135 
(f) TECHNICAL ASSISTANCE
FOR
THE COLLECTION 
AND REPORTING OF DATA.— 
(1) IN GENERAL.—The Secretary may, either di-
rectly or through grant or contract, provide technical 
assistance to enable a health care provider or plan op-
erating under the Medicare program to comply with 
the requirements of this section. 
(2) TYPES OF ASSISTANCE.—Assistance provided 
under this subsection may include assistance to— 
(A) enhance or upgrade computer tech-
nology that will facilitate racial, ethnic, and pri-
mary language data collection and analysis; 
(B) improve methods for health data collec-
tion and analysis including additional popu-
lation groups beyond the Office of Management 
and Budget categories if such groups can be ag-
gregated into the minimum race and ethnicity 
categories; 
(C) develop mechanisms for submitting col-
lected data subject to existing privacy and con-
fidentiality regulations; and 
(D) develop educational programs to raise 
awareness that data collection and reporting by 
race, ethnicity, and preferred language are legal 
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136 
and essential for eliminating health and health 
care disparities. 
(g) ANALYSIS OF RACIAL AND ETHNIC DATA.—The 
Secretary, acting through the Director of the Agency for 
Health Care Research and Quality and in coordination 
with the Administrator of the Centers for Medicare & Med-
icaid Services, shall— 
(1) identify appropriate quality assurance mech-
anisms to monitor for health disparities under the 
Medicare program; 
(2) specify the clinical, diagnostic, or therapeutic 
measures which should be monitored; 
(3) develop new quality measures relating to ra-
cial and ethnic disparities in health and health care; 
(4) identify the level at which data analysis 
should be conducted; and 
(5) share data with external organizations for re-
search and quality improvement purposes, in compli-
ance with applicable Federal privacy laws. 
(h) REPORT.—Not later than 2 years after the date 
of enactment of this Act, and biennially thereafter, the Sec-
retary shall submit to the appropriate committees of Con-
gress a report on the effectiveness of data collection, anal-
ysis, and reporting on race, ethnicity, and primary lan-
guage under the programs administered through title XVIII 
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137 
of the Social Security Act. The report shall evaluate the 
progress made with respect to the plan under subsection (c) 
or subsequent revisions thereto. 
(i) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated to carry out this section, such 
sums as may be necessary for each of fiscal years 2008 
through 2012. 
SEC. 232. ENSURING EFFECTIVE COMMUNICATION IN MEDI-
CARE. 
(a) ENSURING EFFECTIVE COMMUNICATION BY THE 
CENTERS FOR MEDICARE & MEDICAID SERVICES.— 
(1) STUDY ON MEDICARE PAYMENTS FOR LAN-
GUAGE
SERVICES.—The Secretary of Health and 
Human Services shall conduct a study that examines 
ways that Medicare should develop payment systems 
for language services using the results of the dem-
onstration program conducted under section 233. 
(2) ANALYSES.—The study shall include an 
analysis of each of the following: 
(A) How to develop and structure appro-
priate payment systems for language services for 
all Medicare service providers. 
(B) The feasibility of adopting a payment 
methodology for on-site interpreters, including 
interpreters who work as independent contractors 
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138 
and interpreters who work for agencies that pro-
vide on-site interpretation, pursuant to which 
such interpreters could directly bill Medicare for 
services provided in support of physician office 
services for an LEP Medicare patient. 
(C) The feasibility of Medicare contracting 
directly with agencies that provide off-site inter-
pretation including telephonic and video inter-
pretation pursuant to which such contractors 
could directly bill Medicare for the services pro-
vided in support of physician office services for 
an LEP Medicare patient. 
(D) The feasibility of modifying the existing 
Medicare resource-based relative value scale 
(RBRVS) by using adjustments (such as multi-
pliers or add-ons) when a patient is LEP. 
(E) How each of options described in a pre-
vious paragraph would be funded and how such 
funding would affect physician payments, a phy-
sician’s practice, and beneficiary cost-sharing. 
(3) 
VARIATION
IN
PAYMENT
SYSTEM
DE-
SCRIBED.—The payment systems described in sub-
section (b) may allow variations based upon types of 
service providers, available delivery methods, and 
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139 
costs for providing language services including such 
factors as— 
(A) the type of language services provided 
(such as provision of health care or health care 
related services directly in a non-English lan-
guage by a bilingual provider or use of an inter-
preter); 
(B) type of interpretation services provided 
(such as in-person, telephonic, video interpreta-
tion); 
(C) the methods and costs of providing lan-
guage services (including the costs of providing 
language services with internal staff or through 
contract with external independent contractors 
and/or agencies); 
(D) providing services for languages not fre-
quently encountered in the United States; and 
(E) providing services in rural areas. 
(4) REPORT.—The Secretary shall submit a re-
port on the study conducted under subsection (a) to 
appropriate committees of Congress not later than 1 
year after the expiration of the demonstration pro-
gram conducted under section 3. 
(b) HEALTH PLANS.—Section 1857(g)(1) of the Social 
Security Act (42 U.S.C. 1395w–27(g)(1)) is amended— 
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140 
(1) by striking ‘‘or’’ at the end of subparagraph 
(F); 
(2) by adding ‘‘or’’ at the end of subparagraph 
(G); and 
(3) by inserting after subparagraph (G) the fol-
lowing new subparagraph: 
‘‘(H) fails substantially to provide language 
services to limited English proficient bene-
ficiaries enrolled in the plan that are required 
under law;’’. 
SEC. 233. DEMONSTRATION TO PROMOTE ACCESS FOR 
MEDICARE 
BENEFICIARIES 
WITH 
LIMITED 
ENGLISH PROFICIENCY BY PROVIDING REIM-
BURSEMENT FOR CULTURALLY AND LINGUIS-
TICALLY APPROPRIATE SERVICES. 
(a) IN GENERAL.—Within one year after the date of 
the enactment of this Act the Secretary, acting through the 
Centers for Medicare & Medicaid Services, shall award 24 
3-year demonstration grants to eligible Medicare service 
providers to improve effective communication between such 
providers and Medicare beneficiaries who are limited 
English proficient. The Secretary shall not authorize a 
grant larger than $500,000 over three years for any grantee. 
(b) ELIGIBILITY; PRIORITY.— 
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141 
(1) ELIGIBILITY.—To be eligible to receive a 
grant under subsection (1) an entity shall— 
(A) be— 
(i) a provider of services under part A 
of title XVIII of the Social Security Act; 
(ii) a service provider under part B of 
such title; 
(iii) a part C organization offering a 
Medicare part C plan under part C of such 
title; or 
(iv) a PDP sponsor of a prescription 
drug plan under part D of such title; and 
(B) prepare and submit to the Secretary an 
application, at such time, in such manner, and 
accompanied by such additional information as 
the Secretary may require. 
(2) PRIORITY.— 
(A) DISTRIBUTION.—To the extent feasible, 
in awarding grants under this section, the Sec-
retary shall award— 
(i) 6 grants to providers of services de-
scribed in paragraph (1)(A)(i); 
(ii) 6 grants to service providers de-
scribed in paragraph (1)(A)(ii); 
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142 
(iii) 6 grants to organizations de-
scribed in paragraph (1)(A)(iii); and 
(iv) 6 grants to sponsors described in 
paragraph (1)(A)(iv). 
(B) FOR COMMUNITY ORGANIZATIONS.—The 
Secretary shall give priority to applicants that 
have developed partnerships with community or-
ganizations or with agencies with experience in 
language access. 
(C) VARIATION
IN
GRANTEES.—The Sec-
retary shall also ensure that the grantees under 
this section represent, among other factors, vari-
ations 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 sta-
tistical areas with diverse populations. 
(c) USE OF FUNDS.— 
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143 
(1) IN
GENERAL.—A grantee shall use grant 
funds received under this section to pay for the provi-
sion of competent language services to Medicare bene-
ficiaries who are limited English proficient. Com-
petent interpreter services may be provided through 
on-site interpretation, telephonic interpretation, or 
video interpretation or direct provision of health care 
or health care related services by a bilingual health 
care provider. A grantee may use bilingual providers, 
staff, or contract interpreters. A grantee may use 
grant funds to pay for competent translation services. 
A grantee may use up to 10 percent of the grant 
funds to pay for administrative costs associated with 
the provision of competent language services and for 
reporting required under subsection (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 competent lan-
guage services to Medicare beneficiaries who are lim-
ited English proficient, including physicians and 
pharmacies. 
(3) DETERMINATION
OF
PAYMENTS
FOR
LAN-
GUAGE SERVICES.—Payments to grantees shall be cal-
culated based on the estimated numbers of LEP Medi-
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