I 
118TH CONGRESS 
2D SESSION 
H. R. 9161 
To improve the health of minority individuals, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 25, 2024 
Ms. LEE of California (for herself, Ms. CHU, Ms. BARRAGA´N, Mr. HORSFORD, 
Ms. TOKUDA, Ms. PRESSLEY, Ms. GARCIA of Texas, Mrs. FOUSHEE, Mr. 
TAKANO, Mr. KRISHNAMOORTHI, Mr. THANEDAR, Mrs. WATSON COLE-
MAN, Mrs. CHERFILUS-MCCORMICK, Ms. BONAMICI, Ms. VELA´ZQUEZ, 
Ms. SEWELL, Mr. GRIJALVA, Ms. MATSUI, Ms. WILSON of Florida, Mrs. 
NAPOLITANO, Mrs. HAYES, Mrs. RAMIREZ, Mr. GOLDMAN of New York, 
Mr. GOMEZ, Mr. GARCI´A of Illinois, Ms. MENG, Ms. KELLY of Illinois, 
Ms. BLUNT ROCHESTER, Ms. CLARKE of New York, Ms. MOORE of Wis-
consin, Ms. NORTON, Ms. BROWN, Mr. CA´RDENAS, Ms. STRICKLAND, Mr. 
SOTO, and Mr. SCHIFF) introduced the following bill; which was referred 
to the Committee on Energy and Commerce, and in addition to the Com-
mittees on Ways and Means, Agriculture, Oversight and Accountability, 
Education and the Workforce, the Judiciary, the Budget, Veterans’ Af-
fairs, Natural Resources, Armed Services, Homeland Security, Financial 
Services, and Transportation and Infrastructure, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To improve the health of minority individuals, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Accountability Act of 2024’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—DATA COLLECTION AND REPORTING 
Sec. 1001. Strengthening data collection, improving data analysis, and expand-
ing data reporting. 
Sec. 1002. Elimination of prerequisite of direct appropriations for data collec-
tion and analysis. 
Sec. 1003. Collection of data for the Medicare program. 
Sec. 1004. Revision of HIPAA claims standards. 
Sec. 1005. National Center for Health Statistics. 
Sec. 1006. Disparities data collected by the Federal Government. 
Sec. 1007. Data collection and analysis grants to minority-serving institutions. 
Sec. 1008. Safety and effectiveness of drugs with respect to racial and ethnic 
background. 
Sec. 1009. Improving health data regarding Native Hawaiians and Pacific Is-
landers. 
Sec. 1010. Clarification of simplified administrative reporting requirement. 
Sec. 1011. Data collection regarding pandemic preparedness, testing, infections, 
and deaths. 
Sec. 1012. Commission on Ensuring Data for Health Equity. 
Sec. 1013. Task Force on Preventing Bias in AI and Algorithms. 
Sec. 1014. Report on the health of the Middle Eastern and North African pop-
ulation. 
TITLE II—CULTURALLY AND LINGUISTICALLY APPROPRIATE 
HEALTH AND HEALTH CARE 
Sec. 2001. Definitions. 
Sec. 2002. Improving access to services for individuals with limited English 
proficiency. 
Sec. 2003. Ensuring standards for culturally and linguistically appropriate 
services in health care. 
Sec. 2004. Culturally and linguistically appropriate health care in the Public 
Health Service Act. 
Sec. 2005. Pilot program for improvement and development of State medical 
interpreting services. 
Sec. 2006. Training tomorrow’s doctors for culturally and linguistically appro-
priate care: graduate medical education. 
Sec. 2007. Federal reimbursement for culturally and linguistically appropriate 
services under the Medicare, Medicaid, and State Children’s 
Health Insurance Programs. 
Sec. 2008. Increasing understanding of and improving health literacy. 
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Sec. 2009. Requirements for health programs or activities receiving Federal 
funds. 
Sec. 2010. Report on Federal efforts to provide culturally and linguistically ap-
propriate health care services. 
Sec. 2011. English instruction for individuals with limited English proficiency. 
Sec. 2012. Implementation. 
Sec. 2013. Language access services. 
Sec. 2014. Medically underserved populations. 
TITLE III—HEALTH WORKFORCE DIVERSITY 
Sec. 3001. Amendment to the Public Health Service Act. 
Sec. 3002. Hispanic-serving institutions, historically Black colleges and univer-
sities, historically Black professional or graduate institutions, 
Asian American and Native American Pacific Islander-serving 
institutions, Tribal Colleges, regional community-based organi-
zations, and national minority medical associations. 
Sec. 3003. Loan repayment program of Centers for Disease Control and Pre-
vention. 
Sec. 3004. Cooperative agreements for online degree programs at schools of 
public health and schools of allied health. 
Sec. 3005. National Health Care Workforce Commission. 
Sec. 3006. Scholarship and fellowship programs. 
Sec. 3007. McNair Postbaccalaureate Achievement Program. 
Sec. 3008. Rules for determination of full-time equivalent residents for cost-re-
porting periods. 
Sec. 3009. Developing and implementing strategies for local health equity. 
Sec. 3010. Health Professions Workforce Fund. 
Sec. 3011. Future advancement of academic nursing. 
Sec. 3012. Sense of Congress relating to graduate medical education. 
Sec. 3013. Career support for skilled, internationally educated health profes-
sionals. 
Sec. 3014. Study and report on strategies for increasing diversity. 
Sec. 3015. Conrad State 30 program; physician retention. 
Sec. 3016. Grants for schools of medicine and schools of osteopathic medicine 
in underserved areas. 
TITLE IV—IMPROVING HEALTH CARE ACCESS AND QUALITY 
Sec. 4000. Definition. 
Subtitle A—Reducing Barriers to Accessing Care 
Sec. 4001. Protecting protected areas. 
Sec. 4002. Repeal of requirement for documentation evidencing citizenship or 
nationality under the Medicaid program. 
Sec. 4003. LIFT the BAR Act. 
Sec. 4004. Improve affordability and reduce premium costs of health insurance 
for consumers. 
Sec. 4005. Removing citizenship and immigration barriers to access to afford-
able health care under the ACA. 
Sec. 4006. HEAL for Immigrant Families Act. 
Sec. 4007. Study on the uninsured. 
Sec. 4008. Medicaid fallback coverage program for low-income adults in non- 
expansion States. 
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Sec. 4009. Increase and extension of temporary enhanced FMAP for States 
which begin to expend amounts for certain mandatory individ-
uals. 
Subtitle B—Improvement of Coverage 
Sec. 4101. Medicaid in the territories. 
Sec. 4102. Extension of the Supplemental Security Income Program to Puerto 
Rico, the United States Virgin Islands, Guam, and American 
Samoa. 
Sec. 4103. Extension of Medicare secondary payer. 
Sec. 4104. Indian defined in title I of the Patient Protection and Affordable 
Care Act. 
Sec. 4105. Removing Medicare barrier to health care. 
Sec. 4106. Lowering Medicare premiums and prescription drug costs. 
Sec. 4107. Reducing cost-sharing, aligning income and resource eligibility tests, 
simplifying enrollment, and other program improvements for 
low-income beneficiaries. 
Sec. 4108. 100 percent FMAP for medical assistance provided by urban Indian 
organizations. 
Sec. 4109. 100 percent FMAP for medical assistance provided to a Native Ha-
waiian through a federally qualified health center or a Native 
Hawaiian health care system under the Medicaid program. 
Sec. 4110. Repeal of requirement for estate recovery under the Medicaid pro-
gram. 
Sec. 4111. Allow for suspension of Medicare benefits and premium liability for 
individuals who are incarcerated and provide a special enroll-
ment period around the date of release. 
Sec. 4112. Federal employee health benefits plans. 
Sec. 4113. Continuation of Medicaid income eligibility standard for pregnant 
individuals and infants. 
Subtitle C—Expansion of Access 
PART 1—GENERAL PROVISIONS 
Sec. 4201. Amendment to the Public Health Service Act. 
Sec. 4202. Border health grants. 
Sec. 4203. Critical access hospital improvements. 
Sec. 4204. Medicare remote monitoring pilot projects. 
Sec. 4205. Community health center collaborative access expansion. 
Sec. 4206. Facilitating the provision of telehealth services across State lines. 
Sec. 4207. Scoring of preventive health savings. 
Sec. 4208. Sense of Congress on maintenance of effort provisions regarding 
children’s health. 
Sec. 4209. Protection of the HHS Offices of Minority Health. 
Sec. 4210. Office of Minority Health in Veterans Health Administration of De-
partment of Veterans Affairs. 
Sec. 4211. Study of DSH payments to ensure hospital access for low-income 
patients. 
Sec. 4212. Reauthorization of programs under the Native Hawaiian Health 
Care Improvement Act. 
PART 2—RURAL 
Sec. 4221. Establishment of Rural Community Hospital (RCH) Program. 
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Sec. 4222. Rural Health Quality Advisory Commission and demonstration 
projects. 
Sec. 4223. Rural health care services. 
PART 3—INDIAN COMMUNITIES 
Sec. 4231. Assistant Secretary of the Indian Health Service. 
Sec. 4232. Extension of full Federal medical assistance percentage to Indian 
health care providers. 
Sec. 4233. Conferring with urban Indian organizations. 
PART 4—PROVIDERS 
Sec. 4241. Availability of non-English language speaking providers. 
Sec. 4242. Access to essential community providers. 
Sec. 4243. Provider network adequacy in communities of color. 
PART 5—DENTAL 
Sec. 4251. Improving access to dental care. 
Sec. 4252. Oral health literacy and awareness campaign. 
Sec. 4253. Ensuring Kids Have Access to Medically Necessary Dental Care 
Act. 
Subtitle D—Advancing Health Equity Through Payment and Delivery Reform 
Sec. 4301. Centers for Medicare & Medicaid Services reporting and value-based 
programs. 
Sec. 4302. Development and testing of disparity reducing delivery and payment 
models. 
Sec. 4303. Diversity in Centers for Medicare and Medicaid consultation. 
Sec. 4304. Supporting safety net and community-based providers to compete in 
value-based payment systems. 
Sec. 4305. Improving access to care for Medicare and Medicaid beneficiaries. 
Subtitle E—Health Empowerment Zones 
Sec. 4401. Designation of health empowerment zones. 
Sec. 4402. Assistance to those seeking designation. 
Sec. 4403. Benefits of designation. 
Sec. 4404. Definition of Secretary. 
Sec. 4405. Authorization of appropriations. 
Subtitle F—Equitable Health Care for All 
Sec. 4501. Data collection and reporting. 
Sec. 4502. Requiring equitable health care in the hospital value-based pur-
chasing program. 
Sec. 4503. Provision of inequitable health care as a basis for permissive exclu-
sion from Medicare and State health care programs. 
Sec. 4504. Office for Civil Rights and Health Equity of the Department of 
Health and Human Services. 
Sec. 4505. Prohibiting discrimination in health care. 
Sec. 4506. Federal Health Equity Commission. 
Sec. 4507. Grants for hospitals to promote equitable health care and outcomes. 
Subtitle G—Investing in Equity 
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Sec. 4601. Definitions. 
Sec. 4602. Strategy to incentivize health equity. 
Sec. 4603. Pay for Equity Advisory Council. 
TITLE V—IMPROVING HEALTH OUTCOMES FOR WOMEN, 
GENDER-DIVERSE PEOPLE, CHILDREN, AND FAMILIES 
Subtitle A—Underserved Communities 
Sec. 5001. Grants to promote health for underserved communities. 
Subtitle B—Pregnancy Screening 
Sec. 5101. Pregnancy intention screening initiative demonstration program. 
Sec. 5102. Birth defects prevention, risk reduction, and awareness. 
Subtitle C—Pregnancy-Related Care 
Sec. 5201. Community access, resources, and empowerment for moms. 
Sec. 5202. MOMMIES. 
Sec. 5203. Social determinants for moms. 
Sec. 5204. Kira Johnson Act. 
Sec. 5205. Perinatal workforce. 
Sec. 5206. Data to Save Moms Act. 
Sec. 5207. Moms matter. 
Sec. 5208. Justice for Incarcerated Moms. 
Sec. 5209. Tech to save moms. 
Sec. 5210. IMPACT To Save Moms Act. 
Sec. 5211. Protecting moms and babies against climate change. 
Sec. 5212. Protect moms from domestic violence. 
Sec. 5213. Midwives schools and programs expansion. 
Sec. 5214. Gestational diabetes. 
Sec. 5215. Consumer education campaign. 
Sec. 5216. Bibliographic database of systematic reviews for care of childbearing 
individuals and newborns. 
Sec. 5217. Development of interprofessional maternity care educational models 
and tools. 
Sec. 5218. Dissemination of the quality family planning guidelines. 
Subtitle D—Federal Agency Coordination on Maternal Health 
Sec. 5301. Interagency Coordinating Committee on the Promotion of Optimal 
Maternity Outcomes. 
Sec. 5302. Expansion of CDC Prevention Research Centers Program to include 
Centers on Optimal Maternity Outcomes. 
Sec. 5303. Expanding models to be tested by Center for Medicare and Medicaid 
Innovation to explicitly include maternity care and children’s 
health models. 
Sec. 5304. Interagency update to the quality family planning guidelines. 
Subtitle E—Reproductive and Sexual Health 
Sec. 5401. Sense of Congress on urgent issues concerning barriers to abortion 
access and vital solutions. 
Sec. 5402. Emergency contraception education and information programs. 
Sec. 5403. Duties of pharmacies to ensure provision of FDA-approved contra-
ception. 
Sec. 5404. Real Education and Access for Healthy Youth Act. 
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Sec. 5405. Compassionate assistance for rape emergencies. 
Sec. 5406. Menstrual Equity for All Act of 2024. 
Sec. 5407. Additional focus area for the Office on Women’s Health. 
Sec. 5408. Including services furnished by certain students, interns, and resi-
dents supervised by certified nurse midwives or certified mid-
wives within inpatient hospital services under Medicare. 
Sec. 5409. Grants to professional organizations and minority-serving institu-
tions to increase diversity in maternal, reproductive, and sexual 
health professionals. 
Subtitle F—Children’s Health 
Sec. 5501. CARING for Kids Act. 
Sec. 5502. End Diaper Need Act of 2024. 
Sec. 5503. Decreasing the risk factors for sudden unexpected infant death and 
sudden unexplained death in childhood. 
Subtitle G—Elder Care 
Sec. 5601. Expenses for household and elder care services necessary for gainful 
employment. 
Subtitle H—Miscellaneous Provisions 
Sec. 5701. Clarification supporting permissible use of funds for stillbirth pre-
vention activities. 
TITLE VI—MENTAL HEALTH AND SUBSTANCE USE DISORDERS 
Sec. 6001. Sense of Congress. 
Subtitle A—Access to Care and Funding Streams 
Sec. 6101. Coverage of substance use disorder counselor services and peer sup-
port specialist services under part B of the Medicare program. 
Sec. 6102. Reauthorization of Minority Fellowship Program. 
Sec. 6103. Additional funds for National Institutes of Health. 
Sec. 6104. Additional funds for National Institute on Minority Health and 
Health Disparities. 
Sec. 6105. Grants for increasing racial and ethnic minority access to high-qual-
ity trauma support services and mental health care. 
Subtitle B—Interprofessional Care 
Sec. 6201. Health professions competencies to address racial and ethnic mental 
health inequities. 
Sec. 6202. Interprofessional health care teams for behavioral health care. 
Sec. 6203. Integrated Health Care Demonstration Program. 
Subtitle C—Workforce Development 
Sec. 6301. Building an effective workforce in mental health. 
Sec. 6302. Demonstration program to increase language access at eligible 
health centers. 
Sec. 6303. Health professions competencies to address racial and ethnic minor-
ity mental health disparities. 
Subtitle D—Children’s Mental Health 
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Sec. 6401. Grant programs to support pediatric behavioral health care. 
Sec. 6402. Increasing Federal investment in pediatric behavioral health serv-
ices. 
Sec. 6403. Mental health in schools. 
Sec. 6404. Additional support for youth and young adult mental health service 
provision. 
Sec. 6405. Early intervention and prevention programs for transition-age 
youth. 
Sec. 6406. Strategies to increase access to telehealth under Medicaid and Chil-
dren’s Health Insurance Program. 
Sec. 6407. Youth and young adult mental health promotion, prevention, inter-
vention, and treatment. 
Subtitle E—Community-Based Care 
Sec. 6501. Mental health at the border. 
Sec. 6502. Asian American, African American, Native Hawaiian, Pacific Is-
lander, Indigenous, Middle Eastern and North African, and 
Hispanic and Latino behavioral health outreach and education 
strategy. 
Subtitle F—Reports 
Sec. 6601. Addressing racial and ethnic minority mental health disparities re-
search gaps. 
Sec. 6602. Research on adverse health effects associated with interactions with 
law enforcement. 
Sec. 6603. GeoAccess study. 
Sec. 6604. Co-occurring conditions. 
Sec. 6605. Study and report on the AANHPI youth mental health crisis. 
Sec. 6606. Study and report on strategies on the AANHPI behavioral health 
workforce shortage. 
Subtitle G—Miscellaneous Provisions 
Sec. 6701. Strengthening mental health supports for BIPOC communities. 
Sec. 6702. STRONG support for children. 
Sec. 6703. Improving access to mental health. 
Sec. 6704. Program to establish public-private contributions to increase the 
available workforce of school-based mental health service pro-
viders. 
Sec. 6705. School social workers improving student success. 
Sec. 6706. Opioid grants to support caregivers, kinship care families, and kin-
ship caregivers. 
Sec. 6707. Substance Use and Mental Health Services Administration and sub-
agencies. 
TITLE VII—ADDRESSING HIGH-IMPACT MINORITY DISEASES 
Subtitle A—Cancer 
Sec. 7001. Lung cancer mortality reduction. 
Sec. 7002. Expansion of prostate cancer research, outreach, screening, testing, 
access, and treatment effectiveness. 
Sec. 7003. Prostate research, imaging, and men’s education. 
Sec. 7004. Prostate cancer detection research and education. 
Sec. 7005. National Prostate Cancer Council. 
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Sec. 7006. Improved Medicaid coverage for certain breast and cervical cancer 
patients in the territories. 
Sec. 7007. Cancer prevention and treatment demonstration for ethnic and ra-
cial minorities. 
Sec. 7008. Reducing cancer disparities within Medicare. 
Subtitle B—Viral Hepatitis and Liver Cancer Control and Prevention 
Sec. 7101. Biennial assessment of HHS hepatitis B and hepatitis C prevention, 
education, research, and medical management plan. 
Sec. 7102. Liver cancer and disease prevention, awareness, and patient track-
ing grants. 
Subtitle C—Acquired Bone Marrow Failure Diseases 
Sec. 7201. Acquired bone marrow failure diseases. 
Subtitle D—Cardiovascular Disease, Chronic Disease, Obesity, and Other 
Disease Issues 
Sec. 7301. Guidelines for disease screening for minority patients. 
Sec. 7302. CDC Wisewoman Screening Program. 
Sec. 7303. Report on cardiovascular care for women and minorities. 
Sec. 7304. GAO report on structural and systemic factors that perpetuate car-
diovascular disparities. 
Sec. 7305. Coverage of comprehensive tobacco cessation services in Medicaid, 
CHIP, and private health insurance. 
Sec. 7306. Clinical research funding for oral health. 
Sec. 7307. Guide on evidence-based strategies for public health department obe-
sity prevention programs. 
Sec. 7308. Stephanie Tubbs Jones Uterine Fibroid Research and Education 
Act. 
Subtitle E—HIV/AIDS 
Sec. 7401. Statement of policy. 
Sec. 7402. Additional funding for AIDS drug assistance program treatments. 
Sec. 7403. Enhancing the national HIV surveillance system. 
Sec. 7404. Evidence-based strategies for improving linkage to, and retention in, 
appropriate care. 
Sec. 7405. Improving entry into, and retention in, care and antiretroviral ad-
herence for persons with HIV. 
Sec. 7406. Services to reduce HIV/AIDS in racial and ethnic minority commu-
nities. 
Sec. 7407. Minority AIDS initiative. 
Sec. 7408. Health care professionals treating individuals with HIV. 
Sec. 7409. HIV/AIDS provider loan repayment program. 
Sec. 7410. Dental education loan repayment program. 
Sec. 7411. Reducing new HIV infections among injecting drug users. 
Sec. 7412. Report on impact of HIV/AIDS in vulnerable populations. 
Sec. 7413. National HIV/AIDS observance days. 
Sec. 7414. Review of all Federal and State laws, policies, and regulations re-
garding the criminal prosecution of individuals for HIV-related 
offenses. 
Sec. 7415. Expanding support for condoms in prisons. 
Sec. 7416. Automatic reinstatement or enrollment in Medicaid for people who 
test positive for HIV before reentering communities. 
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Sec. 7417. Stop HIV in prison. 
Sec. 7418. Transfer of funds for implementation of Ending the HIV Epidemic: 
A Plan for America. 
Sec. 7419. PrEP access and coverage. 
Subtitle F—Diabetes 
Sec. 7501. Research, treatment, and education. 
Sec. 7502. Research, education, and other activities. 
Sec. 7503. Programs to educate health providers on the causes and effects of 
diabetes in minority populations. 
Sec. 7504. Research, education, and other activities regarding diabetes in 
American Indian populations. 
Sec. 7505. Updated report on health disparities. 
Subtitle G—Lung Disease 
Sec. 7601. Asthma-related activities of the Centers for Disease Control and 
Prevention. 
Sec. 7602. Influenza and pneumonia vaccination campaign. 
Sec. 7603. Chronic obstructive pulmonary disease. 
Subtitle H—Tuberculosis 
Sec. 7701. United States Government assistance to combat tuberculosis. 
Subtitle I—Osteoarthritis and Musculoskeletal Diseases 
Sec. 7801. Osteoarthritis and other musculoskeletal health-related activities of 
the Centers for Disease Control and Prevention. 
Sec. 7802. Grants for comprehensive osteoarthritis and musculoskeletal disease 
health education within health professions schools. 
Subtitle J—Sleep and Circadian Rhythm Disorders 
Sec. 7901. Sleep and circadian rhythm disorders research activities of the Na-
tional Institutes of Health. 
Sec. 7902. Sleep and circadian rhythm health disparities-related activities of 
the Centers for Disease Control and Prevention. 
Sec. 7903. Grants for comprehensive sleep and circadian health education with-
in health professions schools. 
Sec. 7904. Report on impact of sleep and circadian health disorders in vulner-
able and racial/ethnic populations. 
Subtitle K—Kidney Disease Research, Surveillance, Prevention, and 
Treatment 
Sec. 7901A. Kidney disease research in minority populations. 
Sec. 7901A–1. Kidney disease action plan. 
Sec. 7901A–2. Providing for staff-assisted home dialysis for certain hemo-
dialysis and peritoneal dialysis patients. 
Sec. 7901A–3. Increasing kidney transplants in minority populations. 
Sec. 7901A–4. Environmental and occupational health programs. 
Sec. 7901A–5. Understanding the treatment patterns associated with providing 
care and treatment of kidney failure in minority populations. 
Sec. 7901A–6. Encouraging kidney care workforce in under served areas. 
Sec. 7901A–7. The Jack Reynolds Memorial Medigap Expansion Act; Medigap 
coverage for beneficiaries with end-stage renal disease. 
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Subtitle L—Diversity in Clinical Trials 
Sec. 7901B. FDA review of clinical trial best practices. 
Sec. 7901B–1. Diversifying Investigations Via Equitable Research Studies for 
Everyone Trials Act. 
Sec. 7901B–2. Clinical trial diversity. 
Sec. 7901B–3. Patient experience data. 
Subtitle M—Additional Provisions Addressing High-Impact Minority Diseases 
Sec. 7901C. Medicare coverage of multi-cancer early detection screening tests. 
Sec. 7901C–1. Amputation Reduction and Compassion Act. 
Sec. 7901C–2. Eliminating the coinsurance requirement for certain colorectal 
cancer screening tests furnished under the Medicare program. 
Sec. 7901C–3. Expanding the availability of medical nutrition therapy services 
under the Medicare program. 
Sec. 7901C–4. Encouraging the development and use of DISARM antimicrobial 
drugs. 
Sec. 7901C–5. Treat and Reduce Obesity Act. 
Sec. 7901C–6. Incentives, improvements, and outreach to increase diversity in 
Alzheimer’s disease research. 
TITLE VIII—HEALTH INFORMATION TECHNOLOGY 
Sec. 8001. Definitions. 
Subtitle A—Reducing Health Disparities Through Health IT 
Sec. 8101. HRSA assistance to health centers for promotion of Health IT. 
Sec. 8102. Assessment of impact of Health IT on racial and ethnic minority 
communities; outreach and adoption of Health IT in such com-
munities. 
Sec. 8103. Nondiscrimination and health equity in health information tech-
nology. 
Sec. 8104. Language access in health information technology. 
Subtitle B—Modifications To Achieve Parity in Existing Programs 
Sec. 8201. Extending funding to strengthen the Health IT infrastructure in ra-
cial and ethnic minority communities. 
Sec. 8202. Extending competitive grants for the development of loan programs 
to facilitate adoption of certified EHR technology by providers 
serving racial and ethnic minority groups. 
Sec. 8203. Authorization of appropriations. 
Subtitle C—Additional Research and Studies 
Sec. 8301. Data collection and assessments conducted in coordination with mi-
nority-serving institutions. 
Sec. 8302. Study of health information technology in medically underserved 
communities. 
Sec. 8303. Assessment of use and misuse of de-identified health data. 
Subtitle D—Closing Gaps in Funding To Adopt Certified EHRs 
Sec. 8401. Extending Medicaid EHR incentive payments to rehabilitation facili-
ties, long-term care facilities, and home health agencies. 
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Sec. 8402. Extending physician assistant eligibility for Medicaid electronic 
health record incentive payments. 
Subtitle E—Expanding Access to Telehealth Services 
Sec. 8501. Removing geographic requirements for telehealth services. 
Sec. 8502. Expanding originating sites. 
TITLE IX—ACCOUNTABILITY AND EVALUATION 
Sec. 9001. Prohibition on discrimination in Federal assisted health care serv-
ices and research on the basis of sex (including sexual orienta-
tion, gender identity, and pregnancy, including termination of 
pregnancy), race, color, national origin, marital status, familial 
status, or disability status. 
Sec. 9002. Treatment of Medicare payments under title VI of the Civil Rights 
Act of 1964. 
Sec. 9003. Accountability and transparency within the Department of Health 
and Human Services. 
Sec. 9004. United States Commission on Civil Rights. 
Sec. 9005. Sense of Congress concerning full funding of activities to eliminate 
racial and ethnic health disparities. 
Sec. 9006. GAO and NIH reports. 
Sec. 9007. Investigative and enforcement actions. 
Sec. 9008. Federal Health Equity Commission. 
TITLE X—ADDRESSING SOCIAL DETERMINANTS AND IMPROVING 
ENVIRONMENTAL JUSTICE 
Subtitle A—In General 
Sec. 10001. Definitions. 
Sec. 10002. Health impact assessments. 
Sec. 10003. Grant program to conduct environmental health improvement ac-
tivities and to improve social determinants of health. 
Sec. 10004. Additional research on the relationship between the built environ-
ment and the health of community residents. 
Sec. 10005. Environment and public health restoration. 
Sec. 10006. GAO report on health effects of Deepwater Horizon oil rig explo-
sion in the Gulf Coast. 
Sec. 10007. Establish an interagency council and grant programs on social de-
terminants of health. 
Sec. 10008. Correcting Hurtful and Alienating Names in Government Expres-
sion (CHANGE). 
Sec. 10009. Andrew Kearse Accountability for Denial of Medical Care. 
Sec. 10010. Investing in community healing. 
Sec. 10011. Environmental justice mapping and data collection. 
Sec. 10012. Antiracism in public health. 
Sec. 10013. LGBTQ essential data. 
Sec. 10014. Social determinants accelerator. 
Sec. 10015. Improving social determinants of health. 
Sec. 10016. Notification regarding SNAP for students receiving Federal work- 
study assistance. 
Subtitle B—Gun Violence 
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Sec. 10101. Reaffirming research authority of the Centers for Disease Control 
and Prevention. 
Sec. 10102. National Violent Death Reporting System. 
Sec. 10103. Report on effects of gun violence on public health. 
Sec. 10104. Report on effects of gun violence on mental health in minority 
communities. 
Subtitle C—Nutrition for Women, Children, Families 
CHAPTER 1—SENIOR HUNGER PREVENTION 
Sec. 10201. Short title. 
Sec. 10202. Improving SNAP efficacy. 
Sec. 10203. Streamlining nutrition access for older adults and adults with dis-
abilities. 
Sec. 10204. Enrollment and outreach pilot program for older adults, kinship 
families, and adults with disabilities. 
Sec. 10205. Food delivery under supplemental nutrition assistance program. 
Sec. 10206. Commodity supplemental food program. 
Sec. 10207. Seniors farmers’ market nutrition program. 
Sec. 10208. Infrastructure funding for farmers’ markets; local procurement 
pilot program. 
CHAPTER 2—CLOSING THE MEAL GAP 
Sec. 10211. Elimination of time limit. 
Sec. 10212. Inclusion of Puerto Rico in supplemental nutritional assistance 
program. 
Subtitle D—Universal School Meals 
Sec. 10301. Short title. 
Sec. 10302. Effective date. 
CHAPTER 1—SCHOOL BREAKFAST PROGRAM 
Sec. 10311. Free school breakfast program. 
CHAPTER 2—SCHOOL LUNCH PROGRAM 
Sec. 10321. Apportionment to States. 
Sec. 10322. Nutritional and other program requirements. 
Sec. 10323. Special assistance program. 
Sec. 10324. Price for paid lunch. 
Sec. 10325. Summer food service program for children. 
Sec. 10326. Summer electronic benefit transfer for children program. 
Sec. 10327. Child and adult care food program. 
Sec. 10328. Meals and supplements for children in afterschool care. 
Sec. 10329. Pilot projects. 
Sec. 10330. Fresh fruit and vegetable program. 
Sec. 10331. Training, technical assistance, and Food Service Management In-
stitute. 
Sec. 10332. Reimbursement of school meal delinquent debt program. 
Sec. 10333. Conforming amendments. 
CHAPTER 3—ELEMENTARY AND SECONDARY EDUCATION DATA 
Sec. 10341. Measure of poverty. 
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CHAPTER 4—AMENDMENTS TO OTHER PROGRAMS AND LAWS 
Sec. 10351. Supplemental nutrition assistance program. 
Sec. 10352. Higher Education Act of 1965. 
Sec. 10353. Elementary and Secondary Education Act of 1965. 
Sec. 10354. America COMPETES Act. 
Sec. 10355. Workforce Innovation and Opportunity Act. 
Sec. 10356. National Science Foundation Authorization Act of 2002. 
Sec. 10357. Child care and development block grant. 
Sec. 10358. Children’s Health Act of 2000. 
Sec. 10359. Juvenile justice and delinquency prevention. 
TITLE I—DATA COLLECTION 
AND REPORTING 
SEC. 1001. STRENGTHENING DATA COLLECTION, IMPROV-
ING DATA ANALYSIS, AND EXPANDING DATA 
REPORTING. 
(a) AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT.— 
(1) PURPOSE.—The purpose of the amend-
ments made by this subsection is to promote cul-
turally and linguistically appropriate data collection, 
analysis, and reporting by race, ethnicity, sex, pri-
mary language, sexual orientation, disability status, 
gender identity, age, and socioeconomic status in 
federally supported health programs. 
(2) AHRQ GENERAL
AUTHORITIES.—Section 
902(a) of the Public Health Service Act (42 U.S.C. 
299a(a)) is amended— 
(A) in paragraph (8), by striking ‘‘and’’ at 
the end; 
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(B) in paragraph (9), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(10) cultural and linguistic competence of 
health care services and of data collection activities 
described under section 3101.’’. 
(3) DEFINITION OF RACIAL AND ETHNIC MI-
NORITY GROUP.— 
(A) IN GENERAL.—Section 1707(g)(1) of 
the Public Health Service Act (42 U.S.C. 
300u–6(g)(1)) is amended to read as follows: 
‘‘(1)(A) The term ‘racial and ethnic minority 
group’ means a group of individuals who are any of 
the following: 
‘‘(i) American Indian or Alaska Native. 
‘‘(ii) Asian. 
‘‘(iii) Black or African American. 
‘‘(iv) Hispanic or Latino. 
‘‘(v) Middle Eastern or North African. 
‘‘(vi) Native Hawaiian or Pacific Islander. 
‘‘(B) The terms listed in clauses (i) through (vi) 
of subparagraph (A) shall have the meanings given 
such terms for purposes of the Revisions to OMB’s 
Statistical Policy Directive No. 15: Standards for 
Maintaining, Collecting, and Presenting Federal 
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Data on Race and Ethnicity (89 Fed. Reg. 22182; 
March 29, 2024).’’. 
(B) REFERENCES.—Except as otherwise 
specified, any reference to the term ‘‘racial and 
ethnic minority group’’ in any Federal regula-
tion, guidance, order, or document for establish-
ment or implementation of any federally con-
ducted or supported health care or public health 
program, activity, or survey shall be treated as 
having the definition given to such term in sec-
tion 1707(g) of the Public Health Service Act 
(42 U.S.C. 300u–6(g)). 
(C) SIMILAR
TERMINOLOGY.—Not later 
than 2 years after the date of enactment of this 
Act, the Secretary of Health and Human Serv-
ices shall— 
(i) identify all regulations, guidance, 
orders, and documents of the Department 
of Health and Human Services for estab-
lishment or implementation of a health 
care or public health program, activity, or 
survey that use, without a definition, ter-
minology that is similar to the term ‘‘racial 
and ethnic minority group’’; and 
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(ii) take such actions as may be nec-
essary to clarify whether the definition of 
the term ‘‘racial and ethnic minority 
group’’ in section 1707(g)(1) of the Public 
Health Service Act (42 U.S.C. 300u– 
6(g)(1)), as amended by subparagraph (A), 
applies to such terminology. 
(4) OFFICE OF MINORITY HEALTH DUTIES.— 
Section 1707(b)(6) of the Public Health Service Act 
(42 U.S.C. 300u–6(b)(6)) is amended by inserting 
‘‘and, to the extent practicable, subgroups of racial 
and ethnic minority groups’’ after ‘‘the health status 
of each minority group’’. 
(5) OFFICE OF THE NATIONAL COORDINATOR 
FOR HEALTH INFORMATION TECHNOLOGY.—Section 
3001 of the Public Health Service Act (42 U.S.C. 
300jj–11) is amended— 
(A) in subsection (b)— 
(i) in paragraph (10), by striking 
‘‘and’’ at the end; 
(ii) in paragraph (11), by striking the 
period at the end and inserting ‘‘; and’’; 
and 
(iii) by adding at the end the fol-
lowing: 
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‘‘(12) ensures the interoperability of health in-
formation systems among federally conducted or 
supported health care or public health programs, 
State health agencies, and social service agencies.’’; 
and 
(B) by amending clause (vii) in subsection 
(c)(3)(A) to read as follows: 
‘‘(vii) Strategies to enhance the use of 
health information technology in improving 
the quality of health care; reducing medical 
errors; reducing health disparities and en-
suring the provision of equitable health 
services; improving public health; increas-
ing prevention and coordination with com-
munity resources; ensuring interoperability 
among federally conducted or supported 
health care or public health programs, 
State health agencies, and social service 
agencies; and improving the continuity of 
care among health care settings.’’. 
(6) DATA COLLECTION, ANALYSIS, AND QUAL-
ITY.—Section 3101 of the Public Health Service Act 
(42 U.S.C. 300kk) is amended— 
(A) in subsections (a)(1)(A), (a)(1)(C), 
(a)(2)(B), and (a)(2)(E), by striking ‘‘and dis-
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ability status’’ and inserting ‘‘sexual orienta-
tion, gender identity, age, disability status, and 
socioeconomic status’’; 
(B) in subsection (a)(1), by amending sub-
paragraph (D) to read as follows: 
‘‘(D) data for additional population groups 
if such groups can be aggregated into the data 
collection standards described under paragraph 
(2).’’; 
(C) in subsection (a)(2)— 
(i) in subparagraph (C)— 
(I) in clause (i), by striking 
‘‘and’’ at the end; 
(II) in clause (ii)— 
(aa) by striking ‘‘is a minor 
or legally incapacitated’’ and in-
serting ‘‘is a minor, requires as-
sistance with communication in 
speech or writing, or is legally in-
capacitated’’; and 
(bb) by striking the semi-
colon at the end and inserting ‘‘; 
and’’; and 
(III) by adding at the end the 
following: 
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‘‘(iii) collects data in a manner that is 
culturally and linguistically appropriate 
and does not include questions unrelated 
to, or that could potentially deter, care, 
such as questions related to immigration 
status;’’; 
(ii) in subparagraph (D)(iii), by strik-
ing ‘‘and’’ at the end; 
(iii) in subparagraph (E), by striking 
the period at the end and inserting ‘‘; 
and’’; and 
(iv) by adding at the end the fol-
lowing: 
‘‘(F) use, where practicable, the standards 
developed by the Health and Medicine Division 
of the National Academies of Sciences, Engi-
neering, and Medicine (formerly known as the 
‘Institute of Medicine’) in the 2009 publication 
titled ‘Race, Ethnicity, and Language Data: 
Standardization for Health Care Quality Im-
provement’.’’; and 
(D) in subsection (a)(3), by amending sub-
paragraph (B) to read as follows: 
‘‘(B) develop interoperability and security 
systems for data management among federally 
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conducted or supported health care or public 
health programs, State health agencies, and so-
cial service agencies.’’. 
(b) COROLLARY PROVISIONS.— 
(1) RECOMMENDATIONS BY THE DATA COUN-
CIL.—The Data Council of the Department of 
Health and Human Services, in consultation with 
the Director of the National Center for Health Sta-
tistics, the Deputy Assistant Secretary for Minority 
Health, the Deputy Assistant Secretary for Women’s 
Health, the Administrator of the Centers for Medi-
care & Medicaid, the National Coordinator for 
Health Information Technology, and other appro-
priate public and private entities and officials, shall 
make recommendations to the Secretary of Health 
and Human Services concerning how to— 
(A) implement the amendments made by 
this section, while minimizing the cost and ad-
ministrative burdens of data collection and re-
porting on all parties, including patients and 
providers; 
(B) expand awareness among Federal 
agencies, States, territories, Indian Tribes, 
counties, municipalities, health providers, health 
plans, and the general public that data collec-
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tion, analysis, and reporting by race, ethnicity, 
sex, primary language, sexual orientation, gen-
der identity, age, socioeconomic status, and dis-
ability status is legal and necessary to ensure 
equity and nondiscrimination in the quality of 
health care services; 
(C) ensure that future patient record sys-
tems follow Federal standards promulgated 
under the HITECH Act (42 U.S.C. 201 note) 
for the collection and meaningful use of elec-
tronic health data on race, ethnicity, sex, pri-
mary language, sexual orientation, gender iden-
tity, age, socioeconomic status, and disability 
status; 
(D) improve health and health care data 
collection and analysis for more population 
groups if such groups can be aggregated into 
minimum race and ethnicity categories, includ-
ing exploring the feasibility of enhancing collec-
tion efforts in States, counties, and municipali-
ties for racial and ethnic groups that comprise 
a significant proportion of the population of the 
State, county, or municipality; 
(E) provide researchers with greater access 
to racial, ethnic, primary language, sex, sexual 
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orientation, gender identity, age, socioeconomic 
status, and disability status data, subject to all 
applicable privacy and confidentiality require-
ments, including HIPAA privacy and security 
law as defined in section 3009(a) of the Public 
Health Service Act (42 U.S.C. 300jj–19(a)); 
(F) ensure the cultural and linguistic com-
petence of entities that receive Federal support 
to collect and report data pursuant to the 
amendments made by subsection (a); and 
(G) safeguard and prevent the misuse of 
data collected under section 3101 of the Public 
Health Service Act (42 U.S.C. 300kk), as 
amended by subsection (a)(6). 
(2) RULES
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to— 
(A) permit the use of information collected 
under this section or any provision amended by 
this section in a manner that would adversely 
affect any individual providing any such infor-
mation; or 
(B) diminish any requirements on health 
care providers to collect data, including such re-
quirements in effect on or after the date of en-
actment of this Act. 
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(3) TECHNICAL ASSISTANCE FOR THE ANALYSIS 
OF
HEALTH
DISPARITY
DATA.—The Secretary of 
Health and Human Services, acting through the Di-
rector of the Agency for Healthcare Research and 
Quality, and in coordination with the Assistant Sec-
retary for Planning and Evaluation, the Adminis-
trator of the Centers for Medicare & Medicaid Serv-
ices, the Director of the National Center for Health 
Statistics, the Director of the National Institutes of 
Health, and the National Coordinator for Health In-
formation Technology, shall provide technical assist-
ance to agencies of the Department of Health and 
Human Services in meeting Federal standards for 
health disparity data collection and for analysis of 
racial, ethnic, and other disparities in health and 
health care in programs conducted or supported by 
such agencies by— 
(A) identifying appropriate quality assur-
ance mechanisms to monitor for health dispari-
ties; 
(B) specifying the clinical, diagnostic, or 
therapeutic measures which should be mon-
itored; 
(C) developing new quality measures relat-
ing to racial and ethnic disparities and their 
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overlap with other disparity factors in health 
and health care; 
(D) identifying the level at which data 
analysis should be conducted; 
(E) sharing data with external organiza-
tions for research and quality improvement pur-
poses; and 
(F) identifying and addressing issues relat-
ing to the interoperability of Federal- and 
State-level health information systems which 
undermine the ability of health-related pro-
grams collecting data under this section to 
achieve the purpose described in subsection 
(a)(1). 
(4) AUTHORIZATION OF APPROPRIATIONS.—To 
carry out this subsection, subsection (a), and the 
amendments made by subsection (a), there are au-
thorized to be appropriated such sums as may be 
necessary for each of fiscal years 2025 through 
2029. 
(c) ADDITIONAL AMENDMENTS
TO
THE PUBLIC 
HEALTH SERVICE ACT.—Title XXXIV of the Public 
Health Service Act, as added by titles II and III of this 
Act, is further amended by inserting after subtitle B the 
following: 
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‘‘Subtitle 
C—Strengthening 
Data 
Collection, 
Improving 
Data 
Analysis, and Expanding Data 
Reporting 
‘‘SEC. 3431. ESTABLISHING GRANTS FOR DATA COLLECTION 
IMPROVEMENT ACTIVITIES. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Director of the Agency for Healthcare Research and 
Quality and in consultation with the Deputy Assistant 
Secretary for Minority Health, the Director of the Na-
tional Institutes of Health, the Assistant Secretary for 
Planning and Evaluation, the National Coordinator for 
Health Information Technology, and the Director of the 
National Center for Health Statistics, shall establish a 
technical assistance program under which the Secretary 
provides grants to eligible entities to assist such entities 
in complying with section 3101. 
‘‘(b) TYPES
OF ASSISTANCE.—A grant provided 
under this section may be used to— 
‘‘(1) enhance or upgrade computer technology 
that will facilitate collection, analysis, and reporting 
of racial, ethnic, primary language, sexual orienta-
tion, sex, gender identity, socioeconomic status, and 
disability status data; 
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‘‘(2) improve methods for health data collection 
and analysis, including additional population groups 
if such groups can be aggregated into the race and 
ethnicity categories outlined by standards developed 
under section 3101; 
‘‘(3) develop mechanisms for submitting col-
lected data subject to any applicable privacy and 
confidentiality regulations; 
‘‘(4) develop educational programs to inform 
health plans, health providers, health-related agen-
cies, and the general public that data collection and 
reporting by race, ethnicity, primary language, sex-
ual orientation, sex, gender identity, disability sta-
tus, and socioeconomic status are legal and essential 
for eliminating health and health care disparities; 
and 
‘‘(5) develop educational programs to train 
health providers, health care organizations, health 
plans, health-related agencies, and frontline health 
care workers on how to collect and report 
disaggregated data in a culturally and linguistically 
appropriate manner. 
‘‘(c) ELIGIBLE ENTITY.—To be eligible for grants 
under this section, an entity shall be a State, territory, 
Indian Tribe, municipality, county, health provider, health 
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care organization, or health plan making a demonstrated 
effort to bring data collections into compliance with sec-
tion 3101. 
‘‘(d) 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 
2025 through 2029. 
‘‘SEC. 
3432. 
OVERSAMPLING 
OF 
UNDERREPRESENTED 
GROUPS IN FEDERAL HEALTH SURVEYS. 
‘‘(a) NATIONAL STRATEGY.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the National Center for 
Health Statistics, and other officials within the De-
partment of Health and Human Services as the Sec-
retary determines appropriate, shall develop and im-
plement a sustainable national strategy for oversam-
pling underrepresented populations within the cat-
egories of race, ethnicity, sex, primary language, sex-
ual orientation, disability status, gender identity, 
and socioeconomic status as determined appropriate 
by the Secretary in Federal health surveys and pro-
gram data collections. Such national strategy shall 
include a strategy for oversampling of Middle East-
erners and North Africans, Asian Americans, Native 
Hawaiians, and Pacific Islanders. 
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‘‘(2) CONSULTATION.—In developing and imple-
menting a national strategy, as described in para-
graph (1), not later than 180 days after the date of 
the enactment of this section, the Secretary shall— 
‘‘(A) consult with representatives of com-
munity groups, nonprofit organizations, non-
governmental organizations, and government 
agencies working with underrepresented popu-
lations; 
‘‘(B) solicit the participation of representa-
tives from other Federal departments and agen-
cies, including subagencies of the Department 
of Health and Human Services; and 
‘‘(C) consult on, and use as models, the 
2014 National Health Interview Survey over-
sample of Native Hawaiian and Pacific Islander 
populations, the 2016 Behavioral Risk Factor 
Survey of Health Risk Behaviors Among Arab 
Adults Within the State of Michigan, and the 
2017 Behavioral Risk Factor Surveillance Sys-
tem oversample of American Indian and Alaska 
Native communities. 
‘‘(b) PROGRESS REPORT.—Not later than 2 years 
after the date of enactment of this section, the Secretary 
shall submit to the Congress a progress report, which shall 
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include the national strategy required by subsection 
(a)(1). 
‘‘(c) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
priated such sums as may be necessary for each of fiscal 
years 2025 through 2029.’’. 
(d) REPORT TO CONGRESS.—Not later than 2 years 
after the date of enactment of this Act, the Secretary of 
Health and Human Services shall submit a report to Con-
gress on the implementation of this section, including the 
amendments made by this section. 
SEC. 1002. ELIMINATION OF PREREQUISITE OF DIRECT AP-
PROPRIATIONS FOR DATA COLLECTION AND 
ANALYSIS. 
Section 3101 of the Public Health Service Act (42 
U.S.C. 300kk), as amended by section 1001(a), is further 
amended— 
(1) by striking subsection (h); and 
(2) by redesignating subsection (i) as subsection 
(h). 
SEC. 1003. COLLECTION OF DATA FOR THE MEDICARE PRO-
GRAM. 
Part A of title XI of the Social Security Act (42 
U.S.C. 1301 et seq.) is amended by adding at the end 
the following: 
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‘‘COLLECTION OF DATA FOR THE MEDICARE PROGRAM 
‘‘SEC. 1150D. 
‘‘(a) REQUIREMENT.— 
‘‘(1) IN GENERAL.—The Commissioner of So-
cial Security (in this section referred to as the ‘Com-
missioner’), in consultation with the Administrator 
of the Centers for Medicare & Medicaid Services (in 
this section referred to as the ‘Administrator’), shall 
collect data on the race, ethnicity, sex, primary lan-
guage, sexual orientation, gender identity, socio-
economic status, and disability status of all appli-
cants for social security benefits under title II or 
Medicare benefits under title XVIII. 
‘‘(2) DATA COLLECTION STANDARDS.— 
‘‘(A) IN
GENERAL.—In collecting data 
under paragraph (1), the Commissioner shall at 
least use the standards for data collection devel-
oped under section 3101 of the Public Health 
Service Act (42 U.S.C. 300kk) or the standards 
developed by the Office of Management and 
Budget, whichever is more disaggregated. 
‘‘(B) NO STANDARDS AVAILABLE.—In the 
event there are no standards for the demo-
graphic groups listed under paragraph (1), the 
Commissioner shall consult with stakeholder 
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groups representing the various identities as 
well as with the Office of Minority Health with-
in the Centers for Medicare & Medicaid Serv-
ices to develop appropriate standards. 
‘‘(3) DATA
FOR
ADDITIONAL
POPULATION 
GROUPS.—Where practicable, the data collected by 
the Commissioner under paragraph (1) shall include 
data for additional population groups if such groups 
can be aggregated into the race and ethnicity cat-
egories outlined by the data collection standards de-
scribed in paragraph (2)(A). 
‘‘(4) COLLECTION OF DATA FOR MINORS AND 
LEGALLY
INCAPACITATED
INDIVIDUALS.—With re-
spect to the collection of the data described in para-
graph (1) of applicants who are under 18 years of 
age or otherwise legally incapacitated, the Commis-
sioner shall require that— 
‘‘(A) such data be collected from the par-
ent or legal guardian of such an applicant; and 
‘‘(B) the primary language of the parent 
or legal guardian of such an applicant or recipi-
ent be used in collecting the data. 
‘‘(5) QUALITY
OF
DATA.—The Commissioner 
shall periodically review the quality and complete-
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ness of the data collected under paragraph (1) and 
make adjustments as necessary to improve both. 
‘‘(6) TRANSMISSION
OF
DATA.—Upon enroll-
ment for Medicare benefits under title XVIII, the 
Commissioner shall transmit the demographic data 
of an individual as collected under paragraph (1) to 
the Centers for Medicare & Medicaid Services. 
‘‘(7) ANALYSIS
AND
REPORTING
OF
DATA.— 
With respect to the data transmitted under para-
graph (6), the Administrator, in consultation with 
the Commissioner, shall— 
‘‘(A) require that such data be uniformly 
analyzed and that such analysis be reported at 
least annually to Congress; 
‘‘(B) incorporate such data in other anal-
ysis and reporting on health disparities and the 
provision of inequitable health care services by 
a health care provider, as appropriate; 
‘‘(C) make such data available to research-
ers, under the protections outlined in paragraph 
(8); 
‘‘(D) provide opportunities to individuals 
enrolled for Medicare benefits under title XVIII 
to submit updated data; and 
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‘‘(E) ensure that the provision of assist-
ance or benefits to an applicant is not denied 
or otherwise adversely affected because of the 
failure of the applicant to provide any of the 
data collected under paragraph (1). 
‘‘(8) PROTECTION
OF
DATA.—The Commis-
sioner shall ensure (through the promulgation of 
regulations or otherwise) that all data collected pur-
suant to paragraph (1) is protected— 
‘‘(A) under the same privacy protections as 
the Secretary applies to health data under the 
regulations promulgated under section 264(c) of 
the Health Insurance Portability and Account-
ability Act of 1996 (relating to the privacy of 
individually identifiable health information and 
other protections); and 
‘‘(B) from all inappropriate internal use by 
any entity that collects, stores, or receives the 
data, including use of such data in determina-
tions of eligibility (or continued eligibility) in 
health plans, and from other inappropriate 
uses, as defined by the Secretary. 
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to permit the use of information 
collected under this section in a manner that would ad-
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versely affect any individual providing any such informa-
tion. 
‘‘(c) TECHNICAL ASSISTANCE.—The Secretary may, 
either directly or by grant or contract, provide technical 
assistance to enable any entity to comply with the require-
ments of this section or with regulations implementing this 
section. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$500,000,000 for fiscal year 2025 and $100,000,000 for 
each fiscal year thereafter.’’. 
SEC. 1004. REVISION OF HIPAA CLAIMS STANDARDS. 
(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this Act, the Secretary of Health and 
Human Services shall revise the regulations promulgated 
under part C of title XI of the Social Security Act (42 
U.S.C. 1320d et seq.) (relating to the collection of data 
on demographics in a health-related transaction) to re-
quire— 
(1) the use, at a minimum, of standards for 
data collection on race, ethnicity, sex, primary lan-
guage, sexual orientation, gender identity, age, dis-
ability status, and socioeconomic status developed 
under section 3101 of the Public Health Service Act 
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(42 
U.S.C. 
300kk), 
as 
amended 
by 
section 
1001(a)(6); and 
(2) in consultation with the Office of the Na-
tional Coordinator for Health Information Tech-
nology, the designation of the appropriate racial, 
ethnic, primary language, disability, sex, and other 
code sets as required for claims and enrollment data. 
(b) DISSEMINATION.—The Secretary of Health and 
Human Services shall disseminate the new standards de-
veloped under subsection (a) to all entities that are subject 
to the regulations described in such subsection and provide 
technical assistance with respect to the collection of the 
data involved. 
(c) COMPLIANCE.—The Secretary of Health and 
Human Services shall require that entities comply with the 
new standards developed under subsection (a) not later 
than 2 years after the final promulgation of such stand-
ards. 
SEC. 1005. NATIONAL CENTER FOR HEALTH STATISTICS. 
Section 306(n) of the Public Health Service Act (42 
U.S.C. 242k(n)) is amended— 
(1) in paragraph (1), by striking ‘‘2003’’ and 
inserting ‘‘2025’’; 
(2) in paragraph (2), in the first sentence, by 
striking ‘‘2003’’ and inserting ‘‘2025’’; and 
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(3) in paragraph (3), by striking ‘‘2002’’ and 
inserting ‘‘2025’’. 
SEC. 1006. DISPARITIES DATA COLLECTED BY THE FED-
ERAL GOVERNMENT. 
(a) REPOSITORY OF GOVERNMENT DATA.—The Sec-
retary of Health and Human Services, in coordination 
with the officials referenced in subsection (b), shall estab-
lish a centralized electronic repository of Federal Govern-
ment data on factors related to the health and well-being 
of the population of the United States. 
(b) COLLECTION; SUBMISSION.—Not later than 180 
days after the date of enactment of this Act, and January 
31 of each year thereafter, each department, agency, and 
office of the Federal Government that has collected data 
on race, ethnicity, sex, primary language, sexual orienta-
tion, gender identity, age, disability status, or socio-
economic status during the preceding calendar year shall 
submit such data to the repository of Federal Government 
data established under subsection (a). 
(c) ANALYSIS; PUBLIC AVAILABILITY; REPORTING.— 
Not later than April 30, 2024, and April 30 of each year 
thereafter, the Secretary of Health and Human Services, 
acting through the Assistant Secretary for Planning and 
Evaluation, the Assistant Secretary for Health, the Direc-
tor of the Agency for Healthcare Research and Quality, 
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the Director of the National Center for Health Statistics, 
the Administrator of the Centers for Medicare & Medicaid 
Services, the Director of the National Institute on Minor-
ity Health and Health Disparities, and the Deputy Assist-
ant Secretary for Minority Health, shall— 
(1) prepare and make available datasets for 
public use that relate to disparities in health status, 
health care access, health care quality, health out-
comes, public health, the provision of equitable 
health services, and other areas of health and well- 
being by factors that include race, ethnicity, sex, pri-
mary language, sexual orientation, gender identity, 
disability status, age, and socioeconomic status; 
(2) ensure that these datasets are publicly iden-
tified on the repository established under subsection 
(a) as ‘‘disparities’’ data; and 
(3) submit a report to the Congress on the 
availability and use of such data by public stake-
holders. 
SEC. 1007. DATA COLLECTION AND ANALYSIS GRANTS TO 
MINORITY-SERVING INSTITUTIONS. 
(a) AUTHORITY.—The Secretary of Health and 
Human Services, acting through the Director of the Na-
tional Institute on Minority Health and Health Disparities 
and the Deputy Assistant Secretary for Minority Health, 
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shall award grants to eligible entities to access and analyze 
racial and ethnic data on disparities in health and health 
care, and where possible other data on disparities in health 
and health care, to monitor and report on progress to re-
duce and eliminate disparities in health and health care. 
(b) ELIGIBLE ENTITY.—In this section, the term ‘‘el-
igible entity’’ means an entity that has an accredited pub-
lic health, health policy, or health services research pro-
gram and is any of the following: 
(1) A part B institution, as defined in section 
322 of the Higher Education Act of 1965 (20 
U.S.C. 1061). 
(2) A Hispanic-serving institution, as defined in 
section 502 of such Act (20 U.S.C. 1101a). 
(3) A Tribal College or University, as defined in 
section 316 of such Act (20 U.S.C. 1059c). 
(4) An Asian American and Native American 
Pacific Islander-serving institution, as defined in 
section 371(c) of such Act (20 U.S.C. 1067q(c)). 
(c) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2025 through 2029. 
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SEC. 1008. SAFETY AND EFFECTIVENESS OF DRUGS WITH 
RESPECT TO RACIAL AND ETHNIC BACK-
GROUND. 
(a) IN GENERAL.—Chapter V of the Federal Food, 
Drug, and Cosmetic Act (21 U.S.C. 351 et seq.) is amend-
ed by inserting after section 505G (21 U.S.C. 355h) the 
following: 
‘‘SEC. 505H. SAFETY AND EFFECTIVENESS OF DRUGS WITH 
RESPECT TO RACIAL AND ETHNIC BACK-
GROUND. 
‘‘(a) PREAPPROVAL STUDIES.—If there is evidence of 
a racial or ethnic disparity in safety or effectiveness with 
respect to a drug or biological product, then— 
‘‘(1)(A) in the case of a drug, the investigations 
required under section 505(b)(1)(A) shall include 
adequate and well-controlled investigations of the 
disparity; or 
‘‘(B) in the case of a biological product, the evi-
dence required under section 351(a) of the Public 
Health Service Act for approval of a biologics license 
application for the biological product shall include 
adequate and well-controlled investigations of the 
disparity; and 
‘‘(2) if the investigations described in subpara-
graph (A) or (B) of paragraph (1) confirm that 
there is such a disparity, the labeling of the drug or 
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biological product shall include appropriate informa-
tion about the disparity. 
‘‘(b) POSTMARKET STUDIES.— 
‘‘(1) IN GENERAL.—If there is evidence of a ra-
cial or ethnic disparity in safety or effectiveness with 
respect to a drug for which there is an approved ap-
plication under section 505 of this Act or of a bio-
logical product for which there is an approved li-
cense under section 351 of the Public Health Service 
Act, the Secretary may by order require the holder 
of the approved application or license to conduct, by 
a date specified by the Secretary, postmarket studies 
to investigate the disparity. 
‘‘(2) LABELING.—If the Secretary determines 
that the postmarket studies confirm that there is a 
disparity described in paragraph (1), the labeling of 
the drug or biological product shall include appro-
priate information about the disparity. 
‘‘(3) STUDY DESIGN.—The Secretary may, in 
an order under paragraph (1), specify all aspects of 
the design of the postmarket studies required under 
such paragraph for a drug or biological product, in-
cluding the number of studies and study partici-
pants, and the other demographic characteristics of 
the study participants. 
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‘‘(4) MODIFICATIONS OF STUDY DESIGN.—The 
Secretary may, by order and as necessary, modify 
any aspect of the design of a postmarket study re-
quired in an order under paragraph (1) after issuing 
such order. 
‘‘(5) STUDY
RESULTS.—The results from a 
study required under paragraph (1) shall be sub-
mitted to the Secretary as a supplement to the drug 
application or biologics license application. 
‘‘(c) APPLICATIONS UNDER SECTION 505(j).— 
‘‘(1) IN GENERAL.—A drug for which an appli-
cation has been submitted or approved under section 
505(j) shall not be considered ineligible for approval 
under that section or misbranded under section 502 
on the basis that the labeling of the drug omits in-
formation relating to a disparity on the basis of ra-
cial or ethnic background as to the safety or effec-
tiveness of the drug, whether derived from investiga-
tions or studies required under this section or de-
rived from other sources, when the omitted informa-
tion is protected by patent or by exclusivity under 
section 505(j)(5)(F). 
‘‘(2) LABELING.—Notwithstanding paragraph 
(1), the Secretary may require that the labeling of 
a drug approved under section 505(j) that omits in-
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formation relating to a disparity on the basis of ra-
cial or ethnic background as to the safety or effec-
tiveness of the drug include a statement of any ap-
propriate contraindications, warnings, or precautions 
related to the disparity that the Secretary considers 
necessary. 
‘‘(d) DEFINITION.—In this section, the term ‘evi-
dence of a racial or ethnic disparity in safety or effective-
ness’, with respect to a drug or biological product, in-
cludes— 
‘‘(1) evidence that there is a disparity on the 
basis of racial or ethnic background as to safety or 
effectiveness of a drug or biological product in the 
same chemical class as the drug or biological prod-
uct; 
‘‘(2) evidence that there is a disparity on the 
basis of racial or ethnic background in the way the 
drug or biological product is metabolized; and 
‘‘(3) other evidence as the Secretary may deter-
mine appropriate.’’. 
(b) ENFORCEMENT.—Section 502 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 352) is amend-
ed by adding at the end the following: 
‘‘(hh) If it is a drug and the holder of the approved 
application under section 505 or license under section 351 
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of the Public Health Service Act for the drug has failed 
to complete the investigations or studies required under 
section 505H, or comply with any other requirement of 
such section 505H.’’. 
(c) DRUG FEES.—Section 736(a)(1)(A)(ii) of the 
Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
379h(a)(1)(A)(ii)) is amended by inserting after ‘‘are not 
required’’ the following: ‘‘, including postmarket studies 
required under section 505H,’’. 
SEC. 1009. IMPROVING HEALTH DATA REGARDING NATIVE 
HAWAIIANS AND PACIFIC ISLANDERS. 
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 317V (42 U.S.C. 247b–24) the following: 
‘‘SEC. 317W. NATIVE HAWAIIAN AND PACIFIC ISLANDER 
HEALTH DATA. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) INSULAR AREA.—The term ‘insular area’ 
means Guam, the Commonwealth of the Northern 
Mariana Islands, American Samoa, the United 
States Virgin Islands, the Federated States of Mi-
cronesia, the Republic of Palau, or the Republic of 
the Marshall Islands. 
‘‘(2) NATIVE HAWAIIANS AND PACIFIC ISLAND-
ERS (NHPI).—The term ‘Native Hawaiians and Pa-
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cific Islanders’ or ‘NHPI’ means people having ori-
gins in any of the original peoples of American 
Samoa, the Commonwealth of the Northern Mariana 
Islands, the Federated States of Micronesia, Guam, 
Hawaii, the Republic of the Marshall Islands, the 
Republic of Palau, or any other Pacific Island. 
‘‘(3) NHPI STAKEHOLDER GROUPS.—The term 
‘NHPI stakeholder group’ includes each of the fol-
lowing: 
‘‘(A) COMMUNITY
GROUP.—A group of 
NHPI who are organized at the community 
level, and may include a church group, social 
service group, national advocacy organization, 
or cultural group. 
‘‘(B) 
NONPROFIT, 
NONGOVERNMENTAL 
ORGANIZATION.—A group of NHPI with a dem-
onstrated history of addressing NHPI issues, 
including a NHPI coalition. 
‘‘(C) 
DESIGNATED
ORGANIZATION.—An 
entity established to represent NHPI popu-
lations and which has statutory responsibilities 
to provide, or has community support for pro-
viding, health care. 
‘‘(D) GOVERNMENT REPRESENTATIVES OF 
NHPI POPULATIONS.—Representatives from Ha-
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waii, American Samoa, the Commonwealth of 
the Northern Mariana Islands, the Federated 
States of Micronesia, Guam, the Republic of 
Palau, and the Republic of the Marshall Is-
lands. 
‘‘(b) PRELIMINARY HEALTH SURVEY.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the National Center for 
Health Statistics of the Centers for Disease Control 
and Prevention (referred to in this section as 
‘NCHS’), shall conduct a preliminary health survey 
in order to identify the major areas and regions in 
the continental United States, Hawaii, American 
Samoa, the Commonwealth of the Northern Mariana 
Islands, the Federated States of Micronesia, Guam, 
the Republic of Palau, and the Republic of the Mar-
shall Islands in which NHPI people reside. 
‘‘(2) CONTENTS.—The health survey described 
in paragraph (1) shall include health data and any 
other data the Secretary determines to be— 
‘‘(A) useful in determining health status 
and health care needs of NHPI populations; or 
‘‘(B) required for developing or imple-
menting the national strategy under subsection 
(c). 
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‘‘(3) METHODOLOGY.—Methodology for the 
health survey described in paragraph (1), including 
plans for designing questions, implementation, sam-
pling, and analysis, shall be developed in consulta-
tion with NHPI stakeholder groups. 
‘‘(4) TIMEFRAME.—The survey required under 
this subsection shall be completed not later than 18 
months after the date of enactment of the Health 
Equity and Accountability Act of 2024. 
‘‘(c) NATIONAL STRATEGY.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director of the NCHS and other agen-
cies within the Department of Health and Human 
Services as the Secretary determines appropriate, 
shall develop and implement a sustainable national 
strategy for identifying and evaluating the health 
status and health care needs of NHPI populations 
living in the continental United States, Hawaii, 
American Samoa, the Commonwealth of the North-
ern Mariana Islands, the Federated States of Micro-
nesia, Guam, the Republic of Palau, and the Repub-
lic of the Marshall Islands. 
‘‘(2) CONSULTATION.—In developing and imple-
menting a national strategy, as described in para-
graph (1), not later than 180 days after the date of 
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enactment of the Health Equity and Accountability 
Act of 2024, the Secretary— 
‘‘(A) shall consult with representatives of 
NHPI stakeholder groups; and 
‘‘(B) may solicit the participation of rep-
resentatives from other Federal agencies. 
‘‘(d) PROGRESS REPORT.—Not later than 2 years 
after the date of enactment of the Health Equity and Ac-
countability Act of 2024, the Secretary shall submit to 
Congress a progress report, which shall include the na-
tional strategy described in subsection (c)(1). 
‘‘(e) STUDY AND REPORT BY THE HEALTH AND 
MEDICINE DIVISION.— 
‘‘(1) IN GENERAL.—The Secretary shall seek to 
enter into an agreement with the Health and Medi-
cine Division of the National Academies of Sciences, 
Engineering, and Medicine to conduct a study, with 
input from stakeholders in insular areas, on each of 
the following: 
‘‘(A) The standards and definitions of 
health care applied to health care systems in in-
sular areas and the appropriateness of such 
standards and definitions. 
‘‘(B) The status and performance of health 
care systems in insular areas, evaluated based 
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upon standards and definitions, as the Sec-
retary determines appropriate. 
‘‘(C) The effectiveness of donor aid in ad-
dressing health care needs and priorities in in-
sular areas. 
‘‘(D) The progress toward implementation 
of recommendations of the Committee on 
Health Care Services in the United States—As-
sociated Pacific Basin that are set forth in the 
1998 report entitled ‘Pacific Partnerships for 
Health: Charting a New Course’. 
‘‘(2) REPORT.—An agreement described in 
paragraph (1) shall require the Health and Medicine 
Division to submit to the Secretary and to Congress, 
not later than 2 years after the date of the enact-
ment of the Health Equity and Accountability Act of 
2024, a report containing a description of the results 
of the study conducted under paragraph (1), includ-
ing the conclusions and recommendations of the 
Health and Medicine Division for each of the items 
described in subparagraphs (A) through (D) of such 
paragraph. 
‘‘(f) AUTHORIZATION
OF
APPROPRIATIONS.—To 
carry out this section, there are authorized to be appro-
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priated such sums as may be necessary for fiscal years 
2025 through 2029.’’. 
SEC. 1010. CLARIFICATION OF SIMPLIFIED ADMINISTRA-
TIVE REPORTING REQUIREMENT. 
Section 11(a) of the Food and Nutrition Act of 2008 
(7 U.S.C. 2020(a)) is amended by adding at the end the 
following: 
‘‘(5) SIMPLIFIED ADMINISTRATIVE REPORTING 
REQUIREMENT.—With respect to any obligation of a 
State agency to comply with the notification require-
ment under paragraph (2) of section 421(e) of the 
Personal Responsibility and Work Opportunity Rec-
onciliation Act of 1996 (8 U.S.C. 1631(e)), notwith-
standing the requirement to include in that notifica-
tion the names of the sponsor and the sponsored 
alien involved, the State agency shall be considered 
to have complied with the notification requirement if 
the State agency submits to the Attorney General a 
report that includes the aggregate number of excep-
tions granted by the State agency under paragraph 
(1) of that section.’’. 
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SEC. 1011. DATA COLLECTION REGARDING PANDEMIC PRE-
PAREDNESS, 
TESTING, 
INFECTIONS, 
AND 
DEATHS. 
(a) SKILLED NURSING FACILITIES QUALITY RE-
PORTING.—Section 1819 of the Social Security Act (42 
U.S.C. 1395i–3) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(l) REQUIREMENTS RELATING TO REPORTING DUR-
ING PUBLIC HEALTH EMERGENCIES.—During a public 
health emergency declared by the Secretary pursuant to 
section 319 of the Public Health Service Act, a skilled 
nursing facility shall, not later than 1 year after the first 
day of such declaration, and monthly thereafter during the 
application of such declaration, submit to the Secretary 
the following information, with respect to such facility and 
the residents of such facility: 
‘‘(1) 
Information 
described 
in 
section 
483.80(g)(1) of title 42, Code of Federal Regula-
tions. 
‘‘(2) The age, race, ethnicity, sex, sexual ori-
entation, gender identity, socioeconomic status, dis-
ability status, and preferred language of the resi-
dents of such skilled nursing facility.’’. 
(b) TRANSPARENCY OF DEMOGRAPHIC INFORMATION 
IN CERTAIN SETTINGS.— 
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(1) DEMOGRAPHIC
INFORMATION.—The Sec-
retary of Health and Human Services shall post the 
following information with respect to skilled nursing 
facilities (as defined in section 1819(a) of the Social 
Security Act (42 U.S.C. 1395i–3(a))), congregate 
care settings (including skilled nursing facilities, as-
sisted living facilities, prisons and jails, residential 
behavioral health care and psychiatric facilities, and 
facilities providing services for aging adults and peo-
ple with disabilities), and nursing facilities (as de-
fined in section 1919(a) of such Act (42 U.S.C. 
1396r(a))) on the Nursing Home Compare website 
(as described in section 1819(i) of such Act (42 
U.S.C. 1395i–3(i))), or a successor website, aggre-
gated by State: 
(A) The age, race, ethnicity, sex, sexual 
orientation, gender identity, socioeconomic sta-
tus, disability status, and preferred language of 
the residents of such skilled nursing facilities, 
congregate care settings (including skilled nurs-
ing facilities, assisted living facilities, prisons 
and jails, residential behavioral health care and 
psychiatric facilities, and facilities providing 
services for aging adults and people with dis-
abilities), and nursing facilities with suspected 
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(3) IMPLEMENTATION.—Notwithstanding any 
other provision of law, the Secretary of Health and 
Human Services may implement the provisions of 
this subsection by program instruction or otherwise. 
(c) EQUITABLE DATA COLLECTION AND DISCLOSURE 
REGARDING PANDEMICS.—Part A of title XI of the Social 
Security Act (42 U.S.C. 1301 et seq.) as amended by sec-
tion 1003, is further amended by adding at the end the 
following new section: 
‘‘SEC. 1150E. EQUITABLE DATA COLLECTION AND DISCLO-
SURE REGARDING PANDEMICS. 
‘‘(a) IN GENERAL.—Not later than 60 days after the 
Secretary submits to Congress written notification of the 
determination that a disease or disorder presents a public 
health emergency or that a public health emergency other-
wise exists, subject to subsections (b) and (c), the Sec-
retary, acting through the Director of the Centers for Dis-
ease Control and Prevention and the Administrator of the 
Centers for Medicare & Medicaid Services and in consulta-
tion with the Director of the Indian Health Service, shall 
collect and make publicly available on the website of the 
Centers for Disease Control and Prevention and the Cen-
ters for Medicare & Medicaid Services, and update every 
day during a pandemic, data collected across all surveil-
lance systems relating to a public health emergency de-
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clared under section 319 of the Public Health Service Act 
that is caused by a disease (as determined by the Sec-
retary), disaggregated by race, ethnicity, sex, sexual ori-
entation, gender identity, age, preferred language, socio-
economic status, disability status, and county. Such data 
shall include the following: 
‘‘(1) Data relating to all testing for the patho-
gen or pathogens causing the pandemic, including 
the number of individuals tested and the number of 
tests that were positive. 
‘‘(2) Data relating to treatment for the patho-
gen causing the pandemic, including hospitalizations 
and intensive care unit admissions. 
‘‘(3) Data relating to pandemic outcomes, in-
cluding total fatalities and case fatality rates (ex-
pressed as the proportion of individuals who were in-
fected with the pathogen causing the pandemic and 
died from the pathogen). 
‘‘(4) In the case a vaccine is developed in re-
sponse to a pandemic, data relating to such vaccina-
tion, including— 
‘‘(A) the number of vaccines administered; 
‘‘(B) the number of vaccinations offered, 
accepted, and refused; 
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‘‘(C) the most common reasons for refusal; 
and 
‘‘(D) the percentage of vaccine doses allo-
cated and administered to each priority group. 
‘‘(b) APPLICATION OF CERTAIN STANDARDS WITH 
RESPECT TO DATA COLLECTION.—To the extent prac-
ticable, data collected under subsection (a) shall follow 
standards developed by the Department of Health and 
Human Services Office of Minority Health and be col-
lected, analyzed, and reported in accordance with the 
standards promulgated by the Assistant Secretary for 
Planning and Evaluation under title XXXI of the Public 
Health Service Act. 
‘‘(c) PRIVACY.—In publishing data pursuant to sub-
section (a), the Secretary shall take all necessary steps to 
protect the privacy of individuals whose information is in-
cluded in such data, including— 
‘‘(1) complying with privacy protections pro-
vided under the regulations promulgated under sec-
tion 264(c) of the Health Insurance and Account-
ability Act of 1996; and 
‘‘(2) protections from all inappropriate internal 
use by an entity that collects, stores, or receives the 
data, including use of such data in determinations of 
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eligibility (or continued eligibility) in health plans, 
and from inappropriate uses.’’. 
(d) REPORT REQUIREMENTS FOLLOWING PUBLIC 
HEALTH EMERGENCIES.— 
(1) PUBLICLY AVAILABLE SUMMARY.—Not later 
than 60 days after the date on which the Secretary 
of Health and Human Services certifies that a public 
health emergency declared under section 319 of the 
Public Health Service Act has ended, the Secretary 
shall make publicly available on the website of the 
Department of Health and Human Services a sum-
mary of the final statistics related to such emer-
gency. 
(2) REPORT TO CONGRESS.—Not later than 60 
days after the date on which the Secretary of Health 
and Human Services certifies that a public health 
emergency declared under section 319 of the Public 
Health Service Act has ended, the Secretary shall 
submit to the Committee on Health, Education, 
Labor, and Pensions and the Committee on Finance 
of the Senate and the Committee on Energy and 
Commerce and the Committee on Ways and Means 
of the House of Representatives a report— 
(A) describing the testing, hospitalization, 
mortality rates, vaccination rates, and preferred 
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language of patients associated with the pan-
demic by race and ethnicity, rural and urban 
areas (as defined in section 1886(d)(2)(D) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395ww(d)(2)(D))), and congregate care set-
tings (including skilled nursing facilities, as-
sisted living facilities, prisons and jails, residen-
tial behavioral health care and psychiatric facili-
ties, and facilities providing services for aging 
adults and people with disabilities) and noncon-
gregate care settings (as such terms are defined 
by the Secretary); and 
(B) proposing evidenced-based response 
strategies to safeguard the health of these com-
munities in future pandemics. 
SEC. 1012. COMMISSION ON ENSURING DATA FOR HEALTH 
EQUITY. 
(a) IN GENERAL.—Not later than 30 days after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall establish a commission, to be known as the 
‘‘Commission on Ensuring Data for Health Equity’’ (re-
ferred to in this section as the ‘‘Commission’’) to provide 
clear and robust guidance to improve the collection, anal-
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ysis, and use of demographic data in responding to future 
public health emergencies. 
(b) MEMBERSHIP AND CHAIRPERSON.— 
(1) MEMBERSHIP.—The Commission shall be 
composed of— 
(A) the Assistant Secretary for Prepared-
ness and Response; 
(B) the Director of the Centers for Disease 
Control and Prevention; 
(C) the Director of the National Institutes 
of Health; 
(D) the Commissioner of Food and Drugs; 
(E) the Administrator of the Federal 
Emergency Management Agency; 
(F) the Director of the National Institute 
on Minority Health and Health Disparities; 
(G) the Director of the Indian Health 
Service; 
(H) the Administrator of the Centers for 
Medicare & Medicaid Services; 
(I) the Director of the Agency for 
Healthcare Research and Quality; 
(J) the Surgeon General; 
(K) the Administrator of the Health Re-
sources and Services Administration; 
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(L) the Director of the Office of Minority 
Health; 
(M) the Director of the Office on Women’s 
Health; 
(N) the Chairperson of the National Coun-
cil on Disability; 
(O) at least 4 State, local, territorial, and 
Tribal public health officials representing de-
partments of public health, or an Urban Indian 
health representative, who shall represent juris-
dictions from different regions of the United 
States with relatively high concentrations of 
historically marginalized populations and rural 
populations, to be appointed by the Secretary; 
(P) the National Coordinator for Health 
Information Technology; 
(Q) at least 3 independent individuals with 
expertise on racially and ethnically diverse rep-
resentation with knowledge or field experience 
with community-based participatory research on 
racial and ethnic disparities in public health, to 
be appointed by the Secretary; and 
(R) at least 4 individuals with expertise on 
health equity and demographic data disparities 
with knowledge of, or field experience in, lan-
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guage, disability status, sex, sexual orientation, 
gender identity, or socioeconomic status. 
(2) CHAIRPERSON.—The Assistant Secretary 
for Preparedness and Response shall serve as the 
Chairperson of the Commission. 
(c) DUTIES.—The Commission shall— 
(1) examine barriers to collecting, analyzing, 
and using demographic data in public health; 
(2) determine how to best use such data to pro-
mote health equity across the United States and re-
duce racial, Tribal, and other demographic dispari-
ties in health outcomes; 
(3)(A) gather available data related to treat-
ment of individuals with disabilities during the 
COVID–19 pandemic and other public health emer-
gencies, including access to vaccinations, denial of 
treatment for preexisting conditions, removal or de-
nial of disability related equipment (including ven-
tilators and continuous positive airway pressure 
(commonly referred to as ‘‘CPAP’’) machines), and 
data on completion of do-not-resuscitate orders; and 
(B) identify barriers to obtaining accurate and 
timely data related to treatment of such individuals; 
(4) solicit input from public health officials, 
community-connected organizations, health care pro-
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viders, State and local agency officials, Tribal offi-
cials, and other experts on barriers to, and best 
practices for, collecting demographic data; and 
(5) recommend policy changes that the data in-
dicates are necessary to reduce demographic dispari-
ties in health outcomes. 
(d) REPORT.—Not later than 1 year after the date 
of the enactment of this Act, the Commission shall submit 
to Congress, and publish on the website of the Department 
of Health and Human Services, a report containing— 
(1) the findings of the Commission pursuant to 
subsection (c); 
(2) to the extent possible, an analysis of— 
(A) racial and other demographic dispari-
ties in COVID–19 mortality, including an anal-
ysis of comorbidities and case fatality rates; 
(B) sex, sexual orientation, and gender 
identity disparities in COVID–19 treatment and 
mortality; and 
(C) Federal Government policies that dis-
parately exacerbate the COVID–19 impact, and 
recommendations to improve racial and other 
demographic disparities in health outcomes; 
(3) an analysis of COVID–19 treatment of indi-
viduals with disabilities, including equity of access to 
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treatment and equipment and intersections of dis-
ability status with other demographic factors, includ-
ing race; 
(4) an analysis of what demographic data is 
currently being collected, the accuracy of that data 
and any gaps, how this data is currently being used 
to inform efforts to combat COVID–19, and what 
resources are needed to supplement existing public 
health data collection; and 
(5) the Commission’s recommendations with re-
spect to— 
(A) how to enhance State, local, territorial, 
and Tribal capacity to conduct public health re-
search on COVID–19 and in future public 
health emergencies, with a focus on expanded 
capacity to analyze data on disparities cor-
related with race, ethnicity, income, sex, sexual 
orientation, gender identity, age, disability sta-
tus, specific geographic areas, and other rel-
evant demographic characteristics; 
(B) how to collect, process, and disclose to 
the public the data described in subparagraph 
(A) in a way that maintains individual privacy 
while helping direct the State, local, and Tribal 
response to public health emergencies; 
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(C) how to improve demographic data col-
lection related to COVID–19 and other public 
health emergencies in the short-term and long- 
term, including how to continue to grow and 
value the Tribal sovereignty of data and infor-
mation concerning urban and rural Tribal com-
munities; 
(D) how to improve transparency and eq-
uity of treatment for individuals with disabil-
ities during the COVID–19 public health emer-
gency and future public health emergencies; and 
(E) how to support State, local, and Tribal 
capacity to eliminate barriers to vaccinations, 
testing, and treatment during the COVID–19 
public health emergency and future public 
health emergencies. 
(e) STAFF OF COMMISSION.— 
(1) ADDITIONAL STAFF.—The Chairperson of 
the Commission may appoint and fix the pay of ad-
ditional staff to the Commission as the Chairperson 
considers appropriate. 
(2) APPLICABILITY OF CERTAIN CIVIL SERVICE 
LAWS.—The staff of the Commission may be ap-
pointed without regard to the provisions of title 5, 
United States Code, governing appointments in the 
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competitive service, and may be paid without regard 
to the provisions of chapter 51 and subchapter III 
of chapter 53 of that title relating to classification 
and General Schedule pay rates. 
(3) DETAILEES.—Any Federal Government em-
ployee may be detailed to the Commission without 
reimbursement from the Commission, and the 
detailee shall retain the rights, status, and privileges 
of his or her regular employment without interrup-
tion. 
(f) COORDINATION WITH OTHER EFFORTS.—The 
Secretary shall, in establishing the Commission under this 
section, take such steps as may be necessary to ensure 
that the work of the Commission does not overlap with, 
or otherwise duplicate, other Federal Government efforts 
with respect to ensuring health equity in data collection 
in public health emergencies. 
(g) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this section. 
SEC. 1013. TASK FORCE ON PREVENTING BIAS IN AI AND 
ALGORITHMS. 
(a) IN GENERAL.—Not later than 30 days after the 
date of enactment of this Act, the Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
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retary’’) shall establish a Task Force to be known as the 
‘‘Task Force on Preventing AI and Algorithmic Bias in 
Health Care’’ (referred to in this section as the ‘‘Task 
Force’’) to provide clear and robust guidance on how to 
ensure that the development and integration of artificial 
intelligence and algorithmic technologies within the health 
care service delivery process does not exacerbate health 
disparities and inequities, expands access to health care 
services, and improves health care delivery. 
(b) MEMBERSHIP AND CHAIRPERSON.— 
(1) MEMBERSHIP.—The Task Force shall be 
composed of— 
(A) the Chief Information Officer of the 
Department of Health and Human Services; 
(B) the Director of the Centers for Disease 
Control and Prevention; 
(C) the Director of the National Institutes 
of Health; 
(D) the Commissioner of Food and Drugs; 
(E) the Administrator of the Federal 
Emergency Management Agency; 
(F) the Director of the National Institute 
on Minority Health and Health Disparities; 
(G) the Director of the Indian Health 
Service; 
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(H) the Administrator of the Centers for 
Medicare & Medicaid Services; 
(I) the Director of the Agency for 
Healthcare Research and Quality; 
(J) the Surgeon General; 
(K) the Administrator of the Health Re-
sources and Services Administration; 
(L) the Director of the Office of Minority 
Health; 
(M) the Director of the Office on Women’s 
Health; 
(N) the Chairperson of the National Coun-
cil on Disability; 
(O) the National Coordinator for Health 
Information Technology; 
(P) at least 4 State, local, territorial, and 
Tribal public health officials representing de-
partments of public health, or an Urban Indian 
health representative, who shall represent juris-
dictions from different regions of the United 
States with relatively high concentrations of 
historically marginalized populations, to be ap-
pointed by the Secretary; 
(Q) at least 3 independent individuals with 
expertise on racially and ethnically diverse rep-
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resentation with knowledge or field experience 
with community-based participatory research on 
racial and ethnic disparities in public health, to 
be appointed by the Secretary; and 
(R) at least 4 individuals with expertise on 
health equity and demographic data disparities 
with knowledge of, or field experience in, lan-
guage, disability status, sex, sexual orientation, 
gender identity, or socioeconomic status. 
(2) CHAIRPERSON.—The Chief Information Of-
ficer of the Department of Health and Human Serv-
ices (or the Chief Information Officer’s designee) 
shall serve as the Chairperson of the Task Force. 
(c) DUTIES.—The Task Force shall— 
(1) examine artificial intelligence and algo-
rithms in the health care service sector, including 
the health care delivery process relative to the use 
of autonomous human decision makers; 
(2) identify the risks of health care system utili-
zation of artificial intelligence and algorithms in 
terms of civil rights, civil liberties, and discrimina-
tory bias in health care access, quality, and out-
comes; and 
(3) prepare and submit the report under sub-
section (d). 
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(d) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Task Force shall— 
(1) submit a written report of the findings of 
the examination under subsection (c)(1) and rec-
ommendations to Congress with respect to imple-
mentation of artificial intelligence and algorithms in 
health care delivery and mitigation of the risks asso-
ciated with that implementation; and 
(2) publish such report on the website of the 
Department of Health and Human Services. 
(e) PUBLIC COMMENT.—Not later than 60 days after 
the date of the enactment of this Act, the Task Force shall 
publish in the Federal Register a notice providing for a 
public comment period on the duties and activities of the 
Task Force of not less than 90 days, beginning on the 
date of that publication. 
(f) STAFF OF COMMISSION.— 
(1) ADDITIONAL STAFF.—The Chairperson of 
the Task Force may appoint and fix the pay of addi-
tional staff to the Task Force as the Chairperson 
considers appropriate. 
(2) APPLICABILITY OF CERTAIN CIVIL SERVICE 
LAWS.—The staff of the Task Force may be ap-
pointed without regard to the provisions of title 5, 
United States Code, governing appointments in the 
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competitive service, and may be paid without regard 
to the provisions of chapter 51 and subchapter III 
of chapter 53 of that title relating to classification 
and General Schedule pay rates. 
(3) DETAILEES.—Any Federal Government em-
ployee may be detailed to the Task Force without re-
imbursement from the Task Force, and the detailee 
shall retain the rights, status, and privileges of his 
or her regular employment without interruption. 
SEC. 1014. REPORT ON THE HEALTH OF THE MIDDLE EAST-
ERN AND NORTH AFRICAN POPULATION. 
(a) STUDY REQUIRED.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
retary’’) shall conduct or support a comprehensive study 
regarding the unique health patterns and outcomes of 
Middle Eastern and North African (referred to in this sec-
tion as ‘‘MENA’’) populations. 
(b) REQUIREMENTS FOR STUDY.—The comprehen-
sive study under subsection (a) shall include an enumera-
tion of MENA populations across the United States, 
disaggregated by subpopulation, and with respect to each 
such population and subpopulation— 
(1) the rates of— 
(A) obesity, diabetes, sickle cell anemia, 
stroke, asthma, pneumonia, lung cancer, HIV/ 
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AIDS, HPV, high cholesterol, high blood pres-
sure, and chronic heart, lung, and kidney dis-
ease; 
(B) morbidity and mortality, including the 
rates of morbidity and mortality associated with 
the health conditions listed in subparagraph 
(A); 
(C) mental health and substance use dis-
orders; and 
(D) domestic violence, dating violence, sex-
ual assault, sexual harassment, and stalking; 
(2) analysis of— 
(A) the rates described in paragraph (1); 
(B) the leading causes of pregnancy-associ-
ated morbidity and mortality; and 
(C) access to health care facilities and the 
associated outcomes of care; 
(3) analysis, enumeration, or quantification of 
any other health or health-related parameters the 
Secretary may determine necessary; and 
(4) analysis of the relationship between the 
health factors, outcomes, and conditions described in 
paragraphs (1) through (3) and the implementation 
of Federal health programs. 
(c) CONSULTATION.—The Secretary shall— 
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(1) carry out this section in consultation, as ap-
propriate, with the Director of the Census Bureau, 
the Director of the Centers for Disease Control and 
Prevention, the Director of the National Institutes 
of Health, the Assistant Secretary for Mental Health 
and Substance Use, and other stakeholders (includ-
ing community-based organizations); and 
(2) determine through such consultation the 
subpopulations 
to 
be 
used 
for 
purposes 
of 
disaggregation of data pursuant to subsection (b). 
(d) ONLINE PORTAL.—Upon conclusion of the com-
prehensive study under this section, the Secretary shall 
establish a public online portal to catalogue the results of 
the study, its underlying data, and information in the re-
port submitted pursuant to subsection (e). 
(e) REPORTING.— 
(1) INTERIM REPORT.—Not later than 2 years 
after the date of enactment of this Act, the Sec-
retary shall submit to Congress a report outlining 
the challenges associated with, and progress towards 
implementing health data collection for MENA pop-
ulations as a distinct category and the plan for com-
pleting a comprehensive study regarding the unique 
health patterns and outcomes of MENA populations. 
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(2) FINAL REPORT.—Not later than 30 days 
after the conclusion of the comprehensive study 
under this section, the Secretary shall submit to 
Congress a report describing— 
(A) the results of the study conducted 
under this section; and 
(B) the rulemakings and other actions the 
agencies described in subsection (c)(1) can un-
dertake to more equitably include MENA indi-
viduals in their programs. 
(f) PRIVACY.—The Secretary shall not include any 
personally identifiable information on the online portal 
under subsection (d) or in a report under subsection (e). 
(g) DEFINITION OF MIDDLE EASTERN AND NORTH 
AFRICAN; MENA.—In this section, the terms ‘‘Middle 
Eastern and North African’’ or ‘‘MENA’’, with respect to 
individuals or populations, includes individuals and popu-
lations who identify with or belong to one or more nation-
alities or ethnic groups originating in a country (or portion 
thereof) in the Middle Eastern and North African region 
(such as Lebanese, Iranians, Egyptians, Moroccans, Yem-
enis, Chaldeans, Imazighen, Kurds, Palestinians, and 
Yazidis). 
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TITLE II—CULTURALLY AND LIN-
GUISTICALLY 
APPROPRIATE 
HEALTH AND HEALTH CARE 
SEC. 2001. DEFINITIONS. 
In this title, the definitions in section 3400 of the 
Public Health Service Act, as added by section 2004, shall 
apply. 
SEC. 2002. IMPROVING ACCESS TO SERVICES FOR INDIVID-
UALS WITH LIMITED ENGLISH PROFICIENCY. 
(a) PURPOSE.—Consistent with the goals provided in 
Executive Order 13166 (42 U.S.C. 2000d–1 note; relating 
to improving access to services for persons with limited 
English proficiency), it is the purpose of this section— 
(1) to improve Federal agency performance re-
garding access to federally conducted and federally 
assisted programs and activities for individuals with 
limited English proficiency; 
(2) to require each Federal agency to examine 
the services it provides and develop and implement 
a system by which individuals with limited English 
proficiency can obtain culturally competent services 
and meaningful access to those services consistent 
with, and without substantially burdening, the fun-
damental mission of the agency; 
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(3) to require each Federal agency to translate 
any English language written material prepared for 
the general public into the top 15 non-English lan-
guages in the United States (according to the most 
recent data from the American Community Survey 
or its replacement) within established timelines de-
scribed in subsection (b)(2)(C)(v); 
(4) to require each Federal agency to ensure 
that recipients of Federal financial assistance pro-
vide culturally competent services and meaningful 
access to applicants and beneficiaries who are indi-
viduals with limited English proficiency; 
(5) to ensure that recipients of Federal finan-
cial assistance take reasonable steps, consistent with 
the guidelines set forth in the ‘‘Guidance to Federal 
Financial Assistance Recipients Regarding Title VI 
Prohibition Against National Origin Discrimination 
Affecting Limited English Proficient Persons’’ (67 
Fed. Reg. 41455 (June 18, 2002)), to ensure cul-
turally and linguistically appropriate access to their 
programs and activities by individuals with limited 
English proficiency; and 
(6) to ensure compliance with title VI of the 
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 
and section 1557 of the Patient Protection and Af-
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fordable Care Act (42 U.S.C. 18116) (prohibiting 
health care providers and organizations from dis-
criminating in the provision of services). 
(b) FEDERALLY CONDUCTED PROGRAMS AND AC-
TIVITIES.— 
(1) IN
GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency providing financial assistance to, or admin-
istering, a health program or activity described in 
section 2003(a) shall prepare a plan or update a 
plan to improve culturally and linguistically appro-
priate access to such program or activity with re-
spect to individuals with limited English proficiency. 
Not later than 1 year after the date of enactment 
of this Act, each such Federal agency shall ensure 
that such plan is fully implemented. 
(2) PLAN
REQUIREMENT.—Each plan under 
paragraph (1) shall include— 
(A) the steps the agency will take to en-
sure that individuals with limited English pro-
ficiency have access to each health program or 
activity supported or administered by the agen-
cy; 
(B) the policies and procedures for identi-
fying, assessing, and meeting the culturally and 
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linguistically appropriate language needs of its 
beneficiaries that are individuals with limited 
English proficiency served by such program or 
activity; 
(C) the steps the agency will take for such 
program or activity to be culturally and linguis-
tically appropriate by— 
(i) providing a range of language as-
sistance options; 
(ii) giving notice to individuals with 
limited English proficiency of the right to 
competent language services; 
(iii) training staff (at least annually); 
(iv) monitoring and assessing the 
quality of the language services (at least 
annually); and 
(v) translating any English language 
written material prepared for the general 
public into the top 15 non-English lan-
guages in the United States (according to 
the most recent data from the American 
Community Survey or its replacement) 
within established timelines that ensure 
that high-quality, culturally competent 
translated material is provided promptly 
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within not more than 15 calendar days in 
general and within not more than 7 cal-
endar days in the case of any national 
emergency or State disaster declaration; 
(D) the steps the agency will take for such 
program or activity to provide reasonable ac-
commodations necessary for individuals with 
limited English proficiency, including those in-
dividuals with a communication disability, to 
understand communications from the agency; 
(E) the steps the agency will take to en-
sure that applications, forms, and other signifi-
cant documents for such program or activity 
are competently translated into the primary 
language of a client that is an individual with 
limited English proficiency where such mate-
rials are needed to improve access of such client 
to such program or activity; 
(F) the resources the agency will provide 
to improve cultural and linguistic appropriate-
ness to assist recipients of Federal funds to im-
prove access to health care-related programs 
and activities for individuals with limited 
English proficiency; 
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(G) the resources the agency will provide 
to ensure that competent language assistance is 
provided to patients that are individuals with 
limited English proficiency by interpreters or 
trained bilingual staff; 
(H) the resources the agency will provide 
to ensure that family, particularly minor chil-
dren, and friends are not used to provide inter-
pretation services, except as permitted under 
section 1557 of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18116); and 
(I) the steps the agency will take and re-
sources the agency will provide to ensure that 
individuals know their rights, including the abil-
ity to file a complaint. 
(3) SUBMISSION OF PLAN TO DOJ.—Each agen-
cy that is required to prepare a plan under para-
graph (1) shall— 
(A) consult with populations who are di-
rectly impacted by policies in the plan and their 
representatives in the development of the plan; 
and 
(B) when the plan is finalized, send a copy 
of such plan to the Attorney General, to serve 
as the central repository of all such plans. 
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SEC. 2003. ENSURING STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTH CARE. 
(a) APPLICABILITY.—This section shall apply to any 
health program or activity— 
(1) of which any part is receiving Federal fi-
nancial assistance, including credits, subsidies, or 
contracts of insurance; or 
(2) that is carried out (including indirectly 
through contracts, subcontracts, or other support) 
by an executive agency or any entity established 
under title I of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18001 et seq.) (or amend-
ments made thereby). 
(b) STANDARDS.—Each program or activity de-
scribed in subsection (a)— 
(1) shall implement strategies to recruit, retain, 
and promote individuals at all levels to maintain a 
diverse staff and leadership that can provide cul-
turally and linguistically appropriate health care to 
patient populations of the service area of the pro-
gram or activity; 
(2) shall educate and train governance, leader-
ship, and workforce at all levels and across all dis-
ciplines of the program or activity in culturally and 
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linguistically appropriate policies and practices on an 
ongoing basis at least yearly; 
(3) shall offer and provide language assistance, 
including trained and competent bilingual staff and 
interpreter services, to individuals with limited 
English proficiency or who have other communica-
tion needs, at no cost to the individual at all points 
of contact, and during all hours of operation, to fa-
cilitate timely access to health care services and 
health care-related services; 
(4) shall for each language group consisting of 
individuals with limited English proficiency that con-
stitutes 5 percent or 500 individuals, whichever is 
less, of the population of persons eligible to be 
served or likely to be affected or encountered in the 
service area of the program or activity, make avail-
able at a fifth grade reading level— 
(A) easily understood patient-related mate-
rials, including print and multimedia materials, 
in the language of such language group; 
(B) information or notices about termi-
nation of benefits in such language; 
(C) signage; and 
(D) any other documents or types of docu-
ments designated by the Secretary; 
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(5) shall develop and implement clear goals, 
policies, operational plans, and management, ac-
countability, and oversight mechanisms to provide 
culturally and linguistically appropriate services and 
infuse them throughout the planning and operations 
of the program or activity; 
(6) shall conduct initial and ongoing, at least 
annually, organizational assessments of culturally 
and linguistically appropriate services-related activi-
ties and integrate valid linguistic, competence-related 
National Standards for Culturally and Linguistically 
Appropriate Services (CLAS) measures into the in-
ternal audits, performance improvement programs, 
patient satisfaction assessments, continuous quality 
improvement activities, and outcomes-based evalua-
tions of the program or activity and develop ways to 
standardize assessments; 
(7) shall ensure that, consistent with the pri-
vacy protections provided for under the regulations 
promulgated under section 264(c) of the Health In-
surance Portability and Accountability Act of 1996 
(42 U.S.C. 1320d–2 note; Public Law 104–191), 
data on an individual required to be collected pursu-
ant to section 3101 of the Public Health Service Act 
(42 U.S.C. 300kk), including the individual’s alter-
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native format preferences and policy modification 
needs, are— 
(A) collected in health records; 
(B) integrated into the management infor-
mation systems of the program or activity; 
(C) reported in such a way as to be inter-
operable with health information systems at the 
Federal and State levels; and 
(D) periodically updated; 
(8) shall maintain a current demographic, cul-
tural, and epidemiological profile of the community, 
conduct regular assessments of community health 
assets and needs, and use the results of such assess-
ments to accurately plan for and implement services 
that respond to the cultural and linguistic character-
istics of the service area of the program or activity; 
(9) shall develop participatory, collaborative 
partnerships with community-based organizations 
and utilize a variety of formal and informal mecha-
nisms to facilitate community and patient involve-
ment in designing, implementing, and evaluating 
policies and practices to ensure culturally and lin-
guistically appropriate service-related activities; 
(10) shall ensure that conflict and grievance 
resolution processes are culturally and linguistically 
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appropriate and capable of identifying, preventing, 
and resolving cross-cultural conflicts or complaints 
by patients; 
(11) shall annually— 
(A) make available to the public— 
(i) information about the progress and 
successful innovations of the program or 
activity in implementing the standards 
under this section; and 
(ii) translated materials of such infor-
mation that is culturally and linguistically 
appropriate to the communities served 
under this section; and 
(B) provide public notice in such commu-
nities about the availability of such information; 
and 
(12) shall, if requested, regularly make avail-
able to the head of each Federal entity from which 
Federal funds are provided, information about the 
progress and successful innovations of the program 
or activity in implementing the standards under this 
section as required by the head of such entity. 
(c) COMMENTS ACCEPTED THROUGH NOTICE AND 
COMMENT RULEMAKING.—An executive agency carrying 
out a program or activity described in subsection (a)— 
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(1) shall ensure that comments with respect to 
such program or activity that are accepted through 
notice and comment rulemaking are accepted in all 
languages; 
(2) may not require such comments to be sub-
mitted only in English; and 
(3) shall ensure that any such comments that 
are not submitted in English are considered, during 
the agency’s review of such comments, equally as 
such comments that are submitted in English. 
SEC. 2004. CULTURALLY AND LINGUISTICALLY APPRO-
PRIATE 
HEALTH 
CARE 
IN 
THE 
PUBLIC 
HEALTH SERVICE ACT. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
‘‘TITLE 
XXXIV—CULTURALLY 
AND LINGUISTICALLY APPRO-
PRIATE HEALTH CARE 
‘‘SEC. 3400. DEFINITIONS. 
‘‘(a) IN GENERAL.—In this title: 
‘‘(1) BILINGUAL.—The term ‘bilingual’, with 
respect to an individual, means an individual who 
has a sufficient degree of proficiency in 2 languages. 
‘‘(2) COMMUNITY HEALTH WORKER.—The term 
‘community health worker’ means a frontline health 
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worker who is a trusted member of the community 
in which the worker serves or who has an unusually 
close understanding of the community served that 
enables the worker to build trusted relationships, 
serve as a liaison between health and social services 
and the community, facilitate access to services, and 
improve the quality and cultural competence of serv-
ice delivery. 
‘‘(3) CULTURAL.—The term ‘cultural’ means 
relating to integrated patterns of human behavior 
that include the language, thoughts, communica-
tions, actions, customs, beliefs, values, age, and in-
stitutions of racial, ethnic, religious, or social 
groups, including lesbian, gay, bisexual, transgender, 
queer, and questioning individuals, and individuals 
with physical and mental disabilities. 
‘‘(4) CULTURALLY
AND
LINGUISTICALLY
AP-
PROPRIATE.—The term ‘culturally and linguistically 
appropriate’ means being respectful of and respon-
sive to the cultural and linguistic needs of all indi-
viduals. 
‘‘(5) 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 recipient of such 
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services who is limited in English proficiency, or has 
a communication impairment such as a hearing, vi-
sion, speaking, or cognitive disability, that enables 
access to, understanding of, and benefit from health 
care or health care-related services, and full partici-
pation in the development of the treatment plan of 
the recipient. 
‘‘(6) GRIEVANCE RESOLUTION PROCESS.—The 
term ‘grievance resolution process’ means all aspects 
of dispute resolution including filing complaints, 
grievance and appeal procedures, and court action. 
‘‘(7) HEALTH CARE GROUP.—The term ‘health 
care group’ means a group of physicians organized, 
at least in part, for the purposes of providing physi-
cian services under the Medicaid program under title 
XIX of the Social Security Act, the State Children’s 
Health Insurance Program under title XXI of such 
Act, or the Medicare program under title XVIII of 
such Act, including a provider of services under part 
B of such title XVIII, and may include a hospital, 
a hospice provider, a palliative care provider, and 
any other individual or entity furnishing services 
covered under any such program that is affiliated 
with the health care group. 
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‘‘(8) HEALTH CARE.—The term ‘health care’ 
includes all health care needed throughout the life 
cycle and the end of life. 
‘‘(9) HEALTH
CARE
SERVICES.—The term 
‘health care services’ means services that address 
physical and mental health conditions, as well as 
conditions impacted by social determinants of health, 
in all care settings throughout the life cycle and the 
end of life. 
‘‘(10) 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 services. 
‘‘(11) HEALTH EDUCATOR.—The term ‘health 
educator’ includes a professional with a bacca-
laureate degree who is responsible for designing, im-
plementing, and evaluating individual and population 
health promotion, health education (including edu-
cation on end-of-life care options), end-of-life care, 
or chronic disease prevention programs. 
‘‘(12) INDIAN; INDIAN TRIBE.—The terms ‘In-
dian’ and ‘Indian Tribe’ have the meanings given 
such terms in section 4 of the Indian Self-Deter-
mination and Education Assistance Act. 
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‘‘(13) INDIVIDUAL
WITH
A
DISABILITY.—The 
term ‘individual with a disability’ means any indi-
vidual who has a disability as defined for the pur-
pose of section 504 of the Rehabilitation Act of 
1973. 
‘‘(14) INDIVIDUAL
WITH
LIMITED
ENGLISH 
PROFICIENCY.—The term ‘individual with limited 
English proficiency’ means an individual who self- 
identifies on the Census as speaking English less 
than ‘very well’. 
‘‘(15) INTEGRATED
HEALTH
CARE
DELIVERY 
SYSTEM.—The term ‘integrated health care delivery 
system’ means an interdisciplinary system that 
brings together providers from the primary health, 
mental health, substance use disorder, hospice and 
palliative care, and related disciplines to improve the 
health outcomes of an individual and the community. 
Such providers may include hospitals, health, mental 
health, or substance use prevention and treatment 
clinics and providers, home health agencies, home- 
and community-based services providers, congregate 
settings (including any skilled nursing facilities, as-
sisted living facilities, prisons and jails, residential 
behavioral health care and psychiatric facilities, and 
facilities providing services for aging adults and indi-
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viduals with disabilities), ambulatory surgery cen-
ters, rehabilitation centers, employed, independent, 
or contracted physicians, and oral health care pro-
viders. 
‘‘(16) INTERPRETING; INTERPRETATION.—The 
terms ‘interpreting’ and ‘interpretation’ mean the 
transmission of a spoken, written, or signed message 
from one language or format into another, faithfully, 
accurately, and objectively. 
‘‘(17) LANGUAGE ACCESS.—The term ‘language 
access’ means the provision of language services to 
an individual with limited English proficiency or an 
individual with communication disabilities designed 
to enhance that individual’s access to, understanding 
of, or benefit from health care services or health 
care-related services. 
‘‘(18) LANGUAGE ASSISTANCE SERVICES.—The 
term ‘language assistance services’ includes— 
‘‘(A) oral language assistance, including in-
terpretation in non-English languages provided 
in person or remotely by a qualified interpreter 
for an individual with limited English pro-
ficiency, and the use of qualified bilingual or 
multilingual staff to communicate directly with 
individuals with limited English proficiency; 
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‘‘(B) written translation, performed by a 
qualified translator, of written content in paper 
or electronic form into languages other than 
English; and 
‘‘(C) taglines. 
‘‘(19) MINORITY POPULATIONS.—The term ‘mi-
nority populations’ means individuals of racial and 
ethnic minority groups, individuals of sexual and 
gender minority groups, and individuals with a dis-
ability. 
‘‘(20) ONSITE
INTERPRETATION.—The term 
‘onsite interpretation’ means a method of inter-
preting or interpretation for which the interpreter is 
in the physical presence of the provider of health 
care services or health care-related services and the 
recipient of such services who is limited in English 
proficiency or has a communication impairment such 
as an impairment in hearing, vision, or learning. 
‘‘(21) QUALIFIED
INDIVIDUAL
WITH
A
DIS-
ABILITY.—The term ‘qualified individual with a dis-
ability’ means, with respect to a health program or 
activity, an individual with a disability who, with or 
without reasonable modifications to policies, prac-
tices, or procedures, the removal of architectural, 
communication, or transportation barriers, or the 
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provision of auxiliary aids and services, meets the es-
sential eligibility requirements for the receipt of aids, 
benefits, or services offered or provided by the health 
program or activity. 
‘‘(22) QUALIFIED INTERPRETER FOR AN INDI-
VIDUAL WITH A DISABILITY.—The term ‘qualified 
interpreter for an individual with a disability’, with 
respect to an individual with a disability— 
‘‘(A) means an interpreter for such indi-
vidual who by means of a remote interpreting 
service or an onsite appearance— 
‘‘(i) adheres to generally accepted in-
terpreter ethics principles, including client 
confidentiality; and 
‘‘(ii) is able to interpret effectively, ac-
curately, and impartially, both receptively 
and expressively, using any necessary spe-
cialized vocabulary, terminology, and phra-
seology; and 
‘‘(B) may include— 
‘‘(i) sign language interpreters; 
‘‘(ii) oral transliterators, which are in-
dividuals who represent or spell in the 
characters of another alphabet; and 
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‘‘(iii) cued language transliterators, 
which are individuals who represent or 
spell 
by 
using 
a 
small 
number 
of 
handshapes. 
‘‘(23) QUALIFIED INTERPRETER FOR AN INDI-
VIDUAL
WITH
LIMITED
ENGLISH
PROFICIENCY.— 
The term ‘qualified interpreter for an individual with 
limited English proficiency’ means an interpreter 
who by means of a remote interpreting service or an 
onsite appearance— 
‘‘(A) adheres to generally accepted inter-
preter ethics principles, including client con-
fidentiality; 
‘‘(B) has demonstrated proficiency in 
speaking 
and 
understanding 
both 
spoken 
English and one or more other spoken lan-
guages; and 
‘‘(C) is able to interpret effectively, accu-
rately, and impartially, both receptively and ex-
pressly, to and from such languages and 
English, using any necessary specialized vocab-
ulary, terminology, and phraseology. 
‘‘(24) QUALIFIED
TRANSLATOR.—The term 
‘qualified translator’ means a translator who— 
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‘‘(A) adheres to generally accepted trans-
lator ethics principles, including client confiden-
tiality; 
‘‘(B) has demonstrated proficiency in writ-
ing and understanding both written English 
and one or more other written non-English lan-
guages; and 
‘‘(C) is able to translate effectively, accu-
rately, and impartially to and from such lan-
guages and English, using any necessary spe-
cialized vocabulary, terminology, and phrase-
ology. 
‘‘(25) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘racial and ethnic minority group’ has the 
meaning given such term in section 1707(g). 
‘‘(26) 
SECRETARY.—The 
term 
‘Secretary’ 
means the Secretary of Health and Human Services, 
acting through the Director of the Agency for 
Healthcare Research and Quality. 
‘‘(27) 
SEXUAL
AND
GENDER
MINORITY 
GROUP.—The term ‘sexual and gender minority 
group’ 
includes 
lesbian, 
gay, 
bisexual, 
and 
transgender populations, as well as those whose sex-
ual orientation, gender identity and expression, or 
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reproductive development varies from traditional, so-
cietal, cultural, or physiological norms. 
‘‘(28) SIGHT TRANSLATION.—The term ‘sight 
translation’ means the transmission of a written 
message in one language into a spoken or signed 
message in another language, or an alternative for-
mat in English or another language. 
‘‘(29) STATE.—Notwithstanding section 2, the 
term ‘State’ means each of the several States, the 
District of Columbia, the Commonwealth of Puerto 
Rico, the United States Virgin Islands, Guam, 
American Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
‘‘(30) 
TELEPHONIC
INTERPRETATION.—The 
term ‘telephonic interpretation’ (also known as ‘over 
the phone interpretation’ or ‘OPI’) means, with re-
spect to interpretation for an individual with limited 
English proficiency, a method of interpretation in 
which the interpreter is not in the physical presence 
of the provider of health care services or health care- 
related services and such individual receiving such 
services, but the interpreter is connected via tele-
phone. 
‘‘(31) TRANSLATION.—The term ‘translation’ 
means the transmission of a written message in one 
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language into a written or signed message in an-
other language, and includes translation into an-
other language or alternative format, such as large 
print font, Braille, audio recording, or CD. 
‘‘(32) 
UNDERSERVED
COMMUNITIES.—The 
term ‘underserved communities’ means populations 
sharing particular characteristics, or geographic 
communities, who have been systematically denied a 
full opportunity to participate in aspects of eco-
nomic, social, and civic life, such as— 
‘‘(A) Black, Latino, Indigenous, and Na-
tive American persons, Asian Americans, Native 
Hawaiians and Pacific Islanders, Middle East-
erners and North Africans, and other persons 
of color; 
‘‘(B) members of religious minorities; 
‘‘(C) lesbian, gay, bisexual, transgender, 
and queer persons; 
‘‘(D) individuals with a disability; 
‘‘(E) persons who live in rural areas; and 
‘‘(F) persons otherwise adversely affected 
by persistent poverty or inequality. 
‘‘(33) VIDEO
REMOTE
INTERPRETING
SERV-
ICES.—The term ‘video remote interpreting services’ 
means the provision, in health care services or health 
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care-related services, through a qualified interpreter 
for an individual with limited English proficiency, of 
video remote interpreting services that are— 
‘‘(A) in real-time, full-motion video, and 
audio over a dedicated high-speed, wide-band-
width video connection or wireless connection 
that delivers high-quality video images that do 
not produce lags, choppy, blurry, or grainy im-
ages, or irregular pauses in communication; and 
‘‘(B) in a sharply delineated image that is 
large enough to display. 
‘‘(34) VITAL DOCUMENT.—The term ‘vital doc-
ument’ includes applications for government pro-
grams that provide health care services, medical or 
financial consent forms, financial assistance docu-
ments, letters containing important information re-
garding patient instructions (such as prescriptions, 
referrals to other providers, and discharge plans) 
and participation in a program (such as a Medicaid 
managed care program), notices pertaining to the 
reduction, denial, or termination of services or bene-
fits, notices of the right to appeal such actions, and 
notices advising individuals with limited English pro-
ficiency with communication disabilities of the avail-
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ability of free language services, alternative formats, 
and other outreach materials. 
‘‘(b) REFERENCE.—In any reference in this title to 
a regulatory provision applicable to a ‘handicapped indi-
vidual’, the term ‘handicapped individual’ in such provi-
sion shall have the same meaning as the term ‘individual 
with a disability’ as defined in subsection (a). 
‘‘Subtitle A—Resources and Innova-
tion for Culturally and Linguis-
tically Appropriate Health Care 
‘‘SEC. 3401. ROBERT T. MATSUI CENTER FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE HEALTH 
CARE. 
‘‘(a) ESTABLISHMENT.—The Secretary shall estab-
lish and support a center to be known as the ‘Robert T. 
Matsui Center for Culturally and Linguistically Appro-
priate Health Care’ (referred to in this section as the 
‘Center’) to carry out each of the following activities: 
‘‘(1) INTERPRETATION SERVICES.— 
‘‘(A) IN GENERAL.—The Center shall pro-
vide resources via the internet to identify and 
link health care providers to competent and 
qualified interpreter and translation services. 
‘‘(B) TRAINING.—For purposes of pro-
viding the services described in subparagraph 
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(A), the Center shall adopt a language access 
plan that includes training requirements for 
Center staff to provide such services. 
‘‘(2) TRANSLATION OF WRITTEN MATERIAL.— 
‘‘(A) VITAL
DOCUMENTS.—The Center 
shall provide, directly or through contract, to 
providers of health care services and health 
care-related services, at no cost to such pro-
viders and in a timely and reasonable manner, 
vital documents— 
‘‘(i) which may be submitted by an 
entity described in subparagraph (C) for 
translation into non-English languages, or 
alternative formats, at a fifth-grade read-
ing level; and 
‘‘(ii) from competent translation serv-
ices, the quality of which shall be mon-
itored and reported publicly. 
‘‘(B) FORMS.—For each form developed or 
revised by the Secretary that will be used by in-
dividuals with limited English proficiency in 
health care or health care-related settings, the 
Center shall, not later than 45 calendar days of 
the Secretary receiving final approval of the 
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form from the Office of Management and 
Budget— 
‘‘(i) translate the form, at a min-
imum, into the top 15 non-English lan-
guages in the United States according to 
the most recent data from the American 
Community Survey or its replacement; and 
‘‘(ii) post all translated forms on the 
Center’s website. 
‘‘(C) ENTITIES.— 
‘‘(i) IN
GENERAL.—An entity de-
scribed in this subparagraph is— 
‘‘(I) an entity that operates a 
health program or activity, any part 
of which receives Federal financial as-
sistance; 
‘‘(II) an entity established under 
title I of the Patient Protection and 
Affordable Care Act that administers 
a health program or activity; or 
‘‘(III) the Department of Health 
and Human Services. 
‘‘(ii) HEALTH
PROGRAM
OR
ACTIV-
ITY.—For purposes of clause (i), the term 
‘health program or activity’ has the mean-
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ing given such term in section 92.4 of title 
45, Code of Federal Regulations, as in ef-
fect on July 5, 2024. 
‘‘(3) TOLL-FREE
CUSTOMER
SERVICE
TELE-
PHONE
NUMBER.—The 
Center 
shall 
provide, 
through a toll-free number, a customer service line 
for individuals with limited English proficiency that 
is linked to the toll-free telephone number 1–800– 
MEDICARE and a toll-free telephone hotline pro-
vided for pursuant to section 1311(d)(4)(B) of the 
Patient Protection and Affordable Care Act by an 
Exchange established under title I of such Act— 
‘‘(A) to obtain information about federally 
conducted or funded health programs, including 
the Medicare program under title XVIII of the 
Social Security Act, the Medicaid program 
under title XIX of such Act, and the State Chil-
dren’s Health Insurance Program under title 
XXI of such Act, and coverage available 
through an Exchange established under title I 
of the Patient Protection and Affordable Care 
Act, and other sources of free or reduced care 
including federally qualified health centers, enti-
ties receiving assistance under title X, and pub-
lic health departments; 
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‘‘(B) to obtain assistance with applying for 
or accessing these programs and understanding 
Federal notices written in English; and 
‘‘(C) to learn how to access language serv-
ices. 
‘‘(4) 
HEALTH
INFORMATION
CLEARING-
HOUSE.— 
‘‘(A) IN GENERAL.—The Center shall de-
velop and maintain, and make available on the 
internet and in print, an information clearing-
house that includes the information described in 
subparagraphs (B) through (G)— 
‘‘(i) to facilitate the provision of lan-
guage services by providers of health care 
services and health care-related services to 
reduce medical errors; 
‘‘(ii) to improve medical outcomes, im-
prove cultural competence, reduce health 
care costs caused by miscommunication 
with individuals with limited English pro-
ficiency; and 
‘‘(iii) to reduce or eliminate the dupli-
cation of efforts to translate materials. 
‘‘(B) DOCUMENT TEMPLATES.—The Cen-
ter shall collect and evaluate for accuracy, de-
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velop, and make available templates for stand-
ard documents that are necessary for patients 
and consumers to access and make educated de-
cisions about their health care, including tem-
plates for each of the following: 
‘‘(i) Administrative and legal docu-
ments, including— 
‘‘(I) intake forms; 
‘‘(II) forms related to the Medi-
care program under title XVIII of the 
Social Security Act, the Medicaid pro-
gram under title XIX of such Act, 
and the State Children’s Health In-
surance Program under title XXI of 
such Act, including eligibility informa-
tion for such programs; 
‘‘(III) forms informing patients 
of the compliance and consent re-
quirements pursuant to the regula-
tions under section 264(c) of the 
Health Insurance Portability and Ac-
countability Act of 1996; and 
‘‘(IV) documents concerning in-
formed consent, advanced directives, 
and waivers of rights. 
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‘‘(ii) Clinical information, such as how 
to take medications, how to prevent trans-
mission of a contagious disease, and other 
prevention and treatment instructions. 
‘‘(iii) Public health, patient education, 
and outreach materials, such as immuniza-
tion notices, health warnings, or screening 
notices. 
‘‘(iv) Additional health or health care- 
related materials as determined appro-
priate by the Director of the Center. 
‘‘(C) STRUCTURE
OF
FORMS.—In oper-
ating the clearinghouse, the Center shall— 
‘‘(i) ensure that the documents posted 
in English and non-English languages are 
culturally and linguistically appropriate; 
‘‘(ii) allow public review of the docu-
ments before dissemination in order to en-
sure that the documents are understand-
able and culturally and linguistically ap-
propriate for the target populations; 
‘‘(iii) allow health care providers to 
customize the documents for their use; 
‘‘(iv) facilitate access to such docu-
ments; 
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‘‘(v) provide technical assistance with 
respect to the access and use of such infor-
mation; and 
‘‘(vi) carry out any other activities the 
Secretary determines to be useful to fulfill 
the purposes of the clearinghouse. 
‘‘(D) 
LANGUAGE
ASSISTANCE
PRO-
GRAMS.—The Center shall provide for the col-
lection and dissemination of information on cur-
rent examples of language assistance programs 
and strategies to improve language services for 
individuals with limited English proficiency, in-
cluding case studies using de-identified patient 
information, program summaries, and program 
evaluations. 
‘‘(E) CULTURALLY
AND
LINGUISTICALLY 
APPROPRIATE
MATERIALS.—The Center shall 
provide, at no cost, to all health care providers 
and all providers of health care-related services, 
information relating to culturally and linguis-
tically appropriate health care for minority pop-
ulations residing in the United States, includ-
ing— 
‘‘(i) tenets of culturally and linguis-
tically appropriate care; 
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‘‘(ii) culturally and linguistically ap-
propriate self-assessment tools; 
‘‘(iii) culturally and linguistically ap-
propriate training tools; 
‘‘(iv) strategic plans to increase cul-
tural and linguistic appropriateness in dif-
ferent types of providers of health care 
services and health care-related services, 
including regional collaborations among 
health care organizations for health care 
services and health care-related services; 
and 
‘‘(v) culturally and linguistically ap-
propriate information for educators, practi-
tioners, students, and researchers. 
‘‘(F) 
TRANSLATION
GLOSSARIES.—The 
Center shall— 
‘‘(i) develop and publish on its website 
translation glossaries that provide stand-
ardized translations of commonly used 
terms and phrases utilized in documents 
translated by the Center; and 
‘‘(ii) make such glossaries available— 
‘‘(I) free of charge; 
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‘‘(II) in each language in which 
the Center translates forms under 
paragraph (2)(B); 
‘‘(III) in alternative formats in 
accordance with the Americans with 
Disabilities Act of 1990 (42 U.S.C. 
12101 et seq.); and 
‘‘(IV) in paper format upon re-
quest. 
‘‘(G) INFORMATION
ABOUT
PROGRESS.— 
The Center shall— 
‘‘(i) regularly collect and make pub-
licly 
available 
information 
about 
the 
progress of entities receiving grants under 
section 3402 regarding successful innova-
tions in implementing the requirements of 
this subsection; and 
‘‘(ii) provide public notice in the enti-
ties’ communities about the availability of 
such information. 
‘‘(b) DIRECTOR.—The Center shall be headed by a 
Director who shall be appointed by, and who shall report 
to, the Director of the Agency for Healthcare Research 
and Quality. 
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‘‘(c) AVAILABILITY OF LANGUAGE ACCESS.—The Di-
rector of the Center shall collaborate with the Deputy As-
sistant Secretary for Minority Health, the Administrator 
of the Centers for Medicare & Medicaid Services, and the 
Administrator of the Health Resources and Services Ad-
ministration to notify health care providers and health 
care organizations about the availability of language ac-
cess services by the Center. 
‘‘(d) 
EDUCATION.—The 
Secretary, 
directly 
or 
through contract, shall undertake a national education 
campaign to inform providers, individuals with limited 
English proficiency, individuals with hearing or vision im-
pairments, health professionals, graduate schools, commu-
nity health centers, social service providers, and commu-
nity-based organizations about— 
‘‘(1) Federal and State laws and guidelines gov-
erning access to language services; 
‘‘(2) the value of using trained and competent 
interpreters and the risks associated with using fam-
ily members, friends, minors, and untrained bilin-
gual staff; 
‘‘(3) funding sources for developing and imple-
menting language services; and 
‘‘(4) promising practices to effectively provide 
language services. 
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109 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2025 through 2029. 
‘‘SEC. 3402. INNOVATIONS IN CULTURALLY AND LINGUIS-
TICALLY 
APPROPRIATE 
HEALTH 
CARE 
GRANTS. 
‘‘(a) IN GENERAL.— 
‘‘(1) GRANTS.—The Secretary shall award 
grants to eligible entities to enable such entities to 
design, implement, and evaluate innovative, cost-ef-
fective programs to improve culturally and linguis-
tically appropriate access to health care services for 
individuals with limited English proficiency and com-
munication disabilities. 
‘‘(2) COORDINATION.—In making grants under 
this section, and in the design and implementation 
of the program established under this section, the 
Secretary shall coordinate with, and ensure the par-
ticipation of, other agencies including the Health Re-
sources and Services Administration, the National 
Institute on Minority Health and Health Disparities 
at the National Institutes of Health, and the Office 
of Minority Health. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall be— 
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‘‘(1) a city, county, Indian Tribe, State, or sub-
division thereof; 
‘‘(2) an organization described in section 
501(c)(3) of the Internal Revenue Code of 1986 and 
exempt from tax under section 501(a) of such Code; 
‘‘(3) a community health, mental health, or 
substance use disorder center or clinic; 
‘‘(4) a solo or group physician practice; 
‘‘(5) an integrated health care delivery system; 
‘‘(6) a public hospital; 
‘‘(7) a health care group, university, or college; 
or 
‘‘(8) any other entity designated by the Sec-
retary. 
‘‘(c) APPLICATION.—An eligible entity seeking a 
grant under this section shall prepare and submit to the 
Secretary an application, at such time, in such manner, 
and containing such additional information as the Sec-
retary may reasonably require. 
‘‘(d) USE OF FUNDS.—An entity shall use funds re-
ceived through a grant under this section to— 
‘‘(1) develop, implement, and evaluate models of 
providing competent interpretation services through 
onsite interpretation, telephonic interpretation, or 
video remote interpreting services; 
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‘‘(2) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
promote and provide language services to patient 
populations of the service area of the entity; 
‘‘(3) develop and maintain a needs assessment 
that identifies the current demographic, cultural, 
and epidemiological profile of the community to ac-
curately plan for and implement language services 
needed in the service area of the entity; 
‘‘(4) develop a strategic plan to implement lan-
guage services; 
‘‘(5) develop participatory, collaborative part-
nerships with communities encompassing the patient 
populations of individuals with limited English pro-
ficiency served by the grant to gain input in design-
ing and implementing language services; 
‘‘(6) develop and implement grievance resolu-
tion processes that are culturally and linguistically 
appropriate and capable of identifying, preventing, 
and resolving complaints by individuals with limited 
English proficiency; 
‘‘(7) develop short-term medical and mental 
health interpretation training courses and incentives 
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for bilingual health care staff who are asked to pro-
vide interpretation services in the workplace; 
‘‘(8) develop formal training programs, includ-
ing continued professional development and edu-
cation programs as well as supervision, for individ-
uals interested in becoming dedicated health care in-
terpreters and culturally and linguistically appro-
priate providers; 
‘‘(9) provide staff language training instruction, 
which shall include information on the practical limi-
tations of such instruction for nonnative speakers; 
‘‘(10) develop policies that address compensa-
tion in salary for staff who receive training to be-
come either a staff interpreter or bilingual provider; 
‘‘(11) develop other language assistance services 
as determined appropriate by the Secretary; 
‘‘(12) develop, implement, and evaluate models 
of improving cultural competence, including cultural 
competence programs for community health workers; 
‘‘(13) ensure that, consistent with the privacy 
protections provided for under the regulations pro-
mulgated under section 264(c) of the Health Insur-
ance Portability and Accountability Act of 1996 and 
any applicable State privacy laws, data on the indi-
vidual patient or recipient’s race, ethnicity, and pri-
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mary language are collected (and periodically up-
dated) in health records and integrated into the or-
ganization’s information management systems or 
any similar system used to store and retrieve data; 
and 
‘‘(14) ensure that culturally competent care and 
language assistance are available to individuals with 
limited English proficiency. 
‘‘(e) PRIORITY.—In awarding grants under this sec-
tion, the Secretary shall give priority to entities that pri-
marily engage in providing direct care and that have devel-
oped partnerships with community organizations or with 
agencies with experience in improving language access. 
‘‘(f) EVALUATION.— 
‘‘(1) BY GRANTEES.—An entity that receives a 
grant under this section shall submit to the Sec-
retary an evaluation that describes, in the manner 
and to the extent required by the Secretary, the ac-
tivities carried out with funds received under the 
grant, and how such activities improved access to 
health care services and health care-related services 
and the quality of health care for individuals with 
limited English proficiency. Such evaluation shall be 
collected and disseminated through the Robert T. 
Matsui Center for Culturally and Linguistically Ap-
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114 
propriate Health Care established under section 
3401. The Director of the Agency for Healthcare 
Research and Quality shall notify grantees of the 
availability of technical assistance for the evaluation 
and provide such assistance upon request. 
‘‘(2) BY
SECRETARY.—The Director of the 
Agency for Healthcare Research and Quality shall 
evaluate or arrange with other individuals or organi-
zations to evaluate projects funded under this sec-
tion. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2025 through 2029. 
‘‘SEC. 3403. RESEARCH ON CULTURAL AND LANGUAGE COM-
PETENCE. 
‘‘(a) IN GENERAL.—The Secretary shall expand re-
search concerning language access in the provision of 
health care services. 
‘‘(b) ELIGIBILITY.—The Secretary may conduct the 
research described in subsection (a) or enter into contracts 
with other individuals or organizations to conduct such re-
search. 
‘‘(c) USE
OF FUNDS.—Research conducted under 
this section shall be designed to do one or more of the 
following: 
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‘‘(1) To identify the barriers to mental and be-
havioral services that are faced by individuals with 
limited English proficiency. 
‘‘(2) To identify health care providers’ and 
health administrators’ knowledge and awareness of 
the barriers to quality health care services that are 
faced by individuals with limited English proficiency 
and communication disabilities. 
‘‘(3) To identify optimal approaches for deliv-
ering language access. 
‘‘(4) To identify best practices for data collec-
tion, including— 
‘‘(A) the collection by providers of health 
care services and health care-related services of 
data on the race, ethnicity, and primary lan-
guage of recipients of such services, taking into 
account existing research conducted by the Gov-
ernment or private sector; 
‘‘(B) the development and implementation 
of data collection and reporting systems; and 
‘‘(C) effective privacy safeguards for col-
lected data. 
‘‘(5) To develop a minimum data collection set 
for primary language. 
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‘‘(6) To evaluate the most effective ways in 
which the Secretary can create or coordinate, and 
subsidize or otherwise fund, telephonic interpretation 
services for health care providers, taking into consid-
eration, among other factors, the flexibility necessary 
for such a system to accommodate variations in— 
‘‘(A) provider type; 
‘‘(B) languages needed and their frequency 
of use; 
‘‘(C) type of encounter; 
‘‘(D) time of encounter, including whether 
the encounter occurs during regular business 
hours and after hours; and 
‘‘(E) location of encounter. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$5,000,000 for each of fiscal years 2025 through 2029.’’. 
SEC. 2005. PILOT PROGRAM FOR IMPROVEMENT AND DE-
VELOPMENT 
OF 
STATE 
MEDICAL 
INTER-
PRETING SERVICES. 
(a) GRANTS AUTHORIZED.—The Secretary of Health 
and Human Services (referred to in this section as the 
‘‘Secretary’’) shall award 1 grant in accordance with this 
section to each of 3 States (to be selected by the Sec-
retary) to assist each such State in designing, imple-
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menting, and evaluating a statewide program to provide 
onsite interpreter services under the State Medicaid plan. 
(b) GRANT PERIOD.—A grant awarded under this 
section is authorized for the period of 3 fiscal years begin-
ning on October 1, 2024, and ending on September 30, 
2027. 
(c) PREFERENCE.—In awarding a grant under this 
section, the Secretary shall give preference to a State— 
(1) that has a high proportion of qualified LEP 
enrollees, as determined by the Secretary; 
(2) that has a large number of qualified LEP 
enrollees, as determined by the Secretary; 
(3) that has a high growth rate of the popu-
lation of individuals with limited English proficiency, 
as determined by the Secretary; and 
(4) that has a population of qualified LEP en-
rollees that is linguistically diverse, requiring inter-
preter services in at least 200 non-English lan-
guages. 
(d) USE OF FUNDS.—A State receiving a grant under 
this section shall use the grant funds to— 
(1) ensure that all health care providers in the 
State participating in the State Medicaid plan have 
access to onsite interpreter services, for the purpose 
of enabling effective communication between such 
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providers and qualified LEP enrollees during the 
furnishing of items and services and administrative 
interactions; 
(2) establish, expand, procure, or contract for— 
(A) a statewide health care information 
technology system that is designed to achieve 
efficiencies and economies of scale with respect 
to onsite interpreter services provided to health 
care providers in the State participating in the 
State Medicaid plan; and 
(B) an entity to administer such system, 
the duties of which shall include— 
(i) procuring and scheduling inter-
preter services for qualified LEP enrollees; 
(ii) procuring and scheduling inter-
preter services for individuals with limited 
English proficiency seeking to enroll in the 
State Medicaid plan; 
(iii) ensuring that interpreters receive 
payment for interpreter services rendered 
under the system; and 
(iv) consulting regularly with organi-
zations representing LEP consumers, in-
terpreters, and health care providers; and 
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(3) develop mechanisms to establish, improve, 
and strengthen the competency of the medical inter-
pretation workforce that serves qualified LEP enroll-
ees in the State, including a national certification 
process that is valid, credible, and vendor-neutral. 
(e) APPLICATION.—To receive a grant under this sec-
tion, a State shall submit an application at such time and 
containing such information as the Secretary may require, 
which shall include the following: 
(1) A description of the language access needs 
of individuals in the State enrolled in the State Med-
icaid plan. 
(2) A description of the extent to which the 
program will— 
(A) use the grant funds for the purposes 
described in subsection (d); 
(B) meet the health care needs of rural 
populations of the State; and 
(C) collect information that accurately 
tracks the language services requested by con-
sumers as compared to the language services 
provided by health care providers in the State 
participating in the State Medicaid plan. 
(3) A description of how the program will be 
evaluated, including a proposal for collaboration with 
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organizations representing interpreters, consumers, 
and individuals with limited English proficiency. 
(f) DEFINITIONS.—In this section: 
(1) QUALIFIED
LEP
ENROLLEE.—The term 
‘‘qualified LEP enrollee’’ means an individual— 
(A) who is limited English proficient; and 
(B) who is enrolled in a State Medicaid 
plan. 
(2) STATE.—The term ‘‘State’’ has the mean-
ing given the term in section 1101(a)(1) of the So-
cial Security Act (42 U.S.C. 1301(a)(1)), for pur-
poses of title XIX of such Act (42 U.S.C. 1396 et 
seq.). 
(3) STATE MEDICAID PLAN.—The term ‘‘State 
Medicaid plan’’ means a State plan under title XIX 
of the Social Security Act (42 U.S.C. 1396 et seq.) 
or a waiver of such a plan. 
(4) 
UNITED
STATES.—The 
term 
‘‘United 
States’’ has the meaning given the term in section 
1101(a)(2) of the Social Security Act (42 U.S.C. 
1301(a)(2)), for purposes of title XIX of such Act 
(42 U.S.C. 1396 et seq.). 
(g) CONTINUATION PAST DEMONSTRATION.—Any 
State receiving a grant under this section must agree to 
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directly pay for language services in Medicaid for all Med-
icaid providers by the end of the grant period. 
(h) FUNDING.— 
(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated $5,000,000 
to carry out this section. 
(2) AVAILABILITY OF FUNDS.—Amounts appro-
priated pursuant to the authorization in paragraph 
(1) are authorized to remain available without fiscal 
year limitation. 
(3) INCREASED FEDERAL FINANCIAL PARTICI-
PATION.—Section 1903(a)(2)(E) of the Social Secu-
rity Act (42 U.S.C. 1396b(a)(2)(E)) is amended by 
inserting ‘‘(or, in the case of a State that was 
awarded a grant under section 2005 of the Health 
Equity and Accountability Act of 2024, 100 percent 
for each quarter occurring during the grant period 
specified in subsection (b) of such section)’’ after 
‘‘75 percent’’. 
(i) LIMITATION.—No Federal funds awarded under 
this section may be used to provide interpreter services 
from a location outside the United States. 
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SEC. 2006. TRAINING TOMORROW’S DOCTORS FOR CUL-
TURALLY 
AND 
LINGUISTICALLY 
APPRO-
PRIATE CARE: GRADUATE MEDICAL EDU-
CATION. 
(a) DIRECT GRADUATE MEDICAL EDUCATION.—Sec-
tion 1886(h)(4) of the Social Security Act (42 U.S.C. 
1395ww(h)(4)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(L) TREATMENT
OF
CULTURALLY
AND 
LINGUISTICALLY
APPROPRIATE
TRAINING.—In 
determining a hospital’s number of full-time 
equivalent residents for purposes of this sub-
section, all the time that is spent by an intern 
or resident in an approved medical residency 
training program for education and training in 
culturally and linguistically appropriate service 
delivery, which shall include all medically under-
served populations (as defined in section 
330(b)(3) of the Public Health Service Act), 
shall be counted toward the determination of 
full-time equivalency.’’. 
(b) 
INDIRECT
MEDICAL
EDUCATION.—Section 
1886(d)(5)(B) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(B)) is amended by adding at the end the 
following new clause: 
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‘‘(xiv) The provisions of subparagraph (L) of 
subsection (h)(4) shall apply under this subpara-
graph in the same manner as they apply under such 
subsection.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
subsections (a) and (b) shall apply with respect to pay-
ments made to hospitals on or after the date that is 1 
year after the date of the enactment of this Act. 
SEC. 2007. FEDERAL REIMBURSEMENT FOR CULTURALLY 
AND LINGUISTICALLY APPROPRIATE SERV-
ICES UNDER THE MEDICARE, MEDICAID, AND 
STATE 
CHILDREN’S 
HEALTH 
INSURANCE 
PROGRAMS. 
(a) LANGUAGE ACCESS GRANTS
FOR MEDICARE 
PROVIDERS.— 
(1) ESTABLISHMENT.— 
(A) IN
GENERAL.—Not later than 6 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices (in this subsection referred to as the ‘‘Sec-
retary’’), acting through the Centers for Medi-
care & Medicaid Services and in consultation 
with the Center for Medicare and Medicaid In-
novation (as referred to in section 1115A of the 
Social Security Act (42 U.S.C. 1315a)), shall 
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establish a demonstration program under which 
the Secretary shall award grants to eligible 
Medicare service providers to provide culturally 
and linguistically appropriate services to Medi-
care beneficiaries who are limited English pro-
ficient, including beneficiaries who live in di-
verse and underserved communities. 
(B) 
APPLICATION
OF
INNOVATION 
RULES.—The demonstration project under sub-
paragraph (A) shall be conducted in a manner 
that is consistent with the applicable provisions 
of subsections (b), (c), and (d) of section 1115A 
of the Social Security Act (42 U.S.C. 1315a). 
(C) NUMBER OF GRANTS.—To the extent 
practicable, the Secretary shall award not less 
than 24 grants under this subsection. 
(D) GRANT PERIOD.—Except as provided 
in paragraph (2)(D), each grant awarded under 
this subsection shall be for a 3-year period. 
(2) ELIGIBILITY REQUIREMENTS.—To be eligi-
ble for a grant under this subsection, an entity must 
meet the following requirements: 
(A) MEDICARE
PROVIDER.—The entity 
must be— 
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(i) a provider of services under part A 
of title XVIII of the Social Security Act 
(42 U.S.C. 1395c et seq.); 
(ii) a provider of services under part 
B of such title (42 U.S.C. 1395j et seq.); 
(iii) a Medicare Advantage organiza-
tion offering a Medicare Advantage plan 
under part C of such title (42 U.S.C. 
1395w–21 et seq.); or 
(iv) a PDP sponsor offering a pre-
scription drug plan under part D of such 
title (42 U.S.C. 1395w–101 et seq.). 
(B) UNDERSERVED
COMMUNITIES.—The 
entity must serve a community that, with re-
spect to necessary language services for improv-
ing access and utilization of health care among 
individuals who are limited English proficient, 
is disproportionally underserved. 
(C) APPLICATION.—The entity must pre-
pare and submit to the Secretary an applica-
tion, at such time, in such manner, and accom-
panied by such additional information as the 
Secretary may require. 
(D) REPORTING.—In the case of a grantee 
that received a grant under this subsection in 
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a previous year, such grantee is only eligible for 
continued payments under a grant under this 
subsection if the grantee met the reporting re-
quirements under paragraph (9) for such year. 
If a grantee fails to meet the requirements of 
such paragraph for the first year of a grant, the 
Secretary may terminate the grant and solicit 
applications from new grantees to participate in 
the demonstration program. 
(3) DISTRIBUTION.—To the extent feasible, the 
Secretary shall award— 
(A) at least 10 grants to providers of serv-
ices described in paragraph (2)(A)(i); 
(B) at least 10 grants to service providers 
described in paragraph (2)(A)(ii); 
(C) at least 10 grants to organizations de-
scribed in paragraph (2)(A)(iii); and 
(D) at least 10 grants to sponsors de-
scribed in paragraph (2)(A)(iv). 
(4) CONSIDERATIONS IN AWARDING GRANTS.— 
(A) VARIATION
AMONG
GRANTEES.—In 
awarding grants under this subsection, the Sec-
retary shall select grantees to ensure the fol-
lowing: 
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(i) The grantees provide many dif-
ferent types of language services. 
(ii) The grantees serve Medicare bene-
ficiaries who speak different languages, 
and who, as a population, have differing 
needs for language services. 
(iii) The grantees serve Medicare 
beneficiaries in both urban and rural set-
tings. 
(iv) The grantees represent each Cen-
ters for Medicare & Medicaid Services re-
gion, as defined by the Secretary. 
(v) The grantees serve Medicare bene-
ficiaries in at least 2 large metropolitan 
statistical areas with diverse populations, 
including diversity in race, ethnicity, sexual 
orientation, gender identity, disability sta-
tus, and socioeconomic status. 
(B) PRIORITY
FOR
PARTNERSHIPS
WITH 
COMMUNITY ORGANIZATIONS AND AGENCIES.— 
In awarding grants under this subsection, the 
Secretary shall give priority to eligible entities 
that have a partnership with 1 or more of the 
following entities that have experience in pro-
viding language services: 
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(i) A community organization. 
(ii) A consortium of community orga-
nizations, State agencies, and local agen-
cies. 
(5) USE OF FUNDS FOR COMPETENT LANGUAGE 
SERVICES.— 
(A) IN
GENERAL.—Subject to subpara-
graph (E), a grantee may only use grant funds 
received under this subsection to pay for the 
provision of competent language services to 
Medicare beneficiaries who are individuals who 
are limited English proficient to supplement ex-
isting Medicare requirements. 
(B) COMPETENT LANGUAGE SERVICES DE-
FINED.—For purposes of this subsection, the 
term ‘‘competent language services’’ means— 
(i) interpreter and translation services 
that— 
(I) subject to the exceptions 
under subparagraph (C)— 
(aa) if the grantee operates 
in a State that has statewide 
health care interpreter standards, 
meet the State standards cur-
rently in effect; or 
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(bb) if the grantee operates 
in a State that does not have 
statewide health care interpreter 
standards, utilize competent in-
terpreters who follow the Na-
tional Council on Interpreting in 
Health Care’s Code of Ethics and 
Standards of Practice and com-
ply with the requirements of sec-
tion 1557 of the Patient Protec-
tion and Affordable Care Act (42 
U.S.C. 18116) as published in 
the Federal Register on May 18, 
2016, 81 Fed. Reg. 31375; and 
(II) in the case of interpreter 
services, are provided through— 
(aa) onsite interpretation; 
(bb) telephonic interpreta-
tion; or 
(cc) 
video 
interpretation; 
and 
(ii) the direct provision of health care 
or health care-related services by a com-
petent bilingual health care provider. 
(C) EXCEPTIONS.— 
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(i) IN
GENERAL.—The requirements 
of subparagraph (B)(i)(I) do not apply, 
with respect to interpreter and translation 
services and a grantee— 
(I) in the case of a Medicare ben-
eficiary who is limited English pro-
ficient, if— 
(aa) such beneficiary has 
been informed, in the bene-
ficiary’s primary language, of the 
availability of free interpreter 
and translation services and the 
beneficiary instead requests that 
a family member, friend, or other 
person provide such services; and 
(bb) the grantee documents 
such request in the beneficiary’s 
medical record; or 
(II) subject to clause (ii), in the 
case of a medical emergency where 
the delay directly associated with ob-
taining a competent interpreter or 
translation services would jeopardize 
the health of the patient. 
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(ii) CLARIFICATION.—Clause (i)(II) 
shall not be construed to exempt emer-
gency rooms or similar entities that regu-
larly provide health care services in med-
ical emergencies to patients who are indi-
viduals who are limited English proficient 
from any applicable legal or regulatory re-
quirements related to providing competent 
interpreter and translation services without 
undue delay. 
(D) MEDICARE
ADVANTAGE
ORGANIZA-
TIONS AND PDP SPONSORS.—A grantee that is 
a Medicare Advantage organization or a pre-
scription drug plan sponsor must provide at 
least 50 percent of the grant funds that the 
grantee receives under this subsection directly 
to the entity’s network providers (including all 
health providers and pharmacists) for the pur-
pose of providing support for such providers to 
provide competent language services to Medi-
care beneficiaries who are individuals who are 
limited English proficient. 
(E) ADMINISTRATIVE
AND
REPORTING 
COSTS.—A grantee may use up to 10 percent of 
the grant funds to pay for administrative costs 
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associated with the provision of competent lan-
guage services and for reporting required under 
paragraph (9). 
(6) DETERMINATION
OF
AMOUNT
OF
GRANT 
PAYMENTS.— 
(A) IN GENERAL.—Payments to grantees 
under this subsection shall be calculated based 
on the estimated numbers of Medicare bene-
ficiaries who are limited English proficient in a 
grantee’s service area utilizing— 
(i) data on the numbers of English 
learners who speak English less than ‘‘very 
well’’ from the most recently available data 
from the Bureau of the Census or other 
State-based study the Secretary determines 
is likely to yield accurate data regarding 
the number of such individuals in such 
service area; or 
(ii) data provided by the grantee, if 
the grantee routinely collects data on the 
primary language of the Medicare bene-
ficiaries that the grantee serves and the 
Secretary determines that the data is accu-
rate and shows a greater number of indi-
viduals who are limited English proficient 
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than would be estimated using the data 
under clause (i). 
(B) DISCRETION OF SECRETARY.—Subject 
to subparagraph (C), the amount of payment 
made to a grantee under this subsection may be 
modified annually at the discretion of the Sec-
retary, based on changes in the data under sub-
paragraph (A) with respect to the service area 
of a grantee for the year. 
(C) 
LIMITATION
ON
AMOUNT.—The 
amount of a grant made under this subsection 
to a grantee may not exceed $500,000 for the 
period under paragraph (1)(D). 
(7) ASSURANCES.—Grantees under this sub-
section shall, as a condition of receiving a grant 
under this subsection— 
(A) ensure that clinical and support staff 
receive appropriate ongoing education and 
training in linguistically appropriate service de-
livery; 
(B) ensure the linguistic competence of bi-
lingual providers; 
(C) offer and provide appropriate language 
services at no additional charge to each patient 
who is limited English proficient for all points 
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134 
of contact between the patient and the grantee, 
in a timely manner during all hours of oper-
ation; 
(D) notify Medicare beneficiaries of their 
right to receive language services in their pri-
mary language at least annually; 
(E) post signage in the primary languages 
commonly used by the patient population in the 
service area of the organization; and 
(F) ensure that— 
(i) primary language data are col-
lected for recipients of language services 
and such data are consistent with stand-
ards developed under title XXXIV of the 
Public Health Service Act, as added by 
section 2002 of this Act, to the extent such 
standards are available upon the initiation 
of the demonstration program; and 
(ii) consistent with the privacy protec-
tions provided under the regulations pro-
mulgated pursuant to section 264(c) of the 
Health Insurance Portability and Account-
ability Act of 1996 (42 U.S.C. 1320d–2 
note), if the recipient of language services 
is a minor or is incapacitated, primary lan-
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guage data must also be collected on the 
parent or legal guardian of such recipient. 
(8) NO COST SHARING.—Medicare beneficiaries 
who are limited English proficient shall not have to 
pay cost sharing or co-payments for competent lan-
guage services provided under this demonstration 
program. 
(9) REPORTING
REQUIREMENTS
FOR
GRANT-
EES.—Not later than the end of each calendar year, 
a grantee that receives funds under this subsection 
in such year shall submit to the Secretary a report 
that includes the following information: 
(A) The number of Medicare beneficiaries 
to whom competent language services are pro-
vided, disaggregated by age and entitlement 
basis (on the basis of age, disability, or deter-
mination of end stage renal disease). 
(B) The primary languages of those Medi-
care beneficiaries. 
(C) The types of language services pro-
vided to such beneficiaries. 
(D) Whether such language services were 
provided by employees of the grantee or 
through a contract with external contractors or 
agencies. 
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136 
(E) The types of interpretation services 
provided to such beneficiaries, and the approxi-
mate length of time such service is provided to 
such beneficiaries. 
(F) The costs of providing competent lan-
guage services. 
(G) An account of the training or accredi-
tation of bilingual staff, interpreters, and trans-
lators providing services funded by the grant 
under this subsection. 
(10) EVALUATION
AND
REPORT
TO
CON-
GRESS.—Not later than 1 year after the completion 
of a 3-year grant under this subsection, the Sec-
retary shall conduct an evaluation of the demonstra-
tion program under this subsection and shall submit 
to the Congress a report that includes the following: 
(A) An analysis of the patient outcomes 
and the costs of furnishing care to the Medicare 
beneficiaries who are individuals who are lim-
ited English proficient participating in the 
project as compared to such outcomes and costs 
for such Medicare beneficiaries not partici-
pating, based on the data provided under para-
graph (9) and any other information available 
to the Secretary. 
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137 
(B) The effect of delivering language serv-
ices on— 
(i) Medicare beneficiary access to care 
and utilization of services; 
(ii) the efficiency and cost-effective-
ness of health care delivery; 
(iii) patient satisfaction with respect 
to both health service delivery and lan-
guage assistance; 
(iv) health outcomes; and 
(v) the provision of culturally appro-
priate services provided to such bene-
ficiaries. 
(C) The extent to which bilingual staff, in-
terpreters, and translators providing services 
under such demonstration were trained or ac-
credited and the nature of accreditation or 
training needed by type of provider, service, or 
other category as determined by the Secretary 
to ensure the provision of high-quality interpre-
tation, translation, or other language services to 
Medicare beneficiaries if such services are ex-
panded pursuant to section 1115A(c) of the So-
cial Security Act (42 U.S.C. 1315a(c)). 
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138 
(D) Recommendations, if any, regarding 
the extension of such project to the entire Medi-
care Program, subject to the provisions of such 
section 1115A(c). 
(11) APPROPRIATIONS.—There is appropriated 
to carry out this subsection, in equal parts from the 
Federal Hospital Insurance Trust Fund under sec-
tion 1817 of the Social Security Act (42 U.S.C. 
1395i) and the Federal Supplementary Medical In-
surance Trust Fund under section 1841 of such Act 
(42 U.S.C. 1395t), $16,000,000 for each fiscal year 
of the demonstration program. 
(12) 
LIMITED
ENGLISH
PROFICIENT
DE-
FINED.—In this subsection, the term ‘‘limited 
English proficient’’ means individuals who self-iden-
tify on the Census as speaking English less than 
‘‘very well’’. 
(b) LANGUAGE ASSISTANCE SERVICES UNDER THE 
MEDICARE PROGRAM.— 
(1) INCLUSION
AS
RURAL
HEALTH
CLINIC 
SERVICES.—Section 1861 of the Social Security Act 
(42 U.S.C. 1395x) is amended— 
(A) in subsection (aa)(1)— 
(i) in subparagraph (C), by striking 
‘‘and’’ at the end; 
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(ii) in subparagraph (D), by inserting 
‘‘and’’ after the comma at the end; and 
(iii) by inserting after subparagraph 
(D) the following new subparagraph: 
‘‘(E) language assistance services as defined in 
subsection (nnn),’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘Language Assistance Services and Related Terms 
‘‘(nnn) The term ‘language assistance services’ means 
‘language access’ or ‘language assistance services’ (as 
those terms are defined in section 3400 of the Public 
Health Service Act) furnished by a ‘qualified interpreter 
for an individual with limited English proficiency’ or a 
‘qualified translator’ (as those terms are defined in such 
section 3400) to an ‘individual with limited English pro-
ficiency’ (as defined in such section 3400).’’. 
(2) COVERAGE.—Section 1832(a)(2) of the So-
cial Security Act (42 U.S.C. 1395k(a)(2)) is amend-
ed— 
(A) in subparagraph (I), by striking ‘‘and’’ 
at the end; 
(B) in subparagraph (J), by striking the 
period at the end and inserting ‘‘; and’’; and 
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140 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) language assistance services (as de-
fined in section 1861(nnn)).’’. 
(3) PAYMENT.—Section 1833(a) of the Social 
Security Act (42 U.S.C. 1395l(a)) is amended— 
(A) in paragraph (9), by striking ‘‘and’’ at 
the end; 
(B) in paragraph (10), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(C) by inserting after paragraph (10) the 
following new paragraph: 
‘‘(11) in the case of language assistance serv-
ices (as defined in section 1861(nnn)), 100 percent 
of the reasonable charges for such services, as deter-
mined in consultation with the Medicare Payment 
Advisory Commission.’’. 
(4) WAIVER
OF
BUDGET
NEUTRALITY.—For 
the 3-year period beginning on the date of enact-
ment of this section, the budget neutrality provision 
of section 1848(c)(2)(B)(ii) of the Social Security 
Act (42 U.S.C. 1395w–4(c)(2)(B)(ii)) shall not 
apply with respect to language assistance services 
(as defined in section 1861(nnn) of such Act). 
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141 
(c) MEDICARE PARTS C AND D; MEDICARE ADVAN-
TAGE PLANS AND PRESCRIPTION DRUG PLANS REPORT-
ING REQUIREMENT.—Section 1857(e) of the Social Secu-
rity Act (42 U.S.C. 1395w–27(e)) is amended by adding 
at the end the following new paragraph: 
‘‘(6) REPORTING REQUIREMENTS RELATING TO 
EFFECTIVE LANGUAGE SERVICES.—A contract under 
this part shall require a Medicare Advantage organi-
zation (and, through application of section 1860D– 
12(b)(3)(D), a contract under section 1860D–12 
shall require a PDP sponsor) to annually submit 
(for each year of the contract) a report that contains 
information on the internal policies and procedures 
of the organization (or sponsor) related to recruit-
ment and retention efforts directed to workforce di-
versity and linguistically and culturally appropriate 
provision of services in each of the following con-
texts: 
‘‘(A) The collection of data in a manner 
that meets the requirements of title I of the 
Health Equity and Accountability Act of 2024, 
regarding the enrollee population. 
‘‘(B) Education of staff and contractors 
who have routine contact with enrollees regard-
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142 
ing the various needs of the diverse enrollee 
population. 
‘‘(C) Evaluation of the language services 
programs and services offered by the organiza-
tion (or sponsor) with respect to the enrollee 
population, such as through analysis of com-
plaints or satisfaction survey results. 
‘‘(D) Methods by which the plan provides 
to the Secretary information regarding the eth-
nic diversity of the enrollee population. 
‘‘(E) The periodic provision of educational 
information to plan enrollees on the language 
services and programs offered by the organiza-
tion (or sponsor).’’. 
(d) IMPROVING LANGUAGE SERVICES IN MEDICAID 
AND CHIP.— 
(1) 
PAYMENTS
TO
STATES.—Section 
1903(a)(2)(E) of the Social Security Act (42 U.S.C. 
1396b(a)(2)(E)), as amended by section 2005(h)(3), 
is further amended by— 
(A) striking ‘‘75’’ and inserting ‘‘95’’; 
(B) striking ‘‘translation or interpretation 
services’’ and inserting ‘‘language assistance 
services’’; and 
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(C) striking ‘‘children of families’’ and in-
serting ‘‘individuals’’. 
(2) STATE
PLAN
REQUIREMENTS.—Section 
1902(a)(10)(A) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(A)) is amended by striking 
‘‘and (30)’’ and inserting ‘‘(30), and (32)’’. 
(3) DEFINITION
OF
MEDICAL
ASSISTANCE.— 
Section 1905(a) of the Social Security Act (42 
U.S.C. 1396d(a)) is amended— 
(A) in paragraph (31), by striking ‘‘and’’ 
at the end; 
(B) by redesignating paragraph (32) as 
paragraph (33); and 
(C) by inserting after paragraph (31) the 
following new paragraph: 
‘‘(32) language assistance services, as such 
term is defined in section 1861(nnn), provided in a 
timely manner to individuals with limited English 
proficiency as defined in section 3400 of the Public 
Health Service Act; and’’. 
(4) USE
OF
DEDUCTIONS
AND
COST
SHAR-
ING.—Subsections (a)(2) and (b)(2) of section 1916 
of the Social Security Act (42 U.S.C. 1396o) are 
each amended— 
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(A) in subparagraph (I), by striking ‘‘or’’ 
at the end; 
(B) in subparagraph (J), by striking ‘‘; 
and’’ and inserting ‘‘, or’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(K) language assistance services described 
in section 1905(a)(32); and’’. 
(5) CHIP COVERAGE REQUIREMENTS.—Section 
2103 of the Social Security Act (42 U.S.C. 1397cc) 
is amended— 
(A) in subsection (a), in the matter before 
paragraph (1), by striking ‘‘(5), (6), (7) and 
(8)’’ and inserting ‘‘(5) through (13)’’; 
(B) in subsection (c), by adding at the end 
the following new paragraph: 
‘‘(13) LANGUAGE ASSISTANCE SERVICES.—The 
child health assistance provided to a targeted low-in-
come child shall include coverage of language assist-
ance services, as such term is defined in section 
1861(nnn), provided in a timely manner to individ-
uals with limited English proficiency (as defined in 
section 3400 of the Public Health Service Act).’’; 
and 
(C) in subsection (e)(2)— 
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(i) in the heading, by striking ‘‘PRE-
VENTIVE’’ and inserting ‘‘CERTAIN’’; and 
(ii) by inserting ‘‘language assistance 
services described in subsection (c)(12),’’ 
before ‘‘or for pregnancy-related assist-
ance’’. 
(6) DEFINITION
OF
CHILD
HEALTH
ASSIST-
ANCE.—Section 2110(a)(27) of the Social Security 
Act (42 U.S.C. 1397jj(a)(27)) is amended by strik-
ing ‘‘transportation, translation, and outreach serv-
ices’’ and inserting ‘‘transportation services, lan-
guage assistance services as described in section 
2103(c)(13), and outreach services’’. 
(7) STATE
DATA
COLLECTION.—Pursuant to 
the reporting requirement described in section 
2107(b)(1) of the Social Security Act (42 U.S.C. 
1397gg(b)(1)), the Secretary of Health and Human 
Services shall require that States collect data on— 
(A) the primary language of individuals re-
ceiving child health assistance under title XXI 
of the Social Security Act (42 U.S.C. 1397aa et 
seq.); and 
(B) in the case of such individuals who are 
minors or incapacitated, the primary language 
of the individual’s parent or guardian. 
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(8) CHIP PAYMENTS
TO
STATES.—Section 
2105 of the Social Security Act (42 U.S.C. 1397ee) 
is amended— 
(A) in subsection (a)(1)— 
(i) in the matter preceding subpara-
graph (A), by striking ‘‘75’’ and inserting 
‘‘95’’; and 
(ii) in subparagraph (D)(iv), by strik-
ing ‘‘translation or interpretation services’’ 
and inserting ‘‘language assistance serv-
ices’’; and 
(B) in subsection (c)(2)(A), by inserting 
before the period at the end the following: ‘‘, 
except that expenditures pursuant to clause (iv) 
of subparagraph (D) of such paragraph shall 
not count towards this total’’. 
(e) FUNDING
LANGUAGE
ASSISTANCE
SERVICES 
FURNISHED
BY PROVIDERS
OF HEALTH CARE
AND 
HEALTH CARE-RELATED SERVICES THAT SERVE HIGH 
RATES OF UNINSURED LEP INDIVIDUALS.— 
(1) PAYMENT OF COSTS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary of Health and Human 
Services (referred to in this subsection as the 
‘‘Secretary’’) shall make payments (on a quar-
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terly basis) directly to eligible entities to sup-
port the provision of language assistance serv-
ices to individuals with limited English pro-
ficiency in an amount equal to an eligible enti-
ty’s eligible costs for providing such services for 
the quarter. 
(B) FUNDING.—Out of any funds in the 
Treasury not otherwise appropriated, there are 
appropriated to the Secretary such sums as 
may be necessary for each of fiscal years 2025 
through 2029. 
(C) RELATION TO MEDICAID DSH.—Pay-
ments under this subsection shall not offset or 
reduce payments under section 1923 of the So-
cial Security Act (42 U.S.C. 1396r–4), nor 
shall payments under such section be consid-
ered when determining uncompensated costs as-
sociated with the provision of language assist-
ance services for the purposes of this sub-
section. 
(2) 
METHODOLOGY
FOR
PAYMENT
OF 
CLAIMS.— 
(A) IN GENERAL.—The Secretary shall es-
tablish a methodology to determine the average 
per person cost of language assistance services. 
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(B) 
DIFFERENT
ENTITIES.—In 
estab-
lishing such methodology, the Secretary may es-
tablish different methodologies for different 
types of eligible entities. 
(C) NO
INDIVIDUAL
CLAIMS.—The Sec-
retary may not require eligible entities to sub-
mit individual claims for language assistance 
services for individual patients as a requirement 
for payment under this subsection. 
(3) DATA COLLECTION INSTRUMENT.—For pur-
poses of this subsection, the Secretary shall create a 
standard data collection instrument that is con-
sistent with any existing reporting requirements by 
the Secretary or relevant accrediting organizations 
regarding the number of individuals to whom lan-
guage access is provided. 
(4) GUIDELINES.—Not later than 6 months 
after the date of enactment of this Act, the Sec-
retary shall establish and distribute guidelines con-
cerning the implementation of this subsection. 
(5) REPORTING REQUIREMENTS.— 
(A) REPORT TO SECRETARY.—Entities re-
ceiving payment under this subsection shall pro-
vide the Secretary with a quarterly report on 
how the entity used such funds. Such report 
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149 
shall contain aggregate (and may not contain 
individualized) data collected using the instru-
ment under paragraph (3) and shall otherwise 
be in a form and manner determined by the 
Secretary. 
(B) REPORT
TO
CONGRESS.—Not later 
than 2 years after the date of enactment of this 
Act, and every 2 years thereafter, the Secretary 
shall submit a report to Congress concerning 
the implementation of this subsection. 
(6) DEFINITIONS.—In this subsection: 
(A) ELIGIBLE COSTS.—The term ‘‘eligible 
costs’’ means, with respect to an eligible entity 
that provides language assistance services to 
limited English proficient individuals, the prod-
uct of— 
(i) the average per person cost of lan-
guage assistance services, determined ac-
cording to the methodology devised under 
paragraph (2); and 
(ii) the number of individuals with 
limited English proficiency who are pro-
vided language assistance services by the 
entity and for whom no reimbursement is 
available for such services under the 
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amendments made by subsection (a), (b), 
(c), or (d), or by private health insurance. 
(B) ELIGIBLE ENTITY.—The term ‘‘eligible 
entity’’ means an entity that— 
(i) is a Medicaid provider that is— 
(I) a physician; 
(II) a hospital with a low-income 
utilization rate (as defined in section 
1923(b)(3) of the Social Security Act 
(42 U.S.C. 1396r–4(b)(3))) of greater 
than 25 percent; 
(III) a Federally qualified health 
center 
(as 
defined 
in 
section 
1905(l)(2)(B) of the Social Security 
Act (42 U.S.C. 1396d(l)(2)(B))); 
(IV) a hospice provider; or 
(V) a palliative care provider; 
(ii) not later than 6 months after the 
date of the enactment of this Act, provides 
language assistance services to not less 
than 8 percent of the entity’s total number 
of patients; and 
(iii) prepares and submits an applica-
tion to the Secretary, at such time, in such 
manner, and accompanied by such infor-
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mation as the Secretary may require, to 
ascertain the entity’s eligibility for funding 
under this subsection. 
(C) LANGUAGE
ASSISTANCE
SERVICES.— 
The term ‘‘language assistance services’’ has 
the meaning given such term in section 
1861(nnn) of the Social Security Act, as added 
by subsection (b). 
(f) APPLICATION OF CIVIL RIGHTS ACT OF 1964, 
SECTION 1557 OF THE AFFORDABLE CARE ACT, AND 
OTHER LAWS.—Nothing in this section shall be construed 
to limit otherwise existing obligations of recipients of Fed-
eral financial assistance under title VI of the Civil Rights 
Act of 1964 (42 U.S.C. 2000d et seq.), section 1557 of 
the Affordable Care Act (42 U.S.C. 18116), or other laws 
that protect the civil rights of individuals. 
(g) EFFECTIVE DATE.— 
(1) IN
GENERAL.—Except as otherwise pro-
vided and subject to paragraph (2), the amendments 
made by this section shall take effect on January 1, 
2025. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) or a State plan for child 
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