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non-discrimination in the quality of health care serv-
ices; 
(3) ensure that future patient record systems, 
including electronic health records, electronic med-
ical records and patient health records, have data 
code sets for racial, ethnic, and primary language 
identifiers and that such identifiers can be retrieved 
from clinical records, including records transmitted 
electronically; 
(4) improve health and health care data collec-
tion and analysis for more population groups if such 
groups can be aggregated into the minimum race 
and ethnicity categories; 
(5) provide researchers with greater access to 
racial, ethnic, and primary language data, subject to 
privacy and confidentiality regulations; and 
(6) safeguard and prevent the misuse of data 
collected under subsection (a). 
(d) COMPLIANCE WITH STANDARDS.—Data collected 
under subsection (a) shall be obtained, maintained, and 
presented (including for reporting purposes and at a min-
imum) in accordance with the 1997 Office of Management 
and Budget Standards for Maintaining, Collecting, and 
Presenting Federal Data on Race and Ethnicity. 
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(e) LANGUAGE COLLECTION STANDARDS.—Not later 
than 1 year after the date of enactment of this Act, the 
Director of the Office of Minority Health, in consultation 
with the Office for Civil Rights of the Department of 
Health and Human Services, shall develop and dissemi-
nate Standards for the Classification of Federal Data on 
Preferred Written and Spoken Language. 
(f) TECHNICAL ASSISTANCE FOR THE COLLECTION 
AND REPORTING OF DATA.— 
(1) IN GENERAL.—The Secretary may, either 
directly or through grant or contract, provide tech-
nical assistance to enable a health care provider or 
plan operating under the Medicare program to com-
ply with the requirements of this section. 
(2) TYPES
OF
ASSISTANCE.—Assistance pro-
vided 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 col-
lection and analysis including additional popu-
lation groups beyond the Office of Management 
and Budget categories if such groups can be 
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aggregated into the minimum race and ethnicity 
categories; 
(C) develop mechanisms for submitting col-
lected data subject to existing privacy and con-
fidentiality regulations; 
(D) develop educational programs to raise 
awareness that data collection and reporting by 
race, ethnicity, and preferred language are legal 
and essential for eliminating health and health 
care disparities; and 
(E) provide for the revision of existing 
HIPAA claims-related code sets to mandate the 
collection of racial and ethnicity data, and to 
provide a code set for primary language. 
(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 & 
Medicaid Services, shall— 
(1) identify appropriate quality assurance mech-
anisms to monitor for health disparities under the 
Medicare program; 
(2) specify the clinical, diagnostic, or thera-
peutic measures which should be monitored; 
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(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 
research and quality improvement purposes, in com-
pliance with applicable Federal privacy laws. 
(h) REPORT.—Not later than 2 years after the date 
of enactment of this Act, and biennially thereafter, the 
Secretary shall submit to the appropriate committees of 
Congress a report on the effectiveness of data collection, 
analysis, and reporting on race, ethnicity, and primary 
language under the programs administered through title 
XVIII of the Social Security Act. The report shall evaluate 
the progress made with respect to the plan under sub-
section (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.— 
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(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 contrac-
tors and interpreters who work for agencies 
that provide on-site interpretation, pursuant to 
which such interpreters could directly bill Medi-
care for services provided in support of physi-
cian office services for an LEP Medicare pa-
tient. 
(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-
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vided in support of physician office services for 
an LEP Medicare patient. 
(D) The feasibility of modifying the exist-
ing 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 
previous paragraph would be funded and how 
such funding would affect physician payments, 
a physician’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 
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); 
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(C) the methods and costs of providing 
language services (including the costs of pro-
viding language services with internal staff or 
through contract with external independent con-
tractors and/or agencies); 
(D) providing services for languages not 
frequently 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 So-
cial Security Act (42 U.S.C. 1395w–27(g)(1)) is amend-
ed— 
(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 lan-
guage services to limited English proficient 
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beneficiaries enrolled in the plan that are re-
quired 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 serv-
ice providers to improve effective communication between 
such providers and Medicare beneficiaries who are living 
in communities where racial and ethnic minorities, includ-
ing populations that face language barriers, are under-
served with respect to such services. The Secretary shall 
not authorize a grant larger than $500,000 over three 
years for any grantee. 
(b) ELIGIBILITY; PRIORITY.— 
(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; 
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(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 informa-
tion as the Secretary may require. 
(2) PRIORITY.— 
(A) DISTRIBUTION.—To the extent fea-
sible, in awarding grants under this section, the 
Secretary shall award— 
(i) 6 grants to providers of services 
described in paragraph (1)(A)(i); 
(ii) 6 grants to service providers de-
scribed in paragraph (1)(A)(ii); 
(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 
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that have developed partnerships with commu-
nity organizations or with agencies with experi-
ence in language access. 
(C) VARIATION IN GRANTEES.—The Sec-
retary shall also ensure that the grantees under 
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 
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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 
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 
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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 
(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-
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petent bilingual staff or competent inter-
preter or translation services which— 
(I) if the grantee operates in a 
State that has statewide health care 
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 
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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 
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; 
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(3) notify Medicare beneficiaries of their right 
to receive language services in their primary lan-
guage; 
(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. 
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(2) The languages of those Medicare bene-
ficiaries. 
(3) The types of language services provided 
(such as provision of services directly in non-English 
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: 
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(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 
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 
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