I 
109TH CONGRESS 
2D SESSION 
H. R. 6275 
To improve the health of minority individuals. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2006 
Mrs. CHRISTENSEN (for herself, Mr. DAVIS of Alabama, and Ms. NORTON) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committees on Education and 
the Workforce, the Judiciary, Ways and Means, and Resources, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To improve the health of minority individuals. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Health Equity and 
Justice Act of 2006’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
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TITLE I—CULTURALLY AND LINGUISTICALLY APPROPRIATE 
HEALTH CARE 
Sec. 101. Amendment to the Public Health Service Act. 
Sec. 102. Standards for language access services. 
Sec. 103. Federal reimbursement for culturally and linguistically appropriate 
services under the Medicare, Medicaid and State Children’s 
Health Insurance Program. 
Sec. 104. Increasing understanding of health literacy. 
Sec. 105. Report on Federal efforts to provide culturally and linguistically ap-
propriate healthcare services. 
Sec. 106. General Accounting Office report on impact of language access serv-
ices. 
Sec. 107. Definitions. 
Sec. 108. Treatment of the Medicare part B program under title VI of the Civil 
Rights Act of 1964. 
TITLE II—HEALTH WORKFORCE DIVERSITY 
Sec. 201. Amendment to the Public Health Service Act. 
Sec. 202. Health Careers Opportunity Program. 
Sec. 203. Program of Excellence in Health Professions Education for Under-
represented Minorities. 
Sec. 204. Hispanic-serving health professions schools. 
Sec. 205. Health Professions Student Loan fund; authorizations of appropria-
tions regarding students from disadvantaged backgrounds. 
Sec. 206. National Health Service Corps; recruitment and fellowships for indi-
viduals from disadvantaged backgrounds. 
Sec. 207. Loan Repayment Program of the Centers for Disease Control and 
Prevention. 
Sec. 208. Cooperative agreements for online degree programs at schools of pub-
lic health and schools of allied health. 
Sec. 209. Mid-career health professions scholarship program. 
Sec. 210. Strengthening and expanding rural health provider networks. 
Sec. 211. National report on the preparedness of health professionals to care 
for diverse populations. 
Sec. 212. Scholarship and fellowship programs. 
Sec. 213. Advisory Committee on Health Professions Training for Diversity. 
Sec. 214. McNair Postbaccalaureate Achievement program. 
TITLE III—DATA COLLECTION AND REPORTING 
Sec. 301. Amendment to the Public Health Service Act. 
Sec. 302. Collection of race and ethnicity data by the Social Security Adminis-
tration. 
Sec. 303. Revision of HIPAA claims standards. 
Sec. 304. National Center for Health Statistics. 
Sec. 305. Geo-access study. 
Sec. 306. Racial, ethnic, and linguistic data collected by the Federal Govern-
ment. 
TITLE IV—ACCOUNTABILITY AND EVALUATION 
Subtitle A—General Provisions 
Sec. 401. Report on workforce diversity. 
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Sec. 402. Federal agency plan to eliminate disparities and improve the health 
of minority populations. 
Sec. 403. Accountability within the Department of Health and Human Services. 
Sec. 404. Office of Minority Health Disparity Elimination. 
Sec. 405. Establishment of the Indian Health Service as an agency of the Pub-
lic Health Service. 
Sec. 406. Establishment of individual offices of minority health within agencies 
of the Public Health Service. 
Sec. 407. Office of Minority Health at the Centers for Medicare and Medicaid 
Services. 
Sec. 408. Office of Minority Affairs at the Food and Drug Administration. 
Sec. 409. Safety and effectiveness of drugs with respect to racial and ethnic 
background. 
Sec. 410. United States Commission on Civil Rights. 
Sec. 411. Sense of Congress concerning full funding of activities to eliminate 
racial and ethnic health disparities. 
Sec. 412. Guidelines for disease screening for minority patients. 
Subtitle B—Improving Environmental Justice 
Sec. 421. Definitions. 
Sec. 422. Environmental justice responsibilities of Federal agencies. 
Sec. 423. Interagency environmental justice working group. 
Sec. 424. Federal agency strategies. 
Sec. 425. Federal Environmental Justice Advisory Committee. 
Sec. 426. Human health and environmental research, data collection and anal-
ysis. 
TITLE V—HEALTH EMPOWERMENT ZONES 
Sec. 501. Health empowerment zones. 
TITLE I—CULTURALLY AND LIN-
GUISTICALLY 
APPROPRIATE 
HEALTH CARE 
SEC. 101. AMENDMENT TO 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: 
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‘‘TITLE XXIX—CULTURALLY AND 
LINGUISTICALLY 
APPRO-
PRIATE HEALTHCARE 
‘‘SEC. 2900. DEFINITIONS. 
‘‘In this title: 
‘‘(1) APPROPRIATE HEALTHCARE SERVICES.— 
The term ‘appropriate healthcare services’ includes 
services or treatments to address physical, mental, 
and behavioral disorders or syndromes. 
‘‘(2) INDIAN TRIBE.—The term ‘Indian tribe’ 
means any Indian tribe, band, nation, or other orga-
nized group or community, including any Alaska Na-
tive village or group or regional or village corpora-
tion as defined in or established pursuant to the 
Alaska Native Claims Settlement Act (85 Stat. 688) 
(43 U.S.C. 1601 et seq.), which is recognized as eli-
gible for the special programs and services provided 
by the United States to Indians because of their sta-
tus as Indians. 
‘‘(3) LIMITED
ENGLISH
PROFICIENT.—The 
term ‘limited English proficient’ with respect to an 
individual means an individual who cannot speak, 
read, write, or understand the English language at 
a level that permits them to interact effectively with 
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clinical or nonclinical staff at a healthcare organiza-
tion. 
‘‘(4) MINORITY.— 
‘‘(A) IN GENERAL.—The terms ‘minority’ 
and ‘minorities’ refer to individuals from a mi-
nority group. 
‘‘(B) POPULATIONS.—The term ‘minority’, 
with respect to populations, refers to racial and 
ethnic minority groups. 
‘‘(5) MINORITY
GROUP.—The term ‘minority 
group’ has the meaning given the term ‘racial and 
ethnic minority group’. 
‘‘(6) RACIAL AND ETHNIC MINORITY GROUP.— 
The term ‘racial and ethnic minority group’ means 
American Indians and Alaska Natives, African 
Americans (including Caribbean Blacks and Afri-
cans), 
Asian 
Americans, 
Hispanics 
(including 
Latinos), and Native Hawaiians and other Pacific 
Islanders. 
‘‘(7) STATE.—The term ‘State’ means each of 
the several states, the District of Columbia, the 
Commonwealth of Puerto Rico, the Indian tribes, 
the Virgin Islands, Guam, American Samoa, and the 
Commonwealth of the Northern Mariana Islands. 
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‘‘SEC. 2901. IMPROVING ACCESS TO SERVICES FOR INDIVID-
UALS WITH LIMITED ENGLISH PROFICIENCY. 
‘‘(a) PURPOSE.—As provided in Executive Order 
13166, it is the purpose of this section— 
‘‘(1) to improve access to federally conducted 
and federally assisted programs and activities for in-
dividuals who are limited in their English pro-
ficiency; 
‘‘(2) to require each Federal agency to examine 
the services it provides and develop and implement 
a system by which limited English proficient individ-
uals can enjoy meaningful access to those services 
consistent with, and without substantially burdening, 
the fundamental mission of the agency; 
‘‘(3) to require each Federal agency to ensure 
that recipients of Federal financial assistance pro-
vide meaningful access to their limited English pro-
ficient applicants and beneficiaries; 
‘‘(4) to ensure that recipients of Federal finan-
cial assistance take reasonable steps, consistent with 
the guidelines set forth in the Limited English Pro-
ficient Guidance of the Department of Justice (as 
issued on June 12, 2002), to ensure meaningful ac-
cess to their programs and activities by limited 
English proficient individuals; and 
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‘‘(5) to ensure compliance with title VI of the 
Civil Rights Act of 1964 and that healthcare pro-
viders and organizations do not discriminate 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 that carries out health care-related activities 
shall prepare a plan to improve access to the feder-
ally conducted health care-related programs and ac-
tivities of the agency by limited English proficient 
individuals. 
‘‘(2) PLAN REQUIREMENT.—Each plan under 
paragraph (1) shall be consistent with the standards 
set forth in section 102 of the Healthcare Equality 
and Accountability Act, and shall include the steps 
the agency will take to ensure that limited English 
proficient individuals have access to the agency’s 
health care-related programs and activities. Each 
agency shall send a copy of such plan to the Depart-
ment of Justice, which shall serve as the central re-
pository of the agencies’ plans. 
‘‘(c) FEDERALLY ASSISTED PROGRAMS AND ACTIVI-
TIES.— 
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‘‘(1) IN GENERAL.—Not later than 120 days 
after the date of enactment of this Act, each Federal 
agency providing health care-related Federal finan-
cial assistance shall ensure that the guidance for re-
cipients of Federal financial assistance developed by 
the agency to ensure compliance with title VI of the 
Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.) 
is specifically tailored to the recipients of such as-
sistance and is consistent with the standards de-
scribed in section 102 of the Healthcare Equality 
and Accountability Act. Each agency shall send a 
copy of such guidance to the Department of Justice 
which shall serve as the central repository of the 
agencies’ plans. After approval by the Department of 
Justice, each agency shall publish its guidance docu-
ment in the Federal Register for public comment. 
‘‘(2) 
REQUIREMENTS.—The 
agency-specific 
guidance developed under paragraph (1) shall— 
‘‘(A) detail how the general standards es-
tablished under section 102 of the Healthcare 
Equality and Accountability Act will be applied 
to the agency’s recipients; and 
‘‘(B) take into account the types of health 
care services provided by the recipients, the in-
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dividuals served by the recipients, and other 
factors set out in such standards. 
‘‘(3) EXISTING GUIDANCES.—A Federal agency 
that has developed a guidance for purposes of title 
VI of the Civil Rights Act of 1964 that the Depart-
ment of Justice determines is consistent with the 
standards described in section 102 of the Healthcare 
Equality and Accountability Act shall examine such 
existing guidance, as well as the programs and ac-
tivities to which such guidance applies, to determine 
if modification of such guidance is necessary to com-
ply with this subsection. 
‘‘(4) CONSULTATION.—Each Federal agency 
shall consult with the Department of Justice in es-
tablishing the guidances under this subsection. 
‘‘(d) CONSULTATIONS.— 
‘‘(1) IN GENERAL.—In carrying out this sec-
tion, each Federal agency that carriers out health 
care-related activities shall ensure that stakeholders, 
such as limited English proficient individuals and 
their representative organizations, recipients of Fed-
eral assistance, and other appropriate individuals or 
entities, have an adequate and comparable oppor-
tunity to provide input with respect to the actions of 
the agency. 
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‘‘(2) EVALUATION.—Each Federal agency de-
scribed in paragraph (1) shall evaluate the— 
‘‘(A) particular needs of the limited 
English proficient individuals served by the 
agency, and by a recipient of assistance pro-
vided by the agency; 
‘‘(B) burdens of compliance with the agen-
cy guidance and its recipients of the require-
ments of this section; and 
‘‘(C) outcomes or effectiveness of services. 
‘‘SEC. 2902. NATIONAL STANDARDS FOR CULTURALLY AND 
LINGUISTICALLY APPROPRIATE SERVICES IN 
HEALTHCARE. 
‘‘Recipients of Federal financial assistance from the 
Secretary shall, to the extent reasonable and practicable 
after applying the 4-factor analysis described in title V 
of the Guidance to Federal Financial Assistance Recipi-
ents Regarding Title VI Prohibition Against National Ori-
gin Discrimination Affecting Limited-English Proficient 
Persons (June 12, 2002)— 
‘‘(1) implement strategies to recruit, retain, and 
promote individuals at all levels of the organization 
to maintain a diverse staff and leadership that can 
provide culturally and linguistically appropriate 
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healthcare to patient populations of the service area 
of the organization; 
‘‘(2) ensure that staff at all levels and across all 
disciplines of the organization receive ongoing edu-
cation and training in culturally and linguistically 
appropriate service delivery; 
‘‘(3) offer and provide language assistance serv-
ices, including bilingual staff and interpreter serv-
ices, at no cost to each patient with limited English 
proficiency at all points of contact, in a timely man-
ner during all hours of operation; 
‘‘(4) notify patients of their right to receive lan-
guage assistance services in their primary language; 
‘‘(5) ensure the competence of language assist-
ance provided to limited English proficient patients 
by interpreters and bilingual staff, and ensure that 
family, particularly minor children, and friends are 
not used to provide interpretation services— 
‘‘(A) except in case of emergency; or 
‘‘(B) except on request of the patient, who 
has been informed in his or her preferred lan-
guage of the availability of free interpretation 
services; 
‘‘(6) make available easily understood patient- 
related materials, if such materials exist for non-lim-
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ited English proficient patients, including informa-
tion or notices about termination of benefits and 
post signage in the languages of the commonly en-
countered groups or groups represented in the serv-
ice area of the organization; 
‘‘(7) develop and implement clear goals, poli-
cies, operational plans, and management account-
ability and oversight mechanisms to provide cul-
turally and linguistically appropriate services; 
‘‘(8) conduct initial and ongoing organizational 
assessments of culturally and linguistically appro-
priate services-related activities and integrate valid 
linguistic competence-related measures into the in-
ternal audits, performance improvement programs, 
patient satisfaction assessments, and outcomes-based 
evaluations of the organization; 
‘‘(9) 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 (42 
U.S.C. 1320d–2 note)— 
‘‘(A) data on the individual patient’s race, 
ethnicity, and primary language are collected in 
health records, integrated into the organiza-
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tion’s management information systems, and 
periodically updated; and 
‘‘(B) if the patient is a minor or is inca-
pacitated, the primary language of the parent 
or legal guardian is collected; 
‘‘(10) maintain a current demographic, cultural, 
and epidemiological profile of the community as well 
as a needs assessment to accurately plan for and im-
plement services that respond to the cultural and 
linguistic characteristics of the service area of the 
organization; 
‘‘(11) develop participatory, collaborative part-
nerships with communities and utilize a variety of 
formal and informal mechanisms to facilitate com-
munity and patient involvement in designing and im-
plementing culturally and linguistically appropriate 
services-related activities; 
‘‘(12) ensure that conflict and grievance resolu-
tion processes are culturally and linguistically sen-
sitive and capable of identifying, preventing, and re-
solving cross-cultural conflicts or complaints by pa-
tients; 
‘‘(13) regularly make available to the public in-
formation about their progress and successful inno-
vations in implementing the standards under this 
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section and provide public notice in their commu-
nities about the availability of this information; and 
‘‘(14) if requested, regularly make available to 
the head of each Federal entity from which Federal 
funds are received, information about their progress 
and successful innovations in implementing the 
standards under this section as required by the head 
of such entity. 
‘‘SEC. 2903. ROBERT T. MATSUI CENTER FOR CULTURAL 
AND 
LINGUISTIC 
COMPETENCE 
IN 
HEALTHCARE. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Director of the Office of Minority Health Dis-
parity Elimination, shall establish and support a center 
to be known as the ‘Robert T. Matsui Center for Cultural 
and Linguistic Competence in Healthcare’ (referred to in 
this section as the ‘Center’) to carry out the following ac-
tivities: 
‘‘(1) REMOTE
MEDICAL
INTERPRETING.—The 
Center shall provide remote medical interpreting, di-
rectly or through contracts, to healthcare providers 
who otherwise would be unable to provide language 
interpreting services, at reasonable or no cost as de-
termined appropriate by the Director of the Center. 
Methods of interpretation may include remote, si-
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multaneous or consecutive interpreting through tele-
phonic systems, video conferencing, and other meth-
ods determined appropriate by the Secretary for pa-
tients with limited English proficiency. The quality 
of such interpreting shall be monitored and reported 
publicly. Nothing in this paragraph shall be con-
strued to limit the ability of healthcare providers or 
organizations to provide medical interpreting serv-
ices directly and obtain reimbursement for such 
services as provided for under the medicare, med-
icaid or SCHIP programs under titles XVIII, XIX, 
or XXI of the Social Security Act. 
‘‘(2) MODEL
LANGUAGE
ASSISTANCE
PRO-
GRAMS.—The Center shall provide for the collection 
and dissemination of information on current model 
language assistance programs and strategies to im-
prove language access to healthcare for individuals 
with limited English proficiency, including case stud-
ies using de-identified patient information, program 
summaries, and program evaluations. 
‘‘(3) MEDICAL INTERPRETING GUIDELINES.— 
‘‘(A) IN GENERAL.—The Center shall con-
vene a national working group to develop med-
ical interpreting and translation guidelines and 
standards for— 
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‘‘(i) the provision of services; 
‘‘(ii) the actual practice of inter-
preting; 
‘‘(iii) the training of medical inter-
preters and translators, developed by inter-
preters and translators. 
‘‘(B) PUBLICATION.—Not later than 18 
months after the date of enactment of this Act, 
the Center shall publish guidelines and stand-
ards developed under this paragraph in the 
Federal Register. 
‘‘(4) INTERNET
HEALTH
CLEARINGHOUSE.— 
The Center shall develop and maintain an Internet 
clearinghouse to reduce medical errors and improve 
medical outcomes and reduce healthcare costs 
caused by communication with individuals with lim-
ited English proficiency or low functional health lit-
eracy and reduce or eliminate the duplication of ef-
fort to translate materials by— 
‘‘(A) developing and making available tem-
plates for standard documents that are nec-
essary for patients and consumers to access and 
make educated decisions about their healthcare, 
including— 
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