146 
this section represent, among other factors, 
variations in— 
(i) different types of service providers 
and organizations under parts A through 
D of title XVIII of the Social Security Act; 
(ii) languages needed and their fre-
quency of use; 
(iii) urban and rural settings; 
(iv) at least two geographic regions; 
and 
(v) at least two large metropolitan 
statistical areas with diverse populations. 
(c) USE OF FUNDS.— 
(1) IN GENERAL.—A grantee shall use grant 
funds received under this section to pay for the pro-
vision of competent language services to Medicare 
beneficiaries who are limited English proficient. 
Competent interpreter services may be provided 
through on-site interpretation, telephonic interpreta-
tion, or video interpretation or direct provision of 
health care or health care related services by a bilin-
gual health care provider. A grantee may use bilin-
gual providers, staff, or contract interpreters. A 
grantee may use grant funds to pay for competent 
translation services. A grantee may use up to 10 
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percent of the grant funds to pay for administrative 
costs associated with the provision of competent lan-
guage services and for reporting required under sub-
section (E). 
(2) ORGANIZATIONS.—Grantees that are part C 
organizations or PDP sponsors must ensure that 
their network providers receive at least 50 percent of 
the grant funds to pay for the provision of com-
petent language services to Medicare beneficiaries 
who are limited English proficient, including physi-
cians and pharmacies. 
(3) DETERMINATION OF PAYMENTS FOR LAN-
GUAGE SERVICES.—Payments to grantees shall be 
calculated based on the estimated numbers of LEP 
Medicare beneficiaries in a grantee’s service area 
utilizing— 
(A) data on the numbers of limited 
English 
proficient 
individuals 
who 
speak 
English less than ‘‘very well’’ from the most re-
cently available data from the Bureau of the 
Census or other State-based study the Sec-
retary determines likely to yield accurate data 
regarding the number of LEP individuals 
served by the grantee; or 
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(B) the grantee’s own data if the grantee 
routinely collects data on Medicare bene-
ficiaries’ primary language in a manner deter-
mined by the Secretary to yield accurate data 
and such data shows greater numbers of LEP 
individuals than the data listed in subparagraph 
(A). 
(4) LIMITATIONS.— 
(A) REPORTING.—Payments shall only be 
provided under this section to grantees that re-
port their costs of providing language services 
as required under subsection (e). If a grantee 
fails to provide the reports under such section 
for the first year of a grant, the Secretary may 
terminate the grant and solicit applications 
from new grantees to participate in the subse-
quent two years of the demonstration program. 
(B) TYPE OF SERVICES.— 
(i) IN
GENERAL.—Subject to clause 
(ii), payments shall be provided under this 
section only to grantees that utilize com-
petent bilingual staff or competent inter-
preter or translation services which— 
(I) if the grantee operates in a 
State that has statewide health care 
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interpreter standards, meet the State 
standards currently in effect; or 
(II) if the grantee operates in a 
State that does not have statewide 
health care interpreter standards, uti-
lizes competent interpreters who fol-
low the National Council on Inter-
preting in Health Care’s Code of Eth-
ics and Standards of Practice. 
(ii) EXEMPTIONS.—The requirements 
of clause (i) shall not apply— 
(I) in the case of a Medicare ben-
eficiary who is limited English pro-
ficient (who has been informed in the 
beneficiary’s primary language of the 
availability of free interpreter and 
translation services) and who requests 
the use of family, friends, or other 
persons untrained in interpretation or 
translation and the grantee documents 
the request in the beneficiary’s record; 
and 
(II) in the case of a medical 
emergency where the delay directly as-
sociated with obtaining a competent 
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interpreter or translation services 
would jeopardize the health of the pa-
tient. 
Nothing in clause (ii)(II) shall be con-
strued to exempt an emergency rooms or 
similar entities that regularly provide 
health care services in medical emergencies 
from having in place systems to provide 
competent interpreter and translation serv-
ices without undue delay. 
(d) ASSURANCES.—Grantees under this section 
shall— 
(1) ensure that appropriate clinical and support 
staff receive ongoing education and training in lin-
guistically appropriate service delivery; ensure the 
linguistic competence of bilingual providers; 
(2) offer and provide appropriate language serv-
ices at no additional charge to each patient with lim-
ited English proficiency at all points of contact, in 
a timely manner during all hours of operation; 
(3) notify Medicare beneficiaries of their right 
to receive language services in their primary lan-
guage; 
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(4) post signage in the languages of the com-
monly encountered group or groups present in the 
service area of the organization; and 
(5) ensure that— 
(A) primary language data are collected 
for recipients of language services; and 
(B) consistent with the privacy protections 
provided under the regulations promulgated 
pursuant to section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 
(42 U.S.C. 1320d–2 note), if the recipient of 
language services is a minor or is incapacitated, 
the primary language of the parent or legal 
guardian is collected and utilized. 
(e) REPORTING REQUIREMENTS.—Grantees under 
this section shall provide the Secretary with reports at the 
conclusion of the each year of a grant under this section. 
each report shall include at least the following informa-
tion: 
(1) The number of Medicare beneficiaries to 
whom language services are provided. 
(2) The languages of those Medicare bene-
ficiaries. 
(3) The types of language services provided 
(such as provision of services directly in non-English 
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language by a bilingual health care provider or use 
of an interpreter). 
(4) Type of interpretation (such as in-person, 
telephonic, or video interpretation). 
(5) The methods of providing language services 
(such as staff or contract with external independent 
contractors or agencies). 
(6) The length of time for each interpretation 
encounter. 
(7) The costs of providing language services 
(which may be actual or estimated, as determined by 
the Secretary). 
(f) NO COST SHARING.—LEP Beneficiaries shall not 
have to pay cost-sharing or co-pays for language services 
provided through this demonstration program. 
(g) EVALUATION AND REPORT.—The Secretary shall 
conduct an evaluation of the demonstration program 
under this section and shall submit to the appropriate 
committees of Congress a report not later than 1 year 
after the completion of the program. The report shall in-
clude the following: 
(1) An analysis of the patient outcomes and 
costs of furnishing care to the LEP Medicare bene-
ficiaries participating in the project as compared to 
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such outcomes and costs for limited English pro-
ficient Medicare beneficiaries not participating. 
(2) The effect of delivering culturally and lin-
guistically appropriate services on beneficiary access 
to care, utilization of services, efficiency and cost-ef-
fectiveness of health care delivery, patient satisfac-
tion, and select health outcomes. 
(3) Recommendations regarding the extension 
of such project to the entire Medicare program. 
(h) GENERAL PROVISIONS.—Nothing in this section 
shall be construed to limit otherwise existing obligations 
of recipients of Federal financial assistance under title VI 
of the Civil Rights Act of 1964 (42 U.S.C. 2000(d) et 
seq.) or any other statute. 
(i) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$10,000,000 for each fiscal year of the demonstration. 
SEC. 234. DEMONSTRATION TO IMPROVE CARE TO PRE-
VIOUSLY UNINSURED. 
(a) ESTABLISHMENT.—Within one year after the 
date of enactment of this Act, the Secretary shall establish 
a demonstration project to determine the greatest needs 
and most effective methods of outreach to medicare bene-
ficiaries who were previously uninsured. 
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(b) SCOPE.—The demonstration shall be in no fewer 
than 10 sites, and shall include state health insurance as-
sistance programs, community health centers, community- 
based organizations, community health workers, and other 
service providers under parts A, B, and C of title XVIII 
of the Social Security Act. Grantees that are plans oper-
ating under part C shall document that enrollees who were 
previously uninsured receive the ‘‘Welcome to Medicare’’ 
physical exam. 
(c) DURATION.—The Secretary shall conduct the 
demonstration project for a period of 2 years. 
(d) REPORT AND EVALUATION.—The Secretary shall 
conduct an evaluation of the demonstration and not later 
than 1 year after the completion of the project shall sub-
mit to Congress a report including the following: 
(1) An analysis of the effectiveness of outreach 
activities targeting beneficiaries who were previously 
uninsured, such as revising outreach and enrollment 
materials (including the potential for use of video in-
formation), providing one-on-one counseling, working 
with community health workers, and amending the 
Medicare and You handbook. 
(2) The effect of such outreach on beneficiary 
access to care, utilization of services, efficiency and 
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cost-effectiveness of health care delivery, patient sat-
isfaction, and select health outcomes. 
SEC. 235. OFFICE OF THE INSPECTOR GENERAL REPORT 
ON COMPLIANCE WITH AND ENFORCEMENT 
OF NATIONAL STANDARDS ON CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES (CLAS) IN MEDICARE. 
(a) REPORT.—Not later than two years after the date 
of the enactment of this Act, the Inspector General of the 
Department of Health and Human Services shall prepare 
and publish a report on— 
(1) the extent to which Medicare providers and 
plans are complying with the Office for Civil Rights’ 
Guidance to Federal Financial Assistance Recipients 
Regarding Title VI Prohibition Against National Or-
igin Discrimination Affecting Limited English Pro-
ficient Persons and the Office of Minority Health’s 
Culturally and Linguistically Appropriate Services 
Standards in health care; and 
(2) a description of the costs associated with or 
savings related to the provision of language services. 
Such report shall include recommendations on improving 
compliance with CLAS Standards and recommendations 
on improving enforcement of CLAS Standards. 
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(b) IMPLEMENTATION.—Not later than one year 
after the date of publication of the report under subsection 
(a), the Department of Health and Human Services shall 
implement changes responsive to any deficiencies identi-
fied in the report. 
SEC. 236. IOM REPORT ON IMPACT OF LANGUAGE ACCESS 
SERVICES. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services shall seek to enter into an arrangement 
with the Institute of under which the Institute will prepare 
and publish, not later than 3 years after the date of the 
enactment of this Act, a report on the impact of language 
access services on the health and health care of limited 
English proficient populations. 
(b) CONTENTS.—Such report shall include— 
(1) recommendations on the development and 
implementation of policies and practices by health 
care organizations and providers for limited English 
proficient patient populations; 
(2) a description of the effect of providing lan-
guage access services on quality of health care and 
access to care and reduced medical error; and 
(3) a description of the costs associated with or 
savings related to provision of language access serv-
ices. 
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SEC. 237. DEFINITIONS. 
In this subtitle: 
(1) BILINGUAL.—The term ‘‘bilingual’’ with re-
spect to an individual means a person who has suffi-
cient degree of proficiency in two languages and can 
ensure effective communication can occur in both 
languages. 
(2) COMPETENT INTERPRETER SERVICES.—The 
term ‘‘competent interpreter services’’ means a 
trans-language rendition of a spoken message in 
which the interpreter comprehends the source lan-
guage and can speak comprehensively in the target 
language to convey the meaning intended in the 
source language. The interpreter knows health and 
health-related terminology and provides accurate in-
terpretations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source message. 
(3) COMPETENT TRANSLATION SERVICES.—The 
term ‘‘competent translation services’’ means a 
trans-language rendition of a written document in 
which the translator comprehends the source lan-
guage and can write comprehensively in the target 
language to convey the meaning intended in the 
source language. The translator knows health and 
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health-related terminology and provides accurate 
translations by choosing equivalent expressions that 
convey the best matching and meaning to the source 
language and captures, to the greatest possible ex-
tent, all nuances intended in the source document. 
(4) EFFECTIVE
COMMUNICATION.—The term 
‘‘effective communication’’ means an exchange of in-
formation between the provider of health care or 
health care-related services and the limited English 
proficient recipient of such services that enables lim-
ited English proficient individuals to access, under-
stand, and benefit from health care or health care- 
related services. 
(5) 
INTERPRETING/INTERPRETATION.—The 
terms ‘‘interpreting’’ and ‘‘interpretation’’ mean the 
transmission of a spoken message from one language 
into another, faithfully, accurately, and objectively. 
(6) 
HEALTH
CARE
SERVICES.—The 
term 
‘‘health care services’’ means services that address 
physical as well as mental health conditions in all 
care settings. 
(7) HEALTH
CARE-RELATED
SERVICES.—The 
term ‘‘health care-related services’’ means human or 
social services programs or activities that provide ac-
cess, referrals or links to health care. 
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(8) LANGUAGE ACCESS.—The term ‘‘language 
access’’ means the provision of language services to 
an LEP individual designed to enhance that individ-
ual’s access to, understanding of or benefit from 
health care or health care-related services. 
(9) LANGUAGE
SERVICES.—The term ‘‘lan-
guage services’’ means provision of health care serv-
ices directly in a non-English language, interpreta-
tion, translation, and non-English signage. 
(10) LIMITED
ENGLISH
PROFICIENT.—The 
term ‘‘limited English proficient’’ or ‘‘LEP’’ with re-
spect to an individual means an individual who 
speaks a primary language other than English and 
who cannot speak, read, write or understand the 
English language at a level that permits the indi-
vidual to effectively communicate with clinical or 
nonclinical staff at an entity providing health care or 
health care related services. 
(11) MEDICARE PROGRAM.—The term ‘‘Medi-
care program’’ means the programs under parts A 
through D of title XVIII of the Social Security Act. 
(12) SERVICE PROVIDER.—The term ‘‘service 
provider’’ includes all suppliers, providers of services, 
or entities under contract to provide coverage, items 
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or services under any part of title XVIII of the So-
cial Security Act. 
TITLE III—PHYSICIANS’ SERVICE 
PAYMENT REFORM 
SEC. 301. ESTABLISHMENT OF SEPARATE TARGET GROWTH 
RATES FOR SERVICE CATEGORIES. 
(a) ESTABLISHMENT
OF SERVICE CATEGORIES.— 
Subsection (j) of section 1848 of the Social Security Act 
(42 U.S.C. 1395w–4) is amended by adding at the end 
the following new paragraph: 
‘‘(5) SERVICE CATEGORIES.—For services fur-
nished on or after January 1, 2008, each of the fol-
lowing categories of physicians’ services shall be 
treated as a separate ‘service category’: 
‘‘(A) Evaluation and management services 
for primary care (including new and established 
patient office visits delivered by physicians who 
the Secretary determines provide accessible, 
continuous, coordinated, and comprehensive 
care for Medicare beneficiaries, emergency de-
partment visits, and home visits), and for pre-
ventive services (including screening mammog-
raphy, colorectal cancer screening, and other 
services as defined by the Secretary, limited to 
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the recommendations of the United States Pre-
ventive Services Task Force). 
‘‘(B) Evaluation and management services 
not described in subparagraph (A). 
‘‘(C) Imaging services (as defined in sub-
section (b)(4)(B)) and diagnostic tests (other 
than clinical diagnostic laboratory tests) not de-
scribed in subparagraph (A). 
‘‘(D) Procedures that are subject (under 
regulations promulgated to carry out this sec-
tion) to a 10-day or 90-day global period (in 
this paragraph referred to as ‘major proce-
dures’), except that the Secretary may reclas-
sify as minor procedures under subparagraph 
(F) any procedures that would otherwise be in-
cluded in this category if the Secretary deter-
mines that such procedures are not major pro-
cedures. 
‘‘(E) Anesthesia services that are paid on 
the basis of the separate conversion factor for 
anesthesia services determined under subsection 
(d)(1)(D). 
‘‘(F) Minor procedures and any other phy-
sicians’ services that are not described in a pre-
ceding subparagraph.’’. 
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