pneumonia; and 
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(2) the campaign uses targeted, culturally ap-
propriate messages and messengers to reach under-
served communities. 
(c) 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 
2015 through 2019. 
SEC. 779. CHRONIC OBSTRUCTIVE PULMONARY DISEASE 
ACTION PLAN. 
(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention shall conduct, support, 
and expand public health strategies, prevention, diagnosis, 
surveillance, and public and professional awareness activi-
ties regarding chronic obstructive pulmonary disease. 
(b) NATIONAL ACTION PLAN.— 
(1) DEVELOPMENT.—Not later than 2 years 
after the date of the enactment of this Act, the Di-
rector of the National Heart, Lung, and Blood Insti-
tute, in consultation with the Director of the Centers 
for Disease Control and Prevention, shall develop a 
national action plan to address chronic obstructive 
pulmonary disease in the United States with partici-
pation from patients, caregivers, health profes-
sionals, patient advocacy organizations, researchers, 
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providers, public health professionals, and other 
stakeholders. 
(2) CONTENTS.—At a minimum, such plan 
shall include recommendations for— 
(A) public health interventions for the pur-
pose of implementation of the national plan; 
(B) biomedical, health services, and public 
health research on chronic obstructive pul-
monary disease; and 
(C) inclusion of chronic obstructive pul-
monary disease in the health data collections of 
all Federal agencies. 
(3) CONSIDERATION.—In developing such plan, 
the Director of the National Heart, Lung, and Blood 
Institute shall consider the recommendations and 
findings of the Institute of Medicine in the report 
entitled ‘‘A Nationwide Framework for Surveillance 
of Cardiovascular and Chronic Lung Diseases’’ (July 
22, 2011). 
(c) CHRONIC DISEASE PREVENTION PROGRAMS.— 
The Director of the National Heart, Lung, and Blood In-
stitute shall carry out the following: 
(1) Conduct public education and awareness ac-
tivities with patient and professional organizations 
to stimulate earlier diagnosis and improve patient 
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outcomes from treatment of chronic obstructive pul-
monary disease. To the extent known and relevant, 
such public education and awareness activities shall 
reflect differences in chronic obstructive pulmonary 
disease by cause (tobacco, environmental, occupa-
tional, biological, and genetic) and include a focus 
on outreach to undiagnosed and, as appropriate, mi-
nority populations. 
(2) Supplement and expand upon the activities 
of the National Heart, Lung, and Blood Institute by 
making grants to nonprofit organizations, State and 
local jurisdictions, and Indian tribes for the purpose 
of reducing the burden of chronic obstructive pul-
monary disease, especially in disproportionately im-
pacted communities, through public health interven-
tions and related activities. 
(3) Coordinate with the Centers for Disease 
Control and Prevention, the Indian Health Service, 
the Health Resources and Services Administration, 
and the Department of Veterans Affairs to develop 
pilot programs to demonstrate best practices for the 
diagnosis and management of chronic obstructive 
pulmonary disease. 
(4) Develop improved techniques and identify 
best practices, in coordination with the Secretary of 
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Veterans Affairs, for assisting chronic obstructive 
pulmonary disease patients to successfully stop 
smoking, including identification of subpopulations 
with different needs. Initiatives under this para-
graph may include research to determine whether 
successful smoking cessation strategies are different 
for chronic obstructive pulmonary disease patients 
compared to such strategies for patients with other 
chronic diseases. 
(d) ENVIRONMENTAL AND OCCUPATIONAL HEALTH 
PROGRAMS.—The Director of the Centers for Disease 
Control and Prevention shall— 
(1) support research into the environmental and 
occupational causes and biological mechanisms that 
contribute to chronic obstructive pulmonary disease; 
and 
(2) develop and disseminate public health inter-
ventions that will lessen the impact of environmental 
and occupational causes of chronic obstructive pul-
monary disease. 
(e) DATA COLLECTION.—Not later than 180 days 
after the enactment of this Act, the Director of the Na-
tional Heart, Lung, and Blood Institute and the Director 
of the Centers for Disease Control and Prevention, acting 
jointly, shall assess the depth and quality of information 
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on chronic obstructive pulmonary disease that is collected 
in surveys and population studies conducted by the Cen-
ters for Disease Control and Prevention, including wheth-
er there are additional opportunities for information to be 
collected in the National Health and Nutrition Examina-
tion Survey, the National Health Interview Survey, and 
the Behavioral Risk Factors Surveillance System surveys. 
The Director of the National Heart, Lung, and Blood In-
stitute shall include the results of such assessment in the 
national action plan under subsection (b). 
(f) 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 
2015 through 2019. 
Subtitle H—Osteoarthritis and 
Musculoskeletal Diseases 
SEC. 781. FINDINGS. 
The Congress finds as follows: 
(1) Eighty percent of African-American women 
and nearly 74 percent of Hispanic men are either 
overweight or obese, speeding the onset and progres-
sion of arthritis. 
(2) Arthritis affects 46 million Americans, and 
that number will rise to 67 million by the year 2030. 
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(3) Twenty-seven million Americans suffer from 
osteoarthritis, the most common form of arthritis, 
making it the leading cause of disability in the 
United States. Osteoarthritis is sometimes referred 
to as degenerative joint disease. 
(4) Obesity accelerates the onset of arthritis: 70 
percent of obese adults with mild osteoarthritis of 
the knee at age 60 will develop advanced end-stage 
disease by age 80. In contrast, just 43 percent of 
non-obese adults will have end-stage disease over the 
same time period. 
(5) Arthritis affects one in five Americans, and 
is the single greatest cause of chronic pain and dis-
ability in the United States. 
(6) Women, African-Americans, and Hispanics 
have more severe arthritis and functional limitations. 
These same individuals are more likely to be obese, 
diabetic, and have higher incidence of heart dis-
ease—medical conditions that can be improved with 
physical activity. Instead of moving; however, these 
groups have an inactivity rate of 40 to 50 percent, 
which continues to increase. 
(7) Arthritis costs $128 billion a year, including 
$81 billion in direct costs (medical) and $47 billion 
in indirect costs (lost earnings). Each year, $309 bil-
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lion in direct and indirect costs is lost due to dis-
parities in osteoarthritis and musculoskeletal dis-
eases. 
(8) Obesity and other chronic health conditions 
exacerbate the debilitating impact of arthritis, lead-
ing to inactivity, loss of independence, and a per-
petual cycle of comorbid chronic conditions. 
(9) Sixty-one percent of arthritis sufferers are 
women, and women represent 64 percent of an esti-
mated 43 million annual visits to physicians’ offices 
and outpatient clinics where arthritis was the pri-
mary diagnosis. Women also represented 60 percent 
of approximately 1 million hospitalizations that oc-
curred in 2003 for which arthritis was the primary 
diagnosis. 
(10) Women ages 65 and older have up to 21⁄2 
times more disabilities than men of the same age. 
Higher rates of obesity and arthritis among this 
group explained up to 48 percent of the gender gap 
in disability, above all other common chronic health 
conditions. 
(11) The primary indication for total knee 
arthroplasty (TKA), also known as knee replace-
ment, is relief of significant, disabling pain caused 
by severe arthritis. 
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(12) Knee replacement is surgery for people 
with severe knee damage. Knee replacement can re-
lieve pain and allow you to be more active. When 
you have a total knee replacement, the surgeon re-
moves damaged cartilage and bone from the surface 
of your knee joint and replaces them with a man- 
made surface of metal and plastic. In a partial knee 
replacement, the surgeon only replaces one part of 
your knee joint. 
(13) Total hip replacement, also called total hip 
arthroplasty (THA), is used if your hip pain inter-
feres with daily activities and more-conservative 
treatments have not helped. Arthritis damage is the 
most common reason to need hip replacement. 
(14) The odds of a family practice physician 
recommending TKA to a male patient with moderate 
arthritis are twice that of a female patient, while the 
odds of an orthopaedic surgeon recommending TKA 
to a male patient with moderate arthritis are 22 
times that of a female patient. 
(15) African-Americans with doctor-diagnosed 
arthritis have a higher prevalence of severe pain at-
tributable to arthritis, compared with Whites (34.0 
percent versus 22.6 percent). African-Americans, 
compared to Whites, report a higher proportion of 
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work limitations (39.5 percent versus 28.0 percent) 
and a higher prevalence of arthritis-attributable 
work limitation (6.6 percent versus 4.6 percent). 
(16) Hispanics are 50 percent more likely than 
non-Hispanic Whites to report needing assistance 
with at least one instrumental activity of daily living 
and to have difficulty walking. 
(17) African-Americans and Hispanics were 1.3 
times more likely to have activity limitation, 1.6 
times more likely to have work limitations, and 1.9 
times more likely to have severe joint pain than 
Whites. 
(18) In 2003, the Institute of Medicine reported 
that the rates of TKA and THA among African- 
American and Hispanic patients are significantly 
lower than for Whites—even for those with equitable 
health care coverage such as through Medicare or 
the Department of Veterans Affairs. 
(19) According to the Centers for Disease Con-
trol and Prevention, in 2000, African-American 
Medicare enrollees were 37 percent less likely than 
White Medicare enrollees to undergo total knee re-
placements. In 2006, the disparity increased to 39 
percent. 
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(20) Even after adjusting for insurance and 
health access, Hispanics and African-Americans are 
almost 50 percent less likely to undergo total knee 
replacement than Whites. 
SEC. 
782. 
OSTEOARTHRITIS 
AND 
OTHER 
MUSCULO-
SKELETAL HEALTH-RELATED ACTIVITIES OF 
THE CENTERS FOR DISEASE CONTROL AND 
PREVENTION. 
(a) EDUCATION AND AWARENESS ACTIVITIES.—The 
Secretary of Health and Human Services, acting through 
the Director of the Centers for Disease Control and Pre-
vention, shall direct the National Center for Chronic Dis-
ease Prevention and Health Promotion to conduct and ex-
pand the Health Community Program and Arthritis Pro-
gram to educate the public on— 
(1) the causes of, preventive health actions for, 
and effects of arthritis and other musculoskeletal 
conditions in minority patient populations; and 
(2) the effects of such conditions on other 
comorbidities including obesity, hypertension, and 
cardiovascular disease. 
(b) PROGRAMS
ON
ARTHRITIS
AND
MUSCULO-
SKELETAL CONDITIONS.—Education and awareness pro-
grams of the Centers for Disease Control and Prevention 
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on arthritis and other musculoskeletal conditions in minor-
ity communities shall— 
(1) be culturally and linguistically appropriate 
to minority patients, targeting musculoskeletal 
health promotion and prevention programs of each 
major ethnic group, including— 
(A) Native Americans and Alaska Natives; 
(B) Asian-Americans; 
(C) African-Americans/Blacks; 
(D) Hispanic/Latino-Americans; and 
(E) Native Hawaiians and Pacific Island-
ers; and 
(2) include public awareness campaigns directed 
toward these patient populations that emphasize the 
importance of musculoskeletal health, physical activ-
ity, diet and healthy lifestyle, and weight reduction 
for overweight and obese patients. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as necessary for fiscal year 2015 and each sub-
sequent fiscal year. 
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Subtitle I—Sleep and Circadian 
Rhythm Disorders 
SEC. 791. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘Sleep and Circadian Rhythm Disorders Health Dispari-
ties Act’’. 
(b) FINDINGS.—The Congress finds the following: 
(1) Decrements in sleep health such as sleep 
apnea, insufficient sleep time, and insomnia, affect 
50–70 million United States adults. Twelve to eight-
een million United States adults have sleep apnea, a 
chronic disorder characterized by one or more 
pauses in breathing which can last from a few sec-
onds to minutes. They may occur 30 times or more 
an hour, disrupting sleep and resulting in excessive 
daytime sleepiness and loss in productivity. 
(2) Seventy percent of high school students are 
not getting enough sleep on school nights, while 33 
percent of Americans get fewer than 7 hours of sleep 
per night and roughly 6,000 fatal motor vehicle 
crashes are caused by drowsy drivers. 
(3) Insufficient sleep and insomnia are more 
prevalent in women. Women who are pregnant and 
have sleep apnea are at an increased risk of cardio-
vascular complications during pregnancy. The im-
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pact of disparities in sleep health is associated with 
a growing number of health problems, including the 
following: 
(A) Hypertension. 
(B) Cancer. 
(C) Stroke. 
(D) Cardiac arrhythmia. 
(E) Chronic heart failure and heart dis-
ease. 
(F) Diabetes. 
(G) Cognitive functioning and behavior. 
(H) Depression and bipolar disorder. 
(I) Substance abuse. 
(4) A ‘‘sleep disparity’’ exists in that poor sleep 
quality is strongly associated with poverty and race. 
Factors such as employment, education, and health 
status, amongst others, significantly mediated this 
effect only in poor subjects, suggesting a differential 
vulnerability to these factors in poor relative to non- 
poor individuals in the context of sleep quality. 
(5) African-Americans sleep worse than Cauca-
sian Americans. African-Americans take longer to 
fall asleep, report poorer sleep quality, have more 
light and less deep sleep, and nap more often and 
longer. 
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(6) African-Americans and individuals in lower 
socioeconomic status groups may be at an increased 
risk for sleep disturbances and associated health 
consequences. 
(7) Among young African-Americans, the likeli-
hood of having sleep disordered breathing and exhib-
iting risk factors for poor sleep is twice that in 
young Caucasians. Frequent snoring is more com-
mon among African-American and Hispanic women 
and Hispanic men compared to non-Hispanic Cauca-
sians, independent of other factors including obesity. 
(8) African-Americans with sleep disordered 
breathing develop symptoms at a younger age than 
Caucasians but appear less likely to be diagnosed 
and treated in a timely manner. This delay may at 
least in part be due to reduced access to care. 
(9) Sleep loss contributes to increased risk for 
chronic conditions such as obesity, diabetes, and hy-
pertension, all of which have increased prevalence in 
underserved, underrepresented minorities. Racial 
and ethnic disparities related to obesity may also 
contribute to disparities in health outcomes related 
to sleep disordered breathing. 
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(10) Non-Caucasian adults report an insomnia 
rate of 12.9 percent compared to only 6.6 percent 
for Caucasians. 
(11) African-American women have a higher in-
cidence of insomnia than African-American men, 
perhaps related in part to higher risk for chronic 
persisting symptoms. 
SEC. 792. SLEEP AND CIRCADIAN RHYTHM DISORDERS RE-
SEARCH ACTIVITIES OF THE NATIONAL IN-
STITUTES OF HEALTH. 
(a) IN GENERAL.—The Director of the National In-
stitutes of Health, acting through the Director of the Na-
tional Heart, Lung, and Blood Institute, shall— 
(1) continue to expand research activities ad-
dressing sleep health disparities; and 
(2) continue implementation of the ‘‘NIH Sleep 
Disorders Research Plan’’ across all institutes and 
centers of the National Institutes of Health to im-
prove treatment and prevention of sleep health dis-
parities. 
(b) REQUIRED
RESEARCH
ACTIVITIES.—In con-
ducting or supporting research relating to sleep and circa-
dian rhythm, the Director of the National Heart, Lung, 
and Blood Institute shall— 
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(1) advance epidemiology and clinical research 
to achieve a more complete understanding of dispari-
ties in domains of sleep health and across population 
subgroups for which cardiovascular and metabolic 
health disparities exist, including— 
(A) prevalence and severity of sleep apnea; 
(B) habitual sleep duration; 
(C) sleep timing and regularity; and 
(D) insomnia; 
(2) develop study designs and analytical ap-
proaches to explain and predict multilevel and life- 
course determinants of sleep health and to elucidate 
the sleep-related causes of cardiovascular and meta-
bolic health disparities across the age spectrum, in-
cluding such determinants and causes that are— 
(A) environmental; 
(B) biological or genetic; 
(C) psychosocial; 
(D) societal; 
(E) political; or 
(F) economic; 
(3) determine the contribution of sleep impair-
ments such as sleep apnea, insufficient sleep dura-
tion, irregular sleep schedules, and insomnia to un-
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explained disparities in cardiovascular and metabolic 
risk and disease outcomes; 
(4) develop study designs, data sampling and 
collection tools, and analytical approaches to opti-
mize understanding of mediating and moderating 
factors, and feedback mechanisms coupling sleep to 
cardiovascular and metabolic health disparities; 
(5) advance research to understand cultural 
and linguistic barriers (on the person, provider, or 
system level) to access to care, medical diagnosis, 
and treatment of sleep disorders in diverse popu-
lation groups; 
(6) develop and test multilevel interventions (in-
cluding sleep health education in diverse commu-
nities) to reduce disparities in sleep health that will 
impact ability to improve disparities in cardio-
vascular and metabolic risk or disease; 
(7) create opportunities to integrate sleep and 
health disparity science by strategically utilizing re-
sources (existing or anticipated cohorts), exchanging 
scientific data and ideas (cross-over into scientific 
meetings), and develop multidisciplinary investi-
gator-initiated grant applications; and 
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(8) enhance the diversity and foster career de-
velopment of young investigators involved in sleep 
and health disparities science. 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal year 2015 and 
each subsequent fiscal year. 
SEC. 793. SLEEP AND CIRCADIAN RHYTHM HEALTH DIS-
PARITIES-RELATED ACTIVITIES OF THE CEN-
TERS FOR DISEASE CONTROL AND PREVEN-
TION. 
(a) IN GENERAL.—The Director of the Centers for 
Disease Control and Prevention shall conduct, support, 
and expand public health strategies and prevention, diag-
nosis, surveillance, and public and professional awareness 
activities regarding sleep and circadian rhythm disorders. 
(b) FINDINGS.—The Congress finds as follows: 
(1) Sleep disorders and sleep deficiency unre-
lated to a primary sleep disorder are underdiagnosed 
and are increasingly detrimental to health status. 
(2) The consequences to society include addi-
tional diseases, motor vehicle accidents, decreased 
longevity, elevated direct medical costs, and indirect 
costs related to work absenteeism and property dam-
age. 
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(c) REQUIRED
SURVEILLANCE
AND
EDUCATION 
AWARENESS ACTIVITIES.—In conducting or supporting 
research relating to sleep and circadian rhythm disorders 
surveillance and education awareness activities, the Direc-
tor of the Centers for Disease Control and Prevention 
shall— 
(1) ensure that such activities are culturally 
and linguistically appropriate to minority patients, 
targeting sleep and circadian rhythm health pro-
motion and prevention programs of each major eth-
nic group, including— 
(A) Native Americans and Alaska Natives; 
(B) Asian-Americans; 
(C) African-Americans/Blacks; 
(D) Hispanic/Latino-Americans; and 
(E) Native Hawaiians and Pacific Island-
ers; 
(2) collect and compile national and State sur-
veillance data on sleep disorders health disparities; 
(3) continue to develop and implement new 
sleep questions in public health surveillance systems 
to increase public awareness of sleep health and 
sleep disorders and their impact on health; 
(4) publish monthly reports highlighting geo-
graphic, racial, and ethnic disparities in sleep health, 
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as well as relationships between insufficient sleep 
and chronic disease, health risk behaviors, and other 
outcomes as determined necessary by the Director; 
and 
(5) include public awareness campaigns that in-
form patient populations from major ethnic groups 
about the prevalence of sleep and circadian rhythm 
disorders and emphasize the importance of sleep 
health. 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for fiscal year 2015 and 
each subsequent fiscal year. 
TITLE VIII—HEALTH 
INFORMATION TECHNOLOGY 
SEC. 800. DEFINITIONS. 
In this title: 
(1) The term ‘‘certified EHR technology’’ has 
the meaning given to that term in section 3000 of 
the Public Health Service Act (42 U.S.C. 300jj). 
(2) The term ‘‘EHR’’ means an electronic 
health record. 
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Subtitle A—Reducing Health 
Disparities Through Health IT 
SEC. 801. HRSA ASSISTANCE TO HEALTH CENTERS FOR 
PROMOTION OF HEALTH IT. 
The Secretary of Health and Human Services, acting 
through the Administrator of the Health Resources and 
Services Administration, shall expand and intensify the 
programs and activities of the Administration (directly or 
through grants or contracts) to provide technical assist-
ance and resources to health centers (as defined in section 
330(a) of the Public Health Service Act (42 U.S.C. 
254b(a)) to adopt and meaningfully use certified EHR 
technology for the management of chronic diseases and 
health conditions and reduction of health disparities. 
SEC. 802. ASSESSMENT OF IMPACT OF HEALTH IT ON RA-
CIAL AND ETHNIC MINORITY COMMUNITIES; 
OUTREACH AND ADOPTION OF HEALTH IT IN 
SUCH COMMUNITIES. 
(a) NATIONAL COORDINATOR FOR HEALTH INFOR-
MATION TECHNOLOGY.— 
(1) IN
GENERAL.—The National Coordinator 
for Health Information Technology shall conduct an 
evaluation of the level of use and accessibility of 
electronic health records in racial and ethnic minor-
ity communities focusing on whether patients in 
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those communities have providers with EHRs, 
stratified by disparity variables. 
(2) CONTENT.—In conducting the evaluation 
under paragraph (1), the National Coordinator shall 
publish the results of a study regarding the 100,000 
providers recruited by the Regional Extension Cen-
ter established under section 3012 of the Public 
Health Service Act (42 U.S.C. 300jj–32), including 
the race and ethnicity of such providers and the pop-
ulations served by such providers, with the popu-
lations stratified by disparity variables. 
(b) NATIONAL CENTER FOR HEALTH STATISTICS.— 
As soon as practicable after the date of enactment of this 
Act, the Director of the National Center for Health Statis-
tics shall provide to Congress a more detailed analysis of 
the data presented in the Data Brief 79 published by such 
Center in November 2011 (entitled ‘‘Electronic Health 
Record Systems and Intent to Apply for Meaningful Use 
Incentives Among Office-Based Physician Practices’’). 
(c) INSTITUTE
OF MEDICINE.—The Secretary of 
Health and Human Services may enter into an agreement 
with the Institute of Medicine of the National Academies 
that provides such Institute will— 
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(1) evaluate the impact of health information 
technology in racial and ethnic minority commu-
nities; and 
(2) publish a report regarding such evaluation. 
(d) CENTERS FOR MEDICARE & MEDICAID SERV-
ICES.— 
(1) IN GENERAL.—As part of the process of 
collecting information, with respect to a provider, at 
registration and attestation for purposes of the 
Medicare and Medicaid Electronic Health Records 
Incentive Programs, the Secretary of Health and 
Human Services shall collect the race and ethnicity 
of such provider. 
(2) MEDICARE
AND
MEDICAID
ELECTRONIC 
HEALTH
RECORDS
INCENTIVE
PROGRAMS
DE-
FINED.—For purposes of paragraph (1), the term 
‘‘Medicare and Medicaid Electronic Health Records 
Incentive Programs’’ means the incentive programs 
under section 1814(l)(3), subsections (a)(7) and (o) 
of section 1848, subsections (l) and (m) of section 
1853, subsections (b)(3)(B)(ix)(I) and (n) of section 
1886, and subsections (a)(3)(F) and (t) of section 
1903 of the Social Security Act (42 U.S.C. 
1395f(l)(3), 1395w–4, 1395w–23, 1395ww, and 
1396b). 
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(e) NATIONAL COORDINATOR’S ASSESSMENT OF IM-
PACT
OF HIT.—Section 3001(c)(6)(C) of the Public 
Health Service Act (42 U.S.C. 300jj–11(c)(6)(C)) is 
amended— 
(1) in the heading by inserting ‘‘, RACIAL AND 
ETHNIC MINORITY COMMUNITIES,’’ after ‘‘HEALTH 
DISPARITIES’’; 
(2) by inserting ‘‘, in communities with a high 
proportion of individuals from racial and ethnic mi-
nority groups (as defined in section 1707(g)), in-
cluding people with disabilities in these groups,’’ 
after ‘‘communities with health disparities’’; and 
(3) by adding at the end the following new sen-
tence: ‘‘In any publication under the previous sen-
tence, the National Coordinator shall include best 
practices for encouraging partnerships between the 
Federal Government, States, and private entities to 
expand outreach for and the adoption of certified 
EHR technology in communities with a high propor-
tion of individuals from racial and ethnic minority 
groups (as so defined), while also maintaining the 
accessibility requirements of section 508 of the Re-
habilitation Act to encourage patient involvement in 
their own health care. The National Coordinator 
shall— 
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‘‘(i) not later than 6 months after the 
submission to the Congress of the report 
required by section 832 of the Health Eq-
uity and Accountability Act of 2014, estab-
lish criteria for evaluating the impact of 
health information technology on commu-
nities with a high proportion of individuals 
from racial and ethnic minority groups (as 
so defined) taking into account the find-
ings in such report; and 
‘‘(ii) not later than 12 months after 
the submission to the Congress of such re-
ports, conduct and publish the results of 
an evaluation of such impact.’’. 
Subtitle 
B—Modifications 
To 
Achieve Parity in Existing Pro-
grams 
SEC. 811. EXTENDING FUNDING TO STRENGTHEN THE 
HEALTH IT INFRASTRUCTURE IN RACIAL 
AND ETHNIC MINORITY COMMUNITIES. 
Section 3011 of the Public Health Service Act (42 
U.S.C. 300jj–31) is amended— 
(1) in subsection (a), by adding at the end the 
following new paragraph: 
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‘‘(8) Activities described in the previous para-
graphs of this subsection with respect to commu-
nities with a high proportion of individuals from ra-
cial and ethnic minority groups (as defined in sec-
tion 1707(g)).’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(e) ANNUAL REPORT
ON EXPENDITURES.—The 
National Coordinator shall report annually to the Con-
gress on activities and expenditures under this section.’’. 
SEC. 812. PRIORITIZING REGIONAL EXTENSION CENTER AS-
SISTANCE TO RACIAL AND ETHNIC MINORITY 
GROUPS. 
(a) IN GENERAL.—Section 3012(c)(4)(C) of the Pub-
lic Health Service Act (42 U.S.C. 300jj–32(c)(4)(C)) is 
amended by inserting ‘‘or individuals from racial and eth-
nic minority groups (as defined in section 1707(g))’’ after 
‘‘medically underserved individuals’’. 
(b) BIENNIAL EVALUATION.—Section 3012(c)(8) of 
such Act (42 U.S.C. 300jj–32(c)(8)) is amended— 
(1) by inserting: ‘‘Each evaluation panel shall 
include at least one consumer advocate from a racial 
and ethnic minority community served by the center 
involved, at least one patient or family caregiver, 
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ing ‘‘hospital that is a subsection (d) hospital or a sub-
section (d) Puerto Rico hospital’’. 
(b) OFFSETTING REDUCTION.—Subsection (n)(2) of 
section 1886 of the Social Security Act (42 U.S.C. 
1395ww) is amended by adding at the end the following 
new subparagraph: 
‘‘(H) 
BUDGET
NEUTRALITY
ADJUST-
MENT.—The Secretary shall reduce the applica-
ble amounts that would otherwise be deter-
mined under this subsection with respect to— 
‘‘(i) the first fiscal year to which this 
subparagraph applies by an amount that 
the Secretary estimates would ensure that 
estimated aggregate payments under this 
subsection for such fiscal year are not in-
creased as a result of the amendments 
made by subsection (a) of section 841 of 
the Health Equity and Accountability Act 
of 2014; or 
‘‘(ii) a succeeding fiscal year by an 
amount that the Secretary estimates would 
ensure that estimated aggregate payments 
under this subsection for such fiscal year 
are not increased as a result of the amend-
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ments made by subsections (a) and (c) of 
such section.’’. 
(c) CONFORMING
AMENDMENTS.—(1) Subsection 
(b)(3)(B)(ix) of such section is amended— 
(A) in subclause (I), by striking ‘‘(n)(6)(A)’’ 
and inserting ‘‘(n)(6)(B)’’; and 
(B) in subclause (II), by striking ‘‘subsection 
(d) hospital’’ and inserting ‘‘an eligible hospital’’. 
(2) Paragraphs (2) and (4)(A) of section 1853(m) of 
the Social Security Act (42 U.S.C. 1395w–23(m)) are 
each amended by striking ‘‘1886(n)(6)(A)’’ and inserting 
‘‘1886(n)(6)(B)’’. 
(d) IMPLEMENTATION.—Notwithstanding any other 
provision of law, the Secretary of Health and Human 
Services may implement the amendments made by sub-
sections (a), (b) and (c) by program instruction or other-
wise. 
(e) EFFECTIVE DATE.—The amendments made by 
this section shall apply to payments for payment years for 
fiscal years beginning after the date of the enactment of 
this Act. 
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Level 1 Cooperative Agreement (as de-
scribed in paragraph (2)). 
(B) USE OF GRANT FUNDS.—An eligible 
entity awarded a grant under this paragraph 
shall use the funds to further activities to carry 
out environmental health improvement activi-
ties, including— 
(i) addressing community environ-
mental health priorities in accordance with 
paragraph (2)(C)(ii), including— 
(I) geography; 
(II) the built environment; 
(III) air quality; 
(IV) water quality; 
(V) land use; 
(VI) solid waste; 
(VII) housing; 
(VIII) crime; 
(IX) socioeconomic status; 
(X) ethnicity, social construct 
and language preference; 
(XI) educational attainment; 
(XII) employment; 
(XIII) food safety; 
(XIV) nutrition; 
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